Outcome of high security patients admitted to a medium secure unit: the Edenfield Centre study

Abstract

Blattner and Dolan: Outcome of high security patients admitted to a medium secure unit 247 ABSTRACT This study examined the outcome of a cohort of 72 patients from a high secure psychiatric hospital (HSPH) who were admitted to and discharged from the Edenfield Centre over a 16-year period. The sample was predominately male and mentally ill and the majority was subject to restriction orders. Compared with two similar studies focusing specifically on the outcomes of HSPH patients in medium security, our sample had fewer women and the group had more extensive criminal and psychiatric histories. None of our cohort was discharged to the community via district services or transferred to other hospitals. We found that the Edenfield Centre had relatively higher rates of readmissions to the HSPH and a slightly higher reconviction rate than similar studies focusing solely on the outcomes of HSPH patients. In line with previous research, those detained under the legal category of psychopathic disorder were more likely to be reconvicted following discharge to the community than those detained under mental illness. Further large scale studies are needed to compare the outcomes of HSPH patients discharged through medium secure services that operate parallel or integrated aftercare service models.

Prediction of treatment outcomes for personality disordered offenders

“…These findings are consistent with Gray et al (2008) who also found the historical and risk scales to be more predictive than the clinical scale. However, the findings of this study contrasts with research by Blattner and Dolan (2010). They found the clinical scale was the best predictor of poor treatment outcome.…”

“…A number of studies have reported individuals with high psychopathy scores; impulsivity and ASPD are least likely to have successful treatment outcomes (Gray et al, 2004(Gray et al, , 2011Cullen et al, 2011). Further, individuals with high HCR-20 and PCL-R scores are admitted to secure services because they present a significant risk of re-offending (Phillips et al, 2005;Blattner and Dolan, 2010).…”

Patient outcomes following discharge from secure psychiatric hospitals: Systematic review and meta-analysis

“…In total, 20 studies reported on hospital readmissions in 21 cohorts (n = 3522). 15,16,19,[22][23][24][26][27][28][29][30][32][33][34][35]40,44,[52][53][54] The total number of patients readmitted was 1171. Crude readmissions rates (CRARs) ranged from 2926 to 16 461 readmissions per 100 000 person-years (online Table DS3 and Fig.…”

A retrospective study comparing the length of admission of medium secure unit patients admitted in the three decades since 1985

“…Numerous studies have provided detailed analysis of the follow-up of patients discharged from forensic psychiatry units. [3][4][5][6] Given the risks inherent in these patients returning to day-to-day life, further care in supported environments may reduce risk to others at a population level. Responses to serious untoward incidents have changed over time 18,19 and may now be more likely to lead to greater restrictions for patients.…”

“…These studies suggest that patients are at significant risk of readmission and, sadly, at significantly increased risk of death compared with the general population. [3][4][5][6] Admissions to MSUs are now often lengthy, [7][8][9] findings that were echoed by a recent study analysing length of stay data in high secure units across Europe. 10 Factors identified as associated with a longer length of stay include a diagnosis of a psychotic disorder, detention under a restriction orderin particular, those under section 37/41 (Section 37 is a court-issued order that means the patient will be sent to hospital rather than prison, and Section 41 is a so-called 'restriction order' that is designed to reduce the risk to the general public) of the Mental Health Act 1983 (amended 2007)poor treatment response and the seriousness of the index offence.…”