Secure Unit Research Articles

We can still feel good: evaluation of the I can feel good programme second edition in a low secure unit

Purpose This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT programme facilitated at a low-security psychiatric hospital for men with intellectual disability. Through the presentation of programme development, evaluation and revision, a more thorough and transparent understanding of the process involved can be disseminated. Design/methodology/approach The programme lasted approximately 14 months and covered all four modules. N = 5, all-male, ages ranged between 23 and 57 years old. All detained under the MHA (1983) with a primary diagnosis of Mild ID with comorbid psychiatric diagnoses including mental illness, autism spectrum disorders and personality disorder. To evaluate routine effectiveness a pre-post comparison within groups design was used. A standardised GAS approach provided a template to score the degree to which identified goals were achieved over the intervention for participants. Findings Wilcoxon signed-rank tests were used due to data not meeting parametric assumptions regarding normal distribution. Except for the mindfulness module, all modules saw pre to post programme psychometric results in the desired direction, evidencing skills acquisition. Coping in crisis and managing feelings modules outcomes neared statistical significance, with the module of people skills demonstrating statistical significance (p < 0.05). Originality/value Upon examination of the results, it appears as though the second edition pilot programme, displayed initially promising results. The clinical and statistical aspects of the programme are explored, in the hope that clinicians may consider the programme’s application and utility within various clinical contexts, in addition to gaining insight into the process of programme development and refinement.

Challenges and Facilitators During Transitions from Adolescent Medium Secure Units to Adult Services in England: Interviews with Mental Healthcare Professionals

Young people moving from child and adolescent secure hospitals present with complex needs and vulnerabilities and are more likely to experience poor transition outcomes. Previous research has indicated the presence of several risk factors in periods of transition, such as poor liaison among services, lack of proper planning, shortage of beds in adult services, multiple transitions and lack of emotional readiness. However, little evidence exists about the processes and outcomes of transitions from adolescent secure services to adult settings. This study aims to bridge the gap in the existing literature by exploring the views and experiences of key professionals involved in the transition process from six adolescent medium secure units to nine adult secure and community services in England. Thirty-four key workers from 15 child and adolescent (N = 21) and adult (N = 13) forensic hospitals were interviewed to provide information about potential barriers and facilitators to transitions. Face-to-face semi-structured interviews were conducted between January 2016 and December 2017. Thematic analysis was used to identify challenges and facilitators to transitions. Three primary themes were identified: (1) transition processes and preparation; (2) transition barriers and challenges; (3) success factors to transition. Key differences in adult and adolescent service care-models and lack of emotional and developmental readiness to moving onto adult-oriented settings constitute major barriers to positive transition outcomes. Practice and policy implications are considered to address the need for service transformations.

Att arbeta i tvångsvårdens säkra rum – emotioner och säkerhet på särskilda ungdomshem i Sverige

This article is an empirical contribution that adopts Arlie R. Hochschild’s theoretical approach to emotions and emotional work to examine the emotional dimensions of working in secure units for yo ...

Battery Storage Based Convict Tracking of Embedded Platform

There are many law writers in the world, Jail is the spot wherever all the law breakers are put behind the poles There are many probabilities in secure unit that convicts can run away from lockup. There are many types of machinery obtainable in and around the world, none of the effects helps to cut the probabilities of avoidance from the lock up, so we formed a system to keep the convict from avoidance from jail because lockup safety is also the municipal safety in the world. We used RF (Radio F, Actuator frequency) method to guard the lockup. essentially, in a set of connections the space between a pair of nodes is projected from the Radio Frequency (RF). So, we used this scheme to real time monitor the distance between the convict and the control room and we can observe the convicts heart rate. Once convicts try to cross the limit of the jail it gives the awareness to the control room.

Emotional adjustments to violent situations at secure units for adolescents: A staff perspective

Secure units for adolescents are emotion-filled places. This paper examines how secure unit staff are socialized to match emotions to violent situations in a dynamic social context according to different feeling rules. The analysis applies theories about emotional culture as well as feeling rules. The article builds on 53 semi-structural interviews with staff at three secure units for detained boys and girls run by the Swedish National Board of Institutional Care. The findings illustrate different ways in which staff adjust their feelings in violent situations by both breaking and following rules. Results are discussed with respect to three themes: (1) emotional adjustments tuned to co-workers; (2) emotional adjustments tuned to self; and (3) emotional adjustments tuned to youth behaviour. The results show the importance of taking emotions seriously in daily work, as this makes it possible to visualize how staff emotionally socialize into their organization. Due to a lack of education and professional identity among staff, the socialization process is highly relevant, as it is primarily perceptions of youth and co-workers that control and develop feeling rules for staff.

Management of COVID-19 for Persons with Mental Illness in Secure Units: A Rapid International Review to Inform Practice in Québec

ABSTRACT Most countries have implemented guidelines and policies in response to COVID-19 that have had a direct impact on institutionalized or incarcerated persons with mental health problems. Although these strategies are essential to protect these vulnerable persons from the pandemic, they can also have significant consequences on recovery, well-being, as well as rights and freedoms. Accordingly, we conducted a rapid review to identify strategies, challenges and recommendations for dealing with the COVID-19 outbreak in secure settings for persons with mental illness. While most available publications are not empirical in nature, this knowledge synthesis can nevertheless guide managers of psychiatric and forensic psychiatric institutions, and correctional facilities in dealing with the COVID-19 pandemic.

A qualitative exploration of the barriers to and facilitators of clozapine monitoring in a secure psychiatric setting.

To explore the beliefs and understanding of staff and patients at a secure mental health unit regarding clozapine monitoring, and to identify barriers to and facilitators of monitoring. Qualitative semi-structured interviews and focus groups were conducted with 17 staff members and six patients. Six key themes were identified. The key facilitator of effective monitoring was the motivation of staff to help patients to become independent and facilitate recovery. An important barrier was a lack of clarity around the roles of different staff groups in monitoring. Staff and patients widely supported the establishment of an in-patient clozapine clinic and perceived that it would prepare patients for discharge. An in-patient clozapine clinic is a robust mechanism for clozapine monitoring in secure settings. The barriers and facilitators identified here could be applied to other secure units to guide their systems of clozapine monitoring.

Psychiatric care secure units and sexuality of patients.

The desire for emotional and/or sexual relations, although universally felt, is not freely expressed because it's usually shaped by modesty, taboos, the norms and values of the surroundings and of the cultural environment of the people who feel such a desire. It is even constrained, or repressed, by certain laws. This complexity can be significantly increased by the existence of mental health disorders requiring psychiatric care in secure units. Certain notions must be taken into account, such as the relative freedom of patients, compliance with rules, discernment, informed consent, the vulnerability of potential partners, the impact of treatments, etc.

Learning disability, autism and the Criminal Procedure (Scotland) Act

PurposeThis paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.Design/methodology/approachAll CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.FindingsOf the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).Originality/valueThe results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.

Factors Influencing Length of Stay of Forensic Patients: Impact of Clinical and Psychosocial Variables in Medium Secure Setting.

ObjectivesForensic psychiatric care has two, often contradictory, aims—the treatment of mentally ill offenders and the isolation of the perpetrators to ensure public safety. It is essential to ensure that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment. Therefore, identifying the factors affecting the length of stay (LoS) is one of the most important research areas in the forensic psychiatry. The literature on this subject is scarce and to date there no data available on LoS for patients in Eastern or Central European patients.MethodsWe conducted a retrospective analysis of data for 150 inpatients in a medium secure unit. Based on a literature review and clinical experience, variables potentially influencing LoS were identified and included in the analysis.ResultsThe variables that were significantly associated with LoS included duration of mental illness; severity of index offense; whether a crime was committed as a result of hallucinations or during drug treatment discontinuation; if the index offenses was a continuous crime (crimes committed over an extended period of time); persistent psychosis; multiple antipsychotic treatments; as well as a diagnosis of schizophrenia and schizoaffective disorder.ConclusionsOur findings are highly consistent with observations made by other researchers. However, contrary the majority of previous studies our project incorporates data concerning the clinical presentation of patients. For example, we demonstrate that variables measuring treatment resistance might be one of the crucial determinants of LoS, which is a novel research finding.

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

PurposeThere is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services.Design/methodology/approachThe electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined.FindingsApproximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services.Practical implicationsThe results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice.Originality/valueThese results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities.

Tinnitus, paranoid psychosis, homicide and the identificate in an amiable man

A mild-mannered man developed paranoid psychosis following the onset of tinnitus. He subsequently killed a workmate whom he believed had poisoned him causing tinnitus. Post-homicide, the patient’s calm state was rapidly restored. We eventually came to understand that prior to the tinnitus the patient’s inner world was dominated by a phantasy of an idealised ever-available, ever-understanding internal maternal object unconsciously represented by the patient’s love of classical music which unfailingly assuaged his anxiety. Tinnitus, denying him this soothing input, was unconsciously experienced as a hated paternal object destroying the loving union of mother and infant. The homicide victim came to represent this paternal object, the source of projected oedipal murderousness. Retrospectively, the patient’s easy-going ‘chameleon-like’ pre-breakdown personality was understood as a pathological organisation based on acquisitive projective identification with a phantasised mother with ideal receptive capacity – an ‘identificate’ (Sohn 1985) – with (paternal) violence and destructiveness split off and inaccessible. Failure of separation, denial of loss and lack of acceptance of the Oedipus situation precluded the development of the ‘third position’ required for insight and symbolisation. Five years weekly psychotherapy in a secure unit provided some understanding of his inner world and the tragic course of events together with a significant degree of psychic development.

重大な他害行為を行った精神障害者の入院中の回復プロセスの解明と看護支援―M-GTAを用いた前向きさを取り戻した経験に基づく分析―

重大な他害行為を行った精神障害者の入院中の回復プロセスの解明と看護支援―M-GTAを用いた前向きさを取り戻した経験に基づく分析―

The Kindness of Strangers: Single Mothers and the Politics of Friendship in Interwar Cape Town

Abstract Just as a friend is often defined as somebody we like, friendship is thought of as a social, moral, and emotional good. The aura of friendship is in its virtue. But the meaning of friendship depends on who claims it and who the person appears to be whom they describe as their friend. This essay investigates the meaning of friendship in the lives of single mothers in South Africa between the two world wars. The context is Cape Town, where single mothers classified as “white” or “European” attracted the attention of the state. In case records pertaining to the 1913 Children’s Welfare Act, the meaning of friendship was contested between magistrates, police detectives, welfare workers, and single mothers themselves. The struggle over how a case should be resolved was to a great extent a struggle over the meaning of friendship. To the authorities, “friends” were a disturbing presence in the lives of single mothers. While the image of healthy, secure, and stable colonial family units was articulated around the relationship between a mother and a child, it was underwritten by the taken-for-granted presence of a male provider. Analyzing cases where men were in various ways absent forces our emphasis away from the normative standards that guided child welfare work and into the messier social realities against which those standards were applied.

Staff experiences of social climate in a medium secure adolescent unit

Background/aims Medium secure units in the UK for adolescents can be stressful and challenging for the staff who work within them. However, only a limited number of research studies regarding the experience of staff have been conducted within these environments. This study sought to explore how staff working in such settings describe their experiences and the overall ‘social climate’. Methods A total of 15 members of staff from one of the six medium secure establishments in the UK were interviewed, using a semi-structured interview guide. This included managers, senior clinicians, nurses and support workers. The interviews were analysed using thematic analysis. Results Three main themes and seven sub-themes were identified. The three main themes were: ‘the “feel” of the ward’, ‘aspects of ward functioning’ and ‘staff dynamics’. Staff had differing perceptions regarding the social climate of the unit. Conclusions There are multiple factors that contribute to perceptions of social climate. Further research is warranted in order to explore this and to identify those aspects that are linked to negative and positive social climates.

Le passage à l’acte homicidaire inaugural : mythe ou réalité clinique ?

ObjectivesLiterature from the first half of the twentieth century describes unmotivated, brutal, irrational homicides, committed at the onset of a psychiatric illness, without precursor symptoms. This description is no longer found in contemporary scientific articles. Is homicide as the inaugural symptom for psychiatric disorder a truth or a myth? MethodsAfter reviewing international publications, the results of a retrospective descriptive study are presented. This study aimed to describe the patients who were admitted to a French secure unit (Henri Colin) over the past ten years after a homicide committed prior to any psychiatric care. Finally, two clinical cases illustrate these results. ResultsAmong the 19 patients, the large majority are men (94.8%), young adults (31.4 years on average), single (63.1%), and unemployed (63.1%). They have paranoid schizophrenia (63%), abuse substances (73.7%), and committed homicide in a delusional context. The offenders essentially suffer persecutory delusions but also religious and grandiose delusions. Most patients (89.5%) have disorders which have progressed for several months or even several years. DiscussionThe contemporary literature and the results of our study nuance the notion of homicide as the inaugural symptom for mental illness. Indeed, if the aggressors never had contact with mental health services before committing the homicide, they generally suffered from chronic disorders that had previously gone unnoticed. Different hypotheses can explain this delay in access to care: the patient's symptoms, his refusal to consult, his environment, or his socio-emotional isolation. ConclusionsNo particular sociodemographic, clinical, or criminological specificity is highlighted concerning homicides committed before any psychiatric care. Reflection and prevention are therefore based on early identification and intervention in the case of psychiatric disorders, particularly psychotic disorders.

The perceived challenges of working with patients who use new psychoactive substances: a qualitative study in a medium secure unit

PurposeNew psychoactive substances (NPS) are increasingly being used in secure mental health settings. Within these settings, NPS use presents a range of challenges and staff currently lack adequate training to manage these challenges. The purpose of this paper is to explore nursing staffs’ perception of the challenges of working with patients who use NPS and to explore nursing staffs’ perception of their training needs in relation to NPS.Design/methodology/approachA cross-sectional qualitative design was employed. Semi-structured interviews were conducted with eight nursing staff from a medium secure unit (MSU).FindingsA thematic analysis identified three overarching themes: “There Will Always Be Something”, “We Are Doing Our Best” and “If We Know More, We Can Do More”. The findings describe how nursing staff manage NPS use at present, and their perceptions of how training could improve their management of NPS use in the future.Practical implicationsThe findings suggest that MSUs require a local policy for managing NPS use. The research implies that staff training programmes should recognise the existing methods staff use to manage NPS use. The findings also suggest that NPS interventions should target the whole peer group and not just the individual using NPS.Originality/valueThis paper contributes to the limited literature on NPS. The findings demonstrate the importance of developing evidence-based mechanisms for managing NPS use. Changes to practice are suggested, with the view of developing ways in which staff currently manage NPS use by complementing this with specific training on NPS.

An Enhanced Fuzzy Rule Based Protection Scheme for TCSC Compensated Double Circuit Transmission System

ABSTRACT This paper introduces a fault detection and faulty phase selection technique for a double-circuit transmission line with thyristor-controlled series capacitor (TCSC). In a transmission system, the nonlinear operation of TCSC during switching modes distorted the voltage and current signals. The effect is more if the fault occurred at zero fault inception angle. An advanced protection approach to overcome these issues based on dynamic phasor estimation of current from local measurements is proposed in this work. The maximum transient component obtained from three phases is used as an index to accomplish the detection task. However, due to the nonlinear operation of different accessories connected to the controller unit such as metal oxide varistor (MOV) and thyristor circuit, identification of the exact faulty phase is still a challenge. To mitigate this issue, fuzzy decision-based rules are framed so that identification of exact faulty phases is possible. For validation, the method is tested on a 400-kV, 50-Hz power system model developed using EMTDC/PSCAD. Results obtained from simulation indicate that the method is reliable and a secure unit protection can be effectively provided to a double-circuit transmission system equipped with TCSC.

Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England.

This study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people’s and carers’ experiences to improve transition service delivery.

Clinical, Demographic, and Criminal Behavior Characteristics of Patients With Intellectual Disabilities in a Canadian Forensic Program

Background: People with intellectual disability (ID) and forensic issues constitute a challenging clinical group that has been understudied in forensic settings. Methods: We assessed the characteristics of patients with ID under the authority of the Ontario Review Board (ORB) in a large forensic program of a tertiary psychiatric hospital (excluding those with a cognitive disorder) and compared their characteristics with those of a non-ID control group. Results: Among 510 adult ORB patients, 47 had an ID diagnosis. ID patients were of younger age at index offense, with a lower level of education, and were less likely to have been married or employed, more likely to have committed a sexual offense, more likely to have a diagnosis of paraphilia, less likely to be “not criminally responsible,” and more likely to be “unfit to stand trial.” They were also more likely to have committed their index offenses against care professionals and be treated in a secure unit. Conclusion: Our findings have major implications for clinicians, clinical leaders, and policymakers about the specific needs of patients with ID presenting with forensic issues and differing needs in terms of treatment and risk management.