Compulsory treatment in the community: current legal powers

Davies, Steffan

doi:10.1192/apt.8.3.180

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…Multivariable analysis indicated that non-white ethnicity, early childhood maladjustment, and clozapine treatment were all significant independent predictors of time to recall. The average time to recall decreased with consecutive periods of readmission; this is consistent with previous research into returns to hospital in a Canadian sample of forensic patients [9].The rate of recall observed in the current study (45%) is higher than rates observed in previous UK and New Zealand studies (12-35%)[6,10,11], which may be due to differences in the length of follow-up, variations in recall versus readmission practices across study settings, and changes in thresholds for readmission/recall over time and across jurisdictions. Re-hospitalisation does not necessarily reflect treatment failure; it can be argued that a low threshold for recall is justifiable in this population; giving patients the chance to demonstrate their ability to manage community living whilst providing public reassurance.…”

supporting

confidence: 90%

“…Data on the rates of recall compared with standard readmission (i.e., a readmission not requiring formal authorisation from the MoJ) are limited, but there is some indication that recall rates for forensic patients are relatively high. Rates ranging from 12–17% after two years [10] to 35% over a 20-year follow-up period [6] have previously been reported in the UK; compared to a 19% recall rate for conditionally released patients in New Zealand [11]. Recall versus readmission practices vary by locality and over time.…”

Section: Introductionmentioning

confidence: 99%

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Predicting time to recall in patients conditionally released from a secure forensic hospital: A survival analysis

et al. 2018

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supporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Predicting time to recall in patients conditionally released from a secure forensic hospital: A survival analysis

et al. 2018

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“…Community treatment has also undergone substantial changes, for example, assertive outreach, community forensic teams, crisis resolution and home treatment services now provide treatment in the community that was not previously available. The legal powers available for community treatment also changed during the study period, 15 with the introduction of supervised discharge in 1996 (superseded by supervised community treatment orders in the 2007 amendments to the Mental Health Act). The patients' diagnoses also have implications as to whether services are likely to accept them.…”

Section: Discussionmentioning

confidence: 99%

Readmission after discharge from a medium secure unit

et al. 2013

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Aims and methodWe examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.ResultsReadmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.Clinical implicationsThe long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.

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“…Its aim, according to Riordan et al . () and Davies (), has been to ensure that service users continue to engage with psychiatric services to minimize the risks associated with non‐engagement such as relapse in mental state and relapse into illicit drug use. The framework also aims to help patients with social reintegration, which is often stressful and difficult for patients who have been in a secure setting for a long time.…”

Section: Introductionmentioning

confidence: 99%

Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit

Chiringa

Robinson

Clancy

2013

Psychiatric Ment Health Nurs

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Patients who have been discharged from forensic services often have conditions they have to abide by as part of their discharge, and failure to do so leads to recall. We interviewed six men who had been conditionally discharged from forensic services and then been recalled into hospital to find out what they thought went wrong. The reasons they gave for why things went wrong included feeling that the system was unfair and made them feel like criminals even though they did not feel they had put anyone at risk. Some of them were not fully aware of the conditions they needed to adhere to, and some of them had breached the conditions but did not take responsibility for what had happened. In addition, supervision was felt to be very controlling and disruptive rather than supportive when patients were often lonely, bored and needing support. Most participants reported that they experienced poor standards of aftercare in hostels they were required to reside in. In the future, care of patients after conditional discharge should include better communication between patients and their supervisory team, recognition of the need for more support and improvements in the standards of care in hostels, as well as a collaborative approach to risk assessment that might reduce the frequency of relapse and readmission. This study explores how male patients suffering from dual diagnosis in a forensic unit perceive being recalled and readmitted following conditional discharge and their views about how services might be improved. A qualitative approach was used drawing on grounded theory techniques. Audiotaped semistructured interviews collected data from a purposefully selected sample of six participants who had been recalled and met the inclusion criteria of the study. Data were analysed using the constant comparative method. Most participants perceived the recall system as unfair, inappropriately criminalized their behaviour and was based on an assessment of risk that they did not understand or accept. Participants were not fully aware of the conditions of their discharge, and most did not accept responsibility for their role in being recalled and blamed the system. Care following discharge was rarely seen as positive, and poor standards in hostels were reported by most participants. Supervision was often seen as disruptive and controlling, and focused more on surveillance rather than support. Better communication might have helped them understand and adhere to the conditions of their discharge. Participants identified the importance of family and friends to their recovery, the importance of having their own accommodation, and the need to be more independent.

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Compulsory treatment in the community: current legal powers

Abstract: ). His research interests include community supervision and long-term outcomes from general rehabilitation and forensic services. Compulsory treatment in the community: current legal powers

Cited by 7 publications

References 14 publications

Predicting time to recall in patients conditionally released from a secure forensic hospital: A survival analysis

Predicting time to recall in patients conditionally released from a secure forensic hospital: A survival analysis

Readmission after discharge from a medium secure unit

Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit

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