Characteristics and Needs of Long-Stay Forensic Psychiatric Inpatients: A Rapid Review of the Literature

Huband, Nick; Furtado, Vivek; Schel, Sandra H. H.; Eckert, Mareike; Cheung, Natalie; Bulten, Erik; Völlm, Birgit

doi:10.1080/14999013.2017.1405124

Cited by 66 publications

(36 citation statements)

References 82 publications

(58 reference statements)

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“…Due to their backgrounds, namely their offending histories, MDOs are often cared for in secure environments, either in prison or in dedicated forensic-psychiatric hospitals. These institutions are high cost-low volume services that may detain their clientele for long periods of time in highly restrictive conditions (for a review of length of stay in forensic psychiatric institutions see [16]). The purpose of this detention is seen as twofold: care and treatment for the patient (for their own sake as well as in order to reduce future risk) and protection of the public from harm from the offender.…”

Section: Forensic Psychiatrymentioning

confidence: 99%

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

et al. 2018

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Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

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Section: Forensic Psychiatrymentioning

confidence: 99%

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

et al. 2018

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“…Reasons for delayed discharge are likely to include poor response to treatment, ongoing safety issues, and lack of a suitable stepdown facility. A recent review found the factors most frequently associated with longer stay included seriousness of the index offence, history of psychiatric treatment, cognitive deficit, severity of illness, diagnosis of a psychotic disorder and history of violence [18]. Whereas qualitative studies have shown, for example, that forensic patients can appreciate the therapeutic benefit of having a 'safe space' in order to progress [24], there is little information on how long stay patients view the reasons for their long stay in secure settings or how they feel about possible progression through the system, perhaps to a lower level of security or even to discharge to the community.…”

Section: Introductionmentioning

confidence: 99%

The experience of long stay in high and medium secure psychiatric hospitals in England: qualitative study of the patient perspective

Holley

Weaver

Völlm

2020

Int J Ment Health Syst

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Background: Some forensic patients in England remain in secure care for long, possibly unnecessarily prolonged, periods, raising significant ethical and resource issues. Research focused on the patients in secure care has examined quality of life and service provision but not the perspectives of patients experiencing long stays. This study explored how long stay patients experience secure care, what factors they felt influenced long stay, and its impact upon treatment engagement and motivation to progress. Methods: Embedded within a larger epidemiological study, we conducted semi-structured interviews with a purposive sample of forty long stay patients from two high and six medium secure hospitals. Long stay was defined as a 5 years stay in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure. Transcripts were subject to thematic analysis, and narrative analysis at individual case level to explore the relationship between emergent themes. Results: Four themes emerged illustrating participants' attribution, outlook, approach, and readiness for change. A typology of four long stay stances was developed (dynamic acceptance, dynamic resistance, static acceptance, static resistance). These illustrate differences in the extent to which participants believed being in secure care helped them to get better, and actively work towards progression and leaving secure care. There were considerable differences in how patients adopting these stances attributed the reasons for their long stay, they viewed their future, and their motivation to progress. Negative perceptions arose from excessive restrictions, treatment repetition and changes in therapeutic relationships, leading some patients to exhibiting tokenistic engagement and low motivation to progress. Conclusions: Planning care for long stay patients in secure psychiatric settings should take account of the differing stances patient's adopt towards engagement and progression. Service providers should be mindful of these stances and provide patients with individualised opportunities to progress through the secure care treatment pathway, avoiding treatment repetition and maintaining continuity in key professional relationships. Refocusing on quality of life may be appropriate for some long-term patients who are unwilling or unable to move on. For some long-term patients, purpose designed long stay setting may be appropriate.

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“…There are, to our knowledge, no earlier studies specifically investigating this issue, although a number of studies have identified overrepresentation of people from Black and Ethnic Minority groups among those detained under mental health legislation more generally as well as in high and medium secure services in the United Kingdom. On the other hand, a review of studies of 38 publications on long‐stay patients in forensic hospital settings (Huband et al, ), found that being black was associated with shorter length of stay in hospital, so we might have expected to find underrepresentation among people who stay for long periods in secure settings. The issue is likely to be confounded by other factors.…”

Section: Discussionmentioning

confidence: 94%

“…The finding that NHS long-stay patients were more ethnically diverse warrants further discussion. There are, to our knowledge, no earlier studies specifically investigating this issue, although a number of studies have identified (Huband et al, 2018), found that being black was associated with shorter length of stay in hospital, so we might have expected to find underrepresentation among people who stay for long periods in secure settings. The issue is likely to be confounded by other factors.…”

Section: Discussionmentioning

confidence: 95%

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

Kasmi

Duggan

Völlm

2020

Criminal Behav Ment Health

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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.

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Characteristics and Needs of Long-Stay Forensic Psychiatric Inpatients: A Rapid Review of the Literature

Cited by 66 publications

References 82 publications

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

The experience of long stay in high and medium secure psychiatric hospitals in England: qualitative study of the patient perspective

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

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