Women's secure hospital care pathways in practice: a qualitative analysis of clinicians views in England and Wales.

Nadia Somers,Annie Bartlett

doi:10.1186/1472-6963-14-450

Abstract

BackgroundIn England and Wales women form a small but significant group within the wider, largely male, secure hospital population. Secure hospitals are designed to assess and treat individuals with both mental health problems and significant criminal behaviour. The theoretical approach to the care of secure hospital women is increasingly informed by a grasp of gender-specific issues. However, there is a lack of evidence on the adequacy of current structures and processes of care delivery.MethodsThis qualitative study explores the nature and quality of care pathways for women in low and medium secure hospital beds by eliciting participants’ views of factors enhancing or impeding care. Beds are publicly funded and provided either by the National Health Service (NHS) or the Independent Sector (IS). Participants from both sectors were local experts (40 Consultant Psychiatrists, 7 Service Managers) who were well placed to describe their immediate health environment.ResultsEvidence from the study indicates that participants were focused on the physical relocation of women to less secure conditions, even though many women do not readily achieve this.Participants were alert to potential conflicts between ideal care and affordable care. Ideal care was compromised by the absence of suitable local services (beds or community placements), curtailed episodes of care and changes of care team. It was promoted by an awareness of the specific needs of women, continuity of care and support for teams unfamiliar with women’s needs.ConclusionFuture service design must address these challenges in care delivery, incorporating a better understanding of and response to the ways the system can echo women’s experiences of trauma and their negative attachment histories. Specifically, critical transitions in care must not be allowed to further reinforce the discontinuity, failure and rejection experienced by individual women earlier in their lives.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-450) contains supplementary material, which is available to authorized users.

Highlights

In England and Wales women form a small but significant group within the wider, largely male, secure hospital population
Owing to the large quantity of data, the study is presented in two parts; the nature of caring for women mentally disordered offenders (MDOs) and, reported here, pathways in practice
We report here the practical, perhaps more bureaucratic, aspects of the pathway within the following themes: the nature of the “secure care pathway”, cost versus quality of care conflict, the false economy of rapid discharge, the peril of repatriation, gaps and blockages, competing concepts of continuity, fear and reluctance in receiving teams and access to community placements (Table 1)

Summary

Introduction

In England and Wales women form a small but significant group within the wider, largely male, secure hospital population. The theoretical approach to the care of secure hospital women is increasingly informed by a grasp of gender-specific issues. Regional and local secure hospital services in England and Wales for mentally disordered offenders have been developed since 1975 [1,2] based primarily on the needs of men [3,4,5,6]. Caring for mentally disordered offenders, of both genders, involves movement through a multi-organisational system that includes the criminal justice system (police, court diversion schemes, prison), secure hospital care, step down and community (e.g. 24-hour supported accommodation) facilities [18]. In England and Wales, the National Health Service (NHS) and the Independent

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