Characteristics and pathways of long-stay patients in high and medium secure settings in England; a secondary publication from a large mixed-methods study

Article


Völlm, B., Edworthy, R., Huband, N., Talbot, E., Majid, S., Holley, J., Furtado, V., Weaver, T., McDonald, R. and Duggan, C. 2018. Characteristics and pathways of long-stay patients in high and medium secure settings in England; a secondary publication from a large mixed-methods study. Frontiers in Psychiatry. 9. https://doi.org/10.3389/fpsyt.2018.00140
TypeArticle
TitleCharacteristics and pathways of long-stay patients in high and medium secure settings in England; a secondary publication from a large mixed-methods study
AuthorsVöllm, B., Edworthy, R., Huband, N., Talbot, E., Majid, S., Holley, J., Furtado, V., Weaver, T., McDonald, R. and Duggan, C.
Abstract

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood.
Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England.
Method: Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013. The threshold for long-stay status was defined as 5 years in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure settings.
Results: 22% of patients in high security and 18% in medium security met the definition for “long-stay,” with 20% staying longer than 20 years. Of the long-stay sample, 58% were violent offenders (22% both sexual and violent), 27% had been convicted for violent or sexual offences whilst in an institutional setting, and 26% had committed a serious assault on staff in the last 5 years. The most prevalent diagnosis was schizophrenia (60%) followed by personality disorder (47%, predominantly antisocial and borderline types); 16% were categorised as having an intellectual disability. Overall, 7% of the long-stay sample had never been convicted of any offence, and 16.5% had no index offence prompting admission. Although some significant differences were found between the
high and medium secure samples, there were more similarities than contrasts between these two levels of security. The treatment pathways of these long-stay patients involved multiple moves between settings. An unsuccessful referral to a setting of lower security was recorded over the last 5 years for 33% of the sample.
Conclusions: Long-stay patients accounted for one fifth of the forensic inpatient population in England in this representative sample. A significant proportion of this group remain unsettled. High levels of personality pathology and the risk of assaults on staff and others within the care setting are likely to impact on treatment and management. Further research into the treatment pathways of longer stay patients is warranted to understand the complex trajectories of this group.

LanguageEnglish
PublisherFrontiers Media
JournalFrontiers in Psychiatry
ISSN1664-0640
Publication dates
Print16 Apr 2018
Publication process dates
Deposited03 Jan 2019
Submitted25 Nov 2017
Accepted29 Mar 2018
Output statusPublished
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Copyright Statement

Copyright © 2018 Völlm, Edworthy, Huband, Talbot, Majid, Holley, Furtado, Weaver, McDonald and Duggan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Digital Object Identifier (DOI)https://doi.org/10.3389/fpsyt.2018.00140
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Crawford, M., Thana, L., Parker, J., Turner, O., Xing, K., McMurran, M., Moran, P., Weaver, T., Barrett, B., Claringbold, A., Bassett, P. and Sanatinia, R. 2018. Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder. Trials. 19. https://doi.org/10.1186/s13063-018-2920-0
Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management
Metrebian, N., Weaver, T., Pilling, S., Hellier, J., Byford, S., Shearer, J., Mitcheson, L., Astbury, M., Bijral, P., Bogdan, N., Bowden-Jones, O., Day, E., Dunn, J., Finch, E., Forshall, S., Glasper, A., Morse, G., Akhtar, S., Bajaria, J., Bennett, C., Bishop, E., Charles, V., Davey, C., Desai, R., Goodfellow, C., Haque, F., Little, N., McKechnie, H., Morris, J., Mosler, F., Mutz, J., Pauli, R., Poovendran, D., Slater, E. and Strang, J. 2018. Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management. Contemporary Clinical Trials. 71, pp. 124-132. https://doi.org/10.1016/j.cct.2018.06.008
Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme
Day, C., Briskman, J., Crawford, M., Harris, L., McCrone, P., McMurran, M., Moran, P., Morgan, L., Scott, S., Stahl, D., Ramchandani, P. and Weaver, T. 2017. Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme. Contemporary Clinical Trials Communications. 8, pp. 67-74. https://doi.org/10.1016/j.conctc.2017.08.002
Activity and views of service users involved in mental health research: UK survey
Patterson, S., Trite, J. and Weaver, T. 2014. Activity and views of service users involved in mental health research: UK survey. British Journal of Psychiatry. 205 (1), pp. 68-75. https://doi.org/10.1192/bjp.bp.113.128637
Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK Study
Islam, Z., Ford, T., Kramer, T., Paul, M., Parsons, H., Harley, K., Weaver, T., McLaren, S. and Singh, S. 2016. Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK Study. BJPsych Bulletin. 40 (3), pp. 142-148. https://doi.org/10.1192/pb.bp.115.050690
An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence
Rafia, R., Dodd, P., Brennan, A., Meier, P., Hope, V., Ncube, F., Byford, S., Tie, H., Metrebian, N., Hellier, J., Weaver, T. and Strang, J. 2016. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction. 111 (9), pp. 1616-1627. https://doi.org/10.1111/add.13385
Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network
Borschmann, R., Patterson, S., Poovendran, D., Wilson, D. and Weaver, T. 2014. Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network. BMC Medical Research Methodology. 14 (1), p. 23. https://doi.org/10.1186/1471-2288-14-23
Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention
Wilson, E., Randall, C., Patterson, S., Emmerson, B., Moudgil, V. and Weaver, T. 2014. Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention. Australasian Psychiatry. 22 (3), pp. 248-253. https://doi.org/10.1177/1039856214529000
The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services
Belling, R., McLaren, S., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. and Singh, S. 2014. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. Journal of Health Services Research & Policy. 19 (3), pp. 169-176. https://doi.org/10.1177/1355819614527439
Hearing voices simulation: Process and outcomes of training
Patterson, S., Goulter, N. and Weaver, T. 2014. Hearing voices simulation: Process and outcomes of training. Journal of Mental Health Training, Education and Practice. 9 (1), pp. 46-58. https://doi.org/10.1108/JMHTEP-01-2013-0003
Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial
Weaver, T., Metrebian, N., Hellier, J., Pilling, S., Charles, V., Little, N., Poovendran, D., Mitcheson, L., Ryan, F., Bowden-Jones, O., Dunn, J., Glasper, A., Finch, E. and Strang, J. 2014. Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial. The Lancet. 384 (9938), pp. 153-163. https://doi.org/10.1016/S0140-6736(14)60196-3
Multi-method Evaluation of the Management, Organisation and Staffing (MEMOS) in high security treatment services for people with Dangerous and Severe Personality Disorder (DSPD)
Trebilcock, J. and Weaver, T. 2010. Multi-method Evaluation of the Management, Organisation and Staffing (MEMOS) in high security treatment services for people with Dangerous and Severe Personality Disorder (DSPD). Personality Disorder Team.
Everybody knows that the prisoner is going nowhere: Parole Board members’ views about dangerous and severe personality disorder in England and Wales
Trebilcock, J. and Weaver, T. 2012. Everybody knows that the prisoner is going nowhere: Parole Board members’ views about dangerous and severe personality disorder in England and Wales. International Journal of Criminology and Sociology. 1, pp. 141-150. https://doi.org/10.6000/1929-4409.2012.01.14
Changing legal characteristics of dangerous and severe personality disorder (DSPD) patients and prisoners
Trebilcock, J. and Weaver, T. 2012. Changing legal characteristics of dangerous and severe personality disorder (DSPD) patients and prisoners. Journal of Forensic Psychiatry and Psychology. 23 (2), pp. 237-243. https://doi.org/10.1080/14789949.2012.668212
It doesn't have to be treatable: Mental Health Review Tribunal (MHRT) members’ views about Dangerous and Severe Personality Disorder (DSPD)
Trebilcock, J. and Weaver, T. 2012. It doesn't have to be treatable: Mental Health Review Tribunal (MHRT) members’ views about Dangerous and Severe Personality Disorder (DSPD). Journal of Forensic Psychiatry and Psychology. 23 (2), pp. 244-260. https://doi.org/10.1080/14789949.2012.668208
‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services
McLaren, S., Belling, R., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. and Singh, S. 2013. ‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Services Research. 13. https://doi.org/10.1186/1472-6963-13-254
Residents’ perceptions of water quality improvements following remediation work in the Pymme’s Brook catchment, north London, UK
Faulkner, H., Green, A., Pellaumail, K. and Weaver, T. 2001. Residents’ perceptions of water quality improvements following remediation work in the Pymme’s Brook catchment, north London, UK. Journal of Environmental Management. 62 (3), pp. 239-254. https://doi.org/10.1006/jema.2001.0435