The characteristics and needs of older forensic psychiatric patients: a cross-sectional study in secure units within one UK regional service

Claudio Di Lorito,Birgit Völlm,Tom Dening

doi:10.1080/14789949.2019.1659390

Abstract

ABSTRACTAlthough the number of older patients in forensic psychiatric settings is increasing, there is limited information around their sociodemographic characteristics, needs and cognitive abilities. This cross-sectional study focuses on patients aged ≥50 years in three (high, medium and low) secure forensic psychiatric services in England. The study comprises: 1. Analysis of sociodemographic characteristics of all patients (n = 94) in the services; 2. Analysis of the clinical notes and administration of needs and cognitive assessments to a subsample of patients (n = 41). The main outcomes include: sociodemographic characteristics, data on residency, risk, violence, mental and physical health, cognitive ability and individual needs. Data analysis is carried out through descriptive tests and correlation and inferential analyses of outcomes. Results evidence that most patients are White-British single males aged 50–54 years and 88% have at least one physical health condition. A quarter of the patients has cognitive impairment. The most common psychiatric disorder is Personality Disorder (60%); comorbid psychiatric disorders are prevalent (54%). Length of stay averages 6+ years and is longest in high security. Patients’ needs are mostly met. The least met needs are social opportunities. Future comparative research against younger populations could give better context to research findings from this study.

Highlights

Forensic mental health services provide treatment to patients who present an imminent risk to themselves and others (Di Lorito & Völlm, 2018)
This study focused on three in-patient forensic psychiatric settings in England at different levels of security: Rampton Hospital (HS), Arnold Lodge (MS) and the Wells Road Centre (LS), all part of Nottinghamshire Healthcare National Health Service Foundation Trust
We found that mood and anxiety disorders were more prevalent among female patients, substance abuse and comorbid conditions among patients < 55 years old, and substance abuse among White non-British patients

Summary

Introduction

Forensic mental health services provide treatment to patients who present an imminent risk to themselves and others (Di Lorito & Völlm, 2018). Practices vary across countries, owing to different legal systems, regulations and resources (Salize & Dressing, 2007), but common elements include the security and limitation of freedom imposed to the patients and the provision of medical, psychological and social interventions (Tapp, Warren, Fife-Schaw, Perkins, & Moore, 2016). A study by Wong, Lumsden, Fenton, & Fenwick from 1995 found that 8% of the patients in one UK high security hospital were > 60 years. In 2017, patients > 50 years represented 21% of the population in another UK high security hospital (Data provided by the Nottinghamshire Healthcare Trust Applied Information Team). A similar trend has been reported in Italy (Di Lorito et al, 2017) and Germany (Di Lorito & Völlm, 2018)

Methods

Results

Conclusion