Managing returns to prison from medium-secure services: qualitative study

Abstract

Background Little is known about factors that influence discharge decision-making for people admitted to medium-secure services from prison, particularly for those who are returned to prison following treatment. Aims To explore the organisational influences on care pathways through medium-secure services for those admitted from prison. Method We recruited 24 clinicians via purposive and snowball sampling; 13 shared their experiences via a focus group, and 11 shared their experiences via individual semi-structured interviews. A thematic analysis was conducted, producing three overarching themes: maintenance of throughput and service provision, class of two systems, and desirable and undesirable patients. Results Data indicated external factors that direct and, at times, limit clinicians’ pathway decisions, including commissioning criteria and legal status under the Mental Health Act 1983 and within the criminal courts system (i.e. whether on remand or sentenced). These factors also influence how clinicians view the role and function of medium-secure services within the wider forensic mental health system, and therefore the types of patients that are deemed ‘appropriate’ for continued treatment when making discretionary pathway decisions. Conclusions There remains a deficit in adequate resources to meet the mental health needs of prisoners who are admitted to medium-secure services. To meet the clinical need of all admissions, criteria for prolonged treatment in medium-secure services needs to be reconsidered, and it is likely that provision for the medium-secure hospital estate will need to increase substantially if effective rehabilitation of those who transfer from prison is to take place.

Characteristics of People Returned to Prison From Medium Secure Psychiatric Services in England and Wales: National Cohort Study

“…We also conducted a subsequent qualitative investigation with clinicians working in forensic psychiatric services to understand discharge decision-making for individuals admitted from and returned to prison ( 15 ). Clinicians shared the context of constraints in which they operate and the ways in which they perceive these constraints.…”

Parole, where psychiatry meets public protection

“…Leonard et al (2020) found that 28% of remitted patients were sent back to prison because they were assessed as ‘not engaging with treatment’ or because they were too high risk to remain in a medium secure unit. But a subsequent study confirmed that they had not been referred to high secure services (Leonard 2021). They also found that remittal to prison resulted in a loss of access to aftercare, for example several of their cohort were remitted close to their earliest release date or parole eligibility date, and they questioned why these patients did not remain in the medium secure unit to be released from there, which may well have ensured a more successful discharge to the community.…”

The Cruel Optimism of International Prison Regulation: Prison Ontologies and Carceral Harms

“…Flows into prisons are influenced by experience of both the school system (Mallett 2016) and the care system (Day, Bateman, and Pitts 2020). Once under the supervision of the criminal justice system, people are transferred through distinct carceral institutions-for example, to and from police custody-and frequently secure mental health facilities (Leonard, Sanders, and Shaw 2021) and immigration detention (BiD 2013). Each new environment requires the detainee to familiarize themselves with a different set of expectations, challenges, rules, personnel, and oversight bodies.…”