A comparison of long‐term medium secure patients within NHS and private and charitable sector units in England

Abstract

Background In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. Aims To describe and compare characteristics of long‐stay patients in NHS and in PCS medium security hospital units. Methods Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. Results 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. Conclusions The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

“…A reversal of the current system risks wasting the expertise gained by the independent sector and major investment may be required to rebuild NHS services. Furthermore, there may be bias in the CQC data since NHS Trusts may be transferring patients with higher complex needs to the independent sector, necessitating longer admissions [ 14 , 15 ].…”

Challenging behaviour and offending behaviours

“…In their study of long-stay patients in medium security hospital units (including a small number of patients with ID), Kasmi et al (2020) found that just under 10% had no convictions but had been in a medium secure hospital bed for a long periods of time. They suggested that this may be owing to persistent challenging behaviours that had not been referred to the CJS.…”

Understanding weight management in adult secure mental health services: findings from a mixed-methods study in Northern England

“…The majority of such patients are male, of white ethnicity and single, and tend to have low educational attainment (Vo ¨llm et al, 2017). In contrast with patients admitted to acute hospitals for physical health conditions, secure mental health patients frequently experience a length of stay lasting several years (Kasmi et al, 2020). The management of chronic conditions such as overweight and obesity is therefore particularly salient.…”