Psychiatric Services In England Research Articles

Characteristics of People Returned to Prison From Medium Secure Psychiatric Services in England and Wales: National Cohort Study.

BackgroundLittle is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS “prison-transfer” patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too “high risk” to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community.Aim(a) To describe the characteristics of prison-transfers who receive an RMO directed discharge from MSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge.MethodsProspective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk-−20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community.ResultsPersons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending.DiscussionMSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered.

Service transitions, interventions and care pathways following remittal to prison from medium secure psychiatric services in England and Wales: national cohort study.

Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes. To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development. Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons. Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team. Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals' legal rights to ongoing aftercare are upheld.

Community forensic psychiatric services in England and Wales.

Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.

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

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.

ECP05-02 - Early intervention in psychiatry: a waste of valuable resources?

In this presentation I will make the following points. 1. Attempts by the early intervention movement to prevent the onset of psychotic illnesses using either psychological or pharmacological methods have been unsuccessful. This was entirely predictable 2. Efforts to identify vulnerable people before they develop a psychotic illness do more harm than good. This is because the positive predictive value of any test is dependant on the prevalence of the condition to which it is applied. 3. In the United Kingdom, early intervention for psychosis clinicians have been narrow minded and extremely selfish. Their recruitment raids have made it even more difficult for ordinary psychiatric teams to provide decent care to people with serious mental disorders 4. Early intervention teams have been described as jewels in the crown of psychiatric services in England. Their spectacular “success” and enviable public relations skills have tempted some clinical academic colleagues to apply their methods to other psychiatric disorders. Some of this work could be worthwhile but it must be informed by clinical experience and an understanding of epidemiological principles. References McGorry P, Pelosi AJ (2009). Is early intervention in the major psychiatric disorders justified? British Medical Journal, 338, 802–803 Malla A, Pelosi AJ (2010). Is treating patients with first-episode psychosis cost effective? Canadian Journal of Psychiatry, 55, 3–8

Facilities for carers of in-patients in forensic psychiatric services in England and Wales

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

The trouble with NHS psychiatry in England

SummaryIn ‘Wake-up call for British psychiatry’ Craddock et al explained how recent attempts to improve psychosocial care for people with mental illness focus on non-specific psychosocial support. This has been at the expense of proper diagnostic assessment and prescription of treatment by psychiatrists aimed at treatment of specific disorders and recovery. They describe a creeping devaluation of psychiatry which is caricatured as narrow, biological, reductionist, oppressive, discriminatory and stigmatising. Some trusts have implemented ‘New Ways of Working for Psychiatrists’ in a way that undermines the central importance of psychiatrists in mental healthcare. Consequently, patients may be treated in secondary care without ever being seen by a psychiatrist. We consider a number of different changes that have interacted in unforeseen ways, with unintended adverse consequences for psychiatric services in England. We aim to continue the debate here.

Acute inpatient psychiatry in England: an old problem and a new priority

With the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.

Emergency psychiatric services in England and Wales.

Although few policies guide the local planning of emergency psychiatric services in Britain, service users and their carers frequently express a preference for local teams that can respond quickly to crises.1 Acute psychiatric services are now usually provided by sector teams for defined geographical catchment areas.2 The provision of emergency response as part of an integrated range of local services has substantial advantages in terms of continuity of care and service accessibility,3 but such care may be difficult to sustain at night and at weekends for a small sector.4 We describe how emergency services in England and Wales are currently organised and staffed, comparing patterns of provision outside office hours with those during the day. ### and results We sent questionnaires to the general …

The sectorisation of psychiatric services in England and Wales.

Sectorisation is the establishment of small geographical catchment areas with dedicated mental health staff providing services to all patients living in the area. This model of care became very widespread during the 1980s in England and Wales: 81% of District Health Authorities responding to a postal questionnaire in this study were sectorised, and around three-quarters of these had become sectorised after 1980. However, this has occurred without central planning and with very little evaluation. Important questions remain to be answered about its efficacy for the severely mentally ill, about the provision of 24-h cover in a sectorised service, and about which services are appropriately provided at a sectorised and which at a centralised level.