Abstract
BackgroundRoutine outcome measures are increasingly being mandated across mental health services in Australia and overseas. This requirement includes forensic mental health services, but their utility in such specialist services and the inter-relationships between the measures remain unclear. This study sought to characterise the risks, needs and stages of recovery of an entire cohort of forensic patients in one jurisdiction in Australia.MethodsLocal expert groups, comprising of members of the forensic patient treating teams, were formed to gather information about the status and needs of all forensic patients in the State of New South Wales, Australia. The expert groups provided demographic information and completed three assessment tools concerning the risks, needs and stages of recovery of each forensic patient.ResultsThe cohort of 327 forensic patients in NSW appears to be typical of forensic mental health service populations internationally when considering factors such as gender, diagnosis, and index offence. A number of important differences across the three structured tools for forensic patients in different levels of secure service provision are presented. The DUNDRUM Quartet demonstrated interesting findings, particularly in terms of the therapeutic security needs, the treatment completion, and the stages of recovery for the forensic patients in the community. The CANFOR highlighted the level of needs across the forensic patient population, whilst the HCR-20 data showed there was no significant difference in the mean clinical and risk management scores between male forensic patients across levels of security.ConclusionsTo the authors’ knowledge this is the first study of its kind in New South Wales, Australia. We have demonstrated the utility of using a suite of measures to evaluate the risks, needs, and stages of recovery for an entire cohort of forensic patients. The data set helps inform service planning and development, together with providing various avenues for future research.
Highlights
Routine outcome measures are increasingly being mandated across mental health services in Australia and overseas
Male forensic patients were older than female patients at the time of our assessment, but not significantly so (t = 1.079, p = 0.281)
In terms of their placement at the time of assessment, approximately one third were placed in high security, one third were in secure hospital settings or prison, and one third were in the community
Summary
Routine outcome measures are increasingly being mandated across mental health services in Australia and overseas. As Phelan et al have discussed [3], several instruments have been developed to assess the needs of patients with mental health-related difficulties. These instruments adopted purely what was termed the ‘normative approach’, meaning that they were based solely on the expert views of the treating clinician. An example of this is the Medical Research Council’s Needs for Care Assessment [4] developed by a team in London, England, Adams et al BMC Psychiatry (2018) 18:35 which was designed to identify areas of remediable need. From the early 1990s onwards, the importance of a different, subjective, approach to needs assessment has been promoted, with the centrality of service user involvement in their own treatment and care planning being increasingly emphasized [5]
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