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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: 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 ‘secureservice 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: 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.

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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: 4 March 2014

Ian Hall, Evan Yacoub, Neil Boast, Robert Bates, Rebekah Stamps, Sarah Holder and Matthew Beadman

The purpose of this paper is to complete a thorough needs assessment that would enable the development of a robust pathway of care for adults with a learning disability…

Abstract

Purpose

The purpose of this paper is to complete a thorough needs assessment that would enable the development of a robust pathway of care for adults with a learning disability requiring secure care, and to assist commissioners to make informed planning decisions.

Design/methodology/approach

The paper identified people with a learning disability originating from London who were in secure care, and collected data about them. The paper used reference groups to inform the analysis.

Findings

The paper identified 249 people in secure services and was able to include 136 patients in the analysis. In all, 64 were in NHS provision and 72 in independent sector provision; 109 (80.1 per cent) were male and 27 (19.9 per cent) female; on average, patients were cared for 61.5 miles away from their homes; NHS patients were far closer to home; 69.1 per cent had a mild learning disability; 82.3 per cent had a history of violence; approximately one in six patients could not progress due to a lack of an appropriate ward, facility, resource and/or intervention.

Practical implications

Secure care for this population is a major public health issue. Many are placed a long way from home. Local services should be developed, and there should be sufficiently robust “step down” places for patients to be discharged to.

Originality/value

Systematic identification of the needs of a marginalised group to enable better more appropriate care pathways to be developed in the future.

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: 1 December 2008

Max Rutherford and Sean Duggan

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and…

Abstract

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.

Details

The British Journal of Forensic Practice, vol. 10 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 8 June 2012

Fola Esan, Melanie Pittaway, Beatrice Nyamande and Alex Graham

This paper aims to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services.

Abstract

Purpose

This paper aims to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services.

Design/methodology/approach

Some background drivers to the project are explored as well as the experience of service users and staff who were involved in the pilot project. Recommendations on service‐wide implementation of the Shared Pathway are made.

Findings

The Shared Pathway will lead to considerable changes in practice. This will also have resource implications.

Originality/value

The paper shows that the Shared Pathway may be useful in ensuring evidence based outcomes are routinely used by clinicians in secure services in collaboration with patients. It may also clarify to patients what their role is in engaging in treatment that helps them in moving through secure services.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 3 no. 2
Type: Research Article
ISSN: 2042-0927

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Article
Publication date: 12 March 2018

Leah Wooster, Jane McCarthy and Eddie Chaplin

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The…

Abstract

Purpose

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.

Design/methodology/approach

This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.

Findings

The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.

Originality/value

This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 9 no. 1
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 9 January 2018

Birgit Völlm, Shaz Majid and Rachel Edworthy

The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and…

Abstract

Purpose

The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high secure forensic psychiatric care in England. These perspectives are relevant in considering the benefits of a similar long-stay service in England.

Design/methodology/approach

A current in-patient detained in a high secure hospital in England and other mental health service users and carers with experience in forensic-psychiatric settings were asked to watch a documentary on a Dutch high secure long-stay service. Then they were invited to make comparisons between this service and high secure care in England. These perspectives were gained in the context of their membership of the Service User Reference Group of an externally funded study on long-stay in forensic-psychiatric settings in England.

Findings

The small group of participants highlighted the importance of relational security, meaningful occupation, autonomy, positive therapeutic relationships with staff and a homely environment for those with lengthy admissions and perceived these to be better met in the Dutch service. These factors might contribute to improved quality of life that services should strive to achieve, especially for those with prolonged admissions.

Practical implications

Perspectives of service users with lived experience of long-stay in forensic settings are important in informing service developments. Lessons can be learnt from initiatives to improve the quality of life in long-stay services in other countries and consideration be given on how to best manage this unique group.

Originality/value

To the authors’ knowledge this is the first study asking service users about their view on forensic services in other countries. The findings suggest that service users have valuable contributions to make to aid service developments and should be involved in similar such exercises in the future.

Details

Journal of Forensic Practice, vol. 20 no. 2
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 11 May 2012

Elizabeth Beber

This article aims to describe the development of secure services for women with intellectual disability in the UK and to outline what is known about their mental health needs.

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Abstract

Purpose

This article aims to describe the development of secure services for women with intellectual disability in the UK and to outline what is known about their mental health needs.

Design/methodology/approach

The paper is a general review which is based on what is known historically about the subject, findings from the current literature and the author's own personal knowledge of these specialist services.

Findings

Secure services for women with intellectual disability have developed out of mainstream forensic and learning disability services.

Originality/value

Although there is a reasonable body of literature on offending in the intellectually disabled population as a whole, little of this is specific to women. Despite this, the evidence there is suggests that women continue to require secure services and that they have significant mental health needs.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 6 no. 3
Type: Research Article
ISSN: 2044-1282

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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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