Abstract
Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Some patients may stay in such services for excessive periods of time. This causes an economic burden to society and might limit the quality of life of patients. This research therefore aimed to estimate the number of long-stay patients in secure settings in England and to describe their characteristics and care pathways in order to inform service provision. We defined a length of stay exceeding 5 years in medium secure care or 10 years in high secure care or 15 years in a combination of both services as ‘long-stay’. A cross-sectional survey (on April 01, 2013) of all patients resident in all 3 high and 23 medium secure units (16 NHS and 9 independent provider units) was undertaken. Overall, 23.5% of high secure and 18.1% of medium secure patients were long-stayers according to our criteria. One fifth of the long-stayers had stayed in services for more than 20 years. The files of long-stayers were further inspected and their characteristics and pathways identified. Long-stayers had complex pathways, moving ‘around’ between settings rather than moving forward to less secure care. Patients typically had disturbed backgrounds with previous psychiatric admissions, including to secure care, self-harm and significant offending histories. Rates for violent incidents within institutions and seclusion were also high. However, a significant proportion had not shown any recent incidents, and only 50% of patients were involved in psychological therapies. The most common diagnosis was schizophrenia, but about half of the patients were (sometimes additionally) diagnosed with at least one personality disorder. There were a large proportion of unsuccessful referrals to less secure settings. On a positive note, most patients had some form of contact with their families. Implications for service organisation are discussed.
Published Version
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