Abstract
Aims and method To evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.Results Overall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implications Secure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.
Highlights
Summary statistics were calculated for all patients evaluated
In order to evaluate illness severity between the two groups, Health of the Nation Outcome Scales for Users of Secure and Forensic Services (HoNOS-secure) assessment scores taken at admission and discharge were noted.[6]
The study found no significant difference in length of stay or severity of illness based on HoNOS-secure scores at the Primary diagnosis Psychosis Personality disorder Affective disorder
Summary
93 male patients were discharged from the hospital during the data collection period; 9 patients were excluded from the study: 7 were excluded as their admission was less than 3 months and unlikely to be representative of the treatment phase being evaluated, and discharge would have occurred prior to the standard Care Programme Approach meeting held 3 months after admission, where a formal diagnosis would have been made. The legal status of patients in the civil group remained unchanged during the course of their admission, apart from one patient who became informal in the days prior to discharge. Regarding the forensic group, 4 patients were admitted from general adult services, 3 from low secure services, 16 from medium secure services, 28 from prison and 1 from a high secure hospital. In this group, 14 patients changed their legal status prior to discharge; 11 changed from being sentenced prisoners under Section 47/49 to being detained under a notional Section 37, as they had gone past what would have been their automatic release date from prison.
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