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Article
Publication date: 1 November 2005

Andrea Campbell

Abstract High secure services treat patients who may have very complex clinical needs under conditions of security. Until very recently such services were run and managed…

Abstract

Abstract High secure services treat patients who may have very complex clinical needs under conditions of security. Until very recently such services were run and managed on the periphery of the structures and accountability arrangements put in place for the rest of the NHS, becoming isolated from modern thinking and evidence‐based therapeutic practice. A high percentage of patients in the high secure system were assessed as no longer requiring that level of security.Following an inquiry at Ashworth hospital which reported in 1999, steps were taken to bring these services into the mainstream of the NHS, to decentralise further the commissioning and performance management and to develop the capacity and capability to enable discharge of patients to lower levels of security. New partnerships and new relationships have resulted in an NHS Plan target of 400 patients discharged from high security.The inclusion of high security services within Health & Offender Partnerships creates a framework for managing proposed and ongoing changes. High security services are a necessary part of our mental health system and should be valued and developed. This paper outlines how quality improvements will be enabled and embedded.

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The British Journal of Forensic Practice, vol. 7 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 27 July 2010

John Jacques, Sarah‐Jane Spencer and Paul Gilluley

Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings which in general do not have a…

Abstract

Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings which in general do not have a 'longer term focus'. The aim of this investigation was to assess and describe the needs of these patients. A survey questionnaire was designed and sent to responsible clinicians who had patients admitted at least five years previously to the Three Bridges Medium Secure Unit (males) in West London. Carer ratings using the Camberwell Assessment of Need: forensic version (CAN‐FOR) were completed by the primary nurse for each patient, complementing the survey questionnaire. Of 122 medium secure male patients 25 (21%) had been admitted at least five years before. We found high levels of co‐morbidity and treatment resistance. The CAN‐FOR revealed two groups, one with chronic challenging behaviour, treatment‐resistant mental illness and need for a high level of support, and another more able group not needing as much support but with a dependency on the hospital. It is considered here whether certain groups would benefit from a different approach or setting.

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The British Journal of Forensic Practice, vol. 12 no. 3
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 6 August 2021

Alexander Challinor, Kathryn Naylor and Patrick Verstreken

Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide…

Abstract

Purpose

Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated.

Design/methodology/approach

This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm.

Findings

This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends.

Practical implications

This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm.

Originality/value

This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

Details

The Journal of Forensic Practice, vol. 23 no. 3
Type: Research Article
ISSN: 2050-8794

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Open Access
Article
Publication date: 4 January 2018

Clare S. Allely

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group…

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Abstract

Purpose

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings.

Design/methodology/approach

Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Findings

A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed.

Originality/value

To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.

Details

Journal of Criminal Psychology, vol. 8 no. 1
Type: Research Article
ISSN: 2009-3829

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Article
Publication date: 8 December 2010

Evan Yacoub

Low security is a poorly understood concept, particularly in relation to people with an intellectual disability. Characteristics of patients offered an admission to low…

Abstract

Low security is a poorly understood concept, particularly in relation to people with an intellectual disability. Characteristics of patients offered an admission to low secure intellectual disability settings have not been robustly demonstrated. The same applies to staff perceptions of low security. The aims of the study were to ascertain the characteristics of patients referred to a low secure intellectual disability unit which lead to an offer of admission, identify the views of staff working on the unit on the concept of low security, and use both sets of data to discuss low secure provision for people with intellectual disability. A case‐controlled study was carried out for 33 patients referred to the unit over 42 months. The characteristics of 18 patients offered an admission were compared with those of 15 patients not offered an admission, and five of the staff working on the unit were interviewed about the concept of low security. Patients offered an admission were more able than those not offered an admission, posed more risks and were more complex diagnostically. Staff working on the unit agreed that their patients were complex, but felt that they were appropriately placed overall. The challenges of low secure provision were discussed by staff. Patients sampled were complex and heterogeneous, but not necessarily ‘forensic’. Their complexity requires sophisticated care plans and management strategies. This study has implications for referrers, staff, patients and managers, and highlights areas for future research.

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Advances in Mental Health and Intellectual Disabilities, vol. 4 no. 4
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 2 August 2013

Geoff Dickens, Marco Picchioni and Clive Long

The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in…

Abstract

Purpose

The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care.

Design/methodology/approach

The paper uses a retrospective survey of routinely collected incident data from one 207‐bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability.

Findings

In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other‐directed aggression, 31.8 per cent self‐harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self‐harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway.

Research limitations/implications

Incidents, especially those of lower severity, can be under‐reported in routine practice. Information about incident severity was limited.

Practical implications

Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility.

Originality/value

This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.

Details

The Journal of Forensic Practice, vol. 15 no. 3
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 8 December 2010

Ian Hall, Evan Yacoub and Babur Yusufi

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a…

Abstract

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a needs assessment that enabled us to develop a new service for men with intellectual disability who often had substantial additional mental health needs. Consulting with all stakeholders was essential, and we found the service user and family perspectives particularly helpful. We had to make special arguments for some aspects of the treatment programme. We found that foundation trusts that are able to develop services at financial risk, before contracts are signed, enabled development to take place at a faster pace. Good relationships with community teams have been essential, as has true integration with mainstream forensic services. Maintaining a relationship with commissioners was a particularly challenging aspect, perhaps because the development was provider‐led. Despite these challenges, many people with intellectual disability with very high needs are being supported much nearer to home.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 4 no. 4
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 4 March 2014

Laura Willets, Paul Mooney and Nicholas Blagden

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability…

Abstract

Purpose

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services is limited. Staff and patients in Learning Disability services have documented both positive and negative experiences. No research has directly compared the social climate of Learning Disability and non-Learning Disability psychiatric services. The purpose of this paper is to understand how these compare. The study will also compare staff and patient views of social climate and the impact of security on social climate in Learning Disability services.

Design/methodology/approach

A total of 64 patients and 73 staff, from Learning Disability and non-Learning Disability psychiatric hospitals completed the Essen Climate Evaluation Schema (EssenCES) measure of social climate.

Findings

Patients in Learning Disability and non-Learning Disability services did not differ in their perceptions of social climate. Staff in non-Learning Disability services had a more positive perception of social climate than staff in Learning Disability services. Patients and staff did not differ in their views on climate. Security was negatively related to patients’ Experienced Safety.

Originality/value

The findings suggest that staff perceive that the deficits associated with Learning Disabilities may limit patients’ therapeutic experience and relationships with their peers. Despite this, patients with Learning Disabilities feel supported by their peers, have positive views of the treatment process and feel as safe as non-Learning Disabled psychiatric patients.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 5 no. 1
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 22 March 2010

Mick Burns, Wendy Silberman and Ged McCann

This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across…

Abstract

This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across England. The principles, shaped around the 11 competencies laid down in the World Class Commissioning competencies framework (Department of Health, 2008a), were produced following a scoping exercise that looked at provision and commissioning of secure learning disability services within each strategic health authority (SHA) area in England. Specific details were collected about types of services provided, including detailed service specification, quality indicators, how these (specialist) services link with local services (secure and non secure) and cost of services. Information collected about commissioning concentrated on strategic vision, practical commissioning arrangements, how the quality of services was monitored, how access to services was controlled and how ‘secure’ service users are reintegrated back into local (non secure) services and communities. This scoping exercise was augmented by qualitative data obtained from interview with a group of former service users. Themes generated through the interviews were integrated within the general guidance. A quality assurance framework based on the World Class Commissioning Competencies is proposed, against which specialist and local commissioners can benchmark their current commissioning arrangements.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 1 no. 1
Type: Research Article
ISSN: 2042-0927

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Article
Publication date: 13 July 2012

Marian Quinn, Cathy Thomas and Verity Chester

The aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure service for people with…

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Abstract

Purpose

The aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure service for people with intellectual disabilities.

Design/methodology/approach

Patients (37 men, 14 women, Mean age=33.24 years, SD=11.29, age range: 18‐71 years) residing in a secure intellectual disabilities service completed the EssenCES as part of routine clinical practice.

Findings

Reliability analysis revealed acceptable reliability for all three subscales (α=0.76‐0.88). In order to consider one aspect of the construct validity of this measure, a predicted group difference regarding the impact of security level on ratings of social climate was investigated. Analysis revealed that social climate ratings were more positive on low secure wards than medium secure wards as measured by the combined EssenCES subscales F(3, 31)=4.71, p=0.008; Λ=0.69; η2=0.31, and the Experienced Safety subscale, F(1, 33)=7.41, p=0.01.

Research limitations/implications

Future research should consider the link between social climate and treatment outcome within forensic secure intellectual disability services.

Originality/value

Results provide preliminary evidence to suggest that the EssenCES subscales (patient report) are reliable in this previously unconsidered population. However the validity of the measure is still unclear and requires further investigation.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 6 no. 4
Type: Research Article
ISSN: 2044-1282

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