A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

Abstract

, et al. A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation. Health Serv Deliv Res 2017;5(11). Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/1024/06. The contractual start date was in March 2013. The final report began editorial review in March 2016 and was accepted for publication in September 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the ...

Ageing patients in forensic psychiatric settings: A review of the literature

“…However, given the recent changes in societal attitudes toward older offenders (ie, older offenders are treated less leniently than in the past, in particular when they commit sexual offences) and the phenomenon of an ageing population—among other factors—older patients in secure settings have now come to account for a higher share of the total population. In a national multicentre study of long‐stay patients in medium and high secure settings in England, around 30% were aged over 50 years old . Similar prevalence rates have been reported in other countries.…”

Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

“…In recent years, prolonged inpatient treatment in psychiatry in general and forensic psychiatry in particular has faced more and more criticism and scientific scrutiny: Especially within involuntary treatment settings, inappropriately long stays have been viewed as potentially unethical (1)(2)(3)(4)(5)(6). In addition, doubts have been raised about the benefits of prolonged inpatient treatment for patients' rehabilitation (3,7).…”

“…The internationally observed prolongation of forensic hospitalizations in the past years (1,3,7,(15)(16)(17), as well as the ever-growing demand for forensic services (18)(19)(20)(21), have become a subject of socio-political debate with urgent need for more research on avenues to reduce the duration of inpatient treatments in order to reduce exploding costs whenever possible (2,4). A recent review of 38 studies in eleven countries summarized a rich set of patient characteristics contributing to length of stay in psychiatric inpatient treatment (6), but concluded that just ten studies were useful in identifying clinically useful predictive factors, since "more rigorous multivariate statistical techniques" are required in order to eliminate confounding factors. Its authors also conducted an extensive qualitative and quantitative exploratory inquiry of the topic drawing on information from all stakeholders (patients, treatment professionals, experts) and mentioned not conducting file reviews on long-stay versus non-long-stay patients in forensic psychiatry (using adequate sophisticated statistical tools) as a key limitation to their comprehensive work.…”

“…By for the first time (to our knowledge) applying machine learning to the study of predictors of length of stay in forensic psychiatry in order to better meet the statistical needs of this complexly (nonlinearly) interrelated set of data (6), the current study aims to help provide more clarity on prior inconsistencies. These will be summarized in the remainder of this section along with frequently confirmed prior findings since they have informed the primary set of variables explored in the present study (also see Table 1 for a summary).…”

“…This left a total of 143 forensic patients meeting the inclusion criteria of this study. These strict criteria ensured presence of the same legal requirements for being released in all examined cases, and that the "true" length of inpatient treatment was considered, as recently proposed in a review of extant research (6).…”