Recorded incidents in a high‐secure hospital: A descriptive analysis

Uppal, Gobinderjit; McMurran, Mary

doi:10.1002/cbm.741

Cited by 47 publications

(47 citation statements)

References 14 publications

(20 reference statements)

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“…Few studies have thus far described incidents while in forensic care (e.g. Uppal et al 123 ), although recent behaviour within institutions might arguably be at least as important as previous offending in determining future placement, in particular for those whose index offences are many years, sometimes decades, in the past. Others have found that need for seclusion 81 and absonsion and aggression 79 during admission are associated with longer LoS.…”

Section: Offending and Riskmentioning

confidence: 99%

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

Völlm

Edworthy

Holley

et al. 2017

Health Serv Deliv Res

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, 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 ...

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Section: Offending and Riskmentioning

confidence: 99%

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

Völlm

Edworthy

Holley

et al. 2017

Health Serv Deliv Res

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“…Self-harm incidents as a service-level outcome indicator were reported in only two studies. 59,62 Neither of these studies reported change over time in self-harm as a result of intervention at the service level.…”

Section: Reoffending/'offending-like' Behaviour/incidentsmentioning

confidence: 99%

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Morrissey

Geach

Alexander³

et al. 2017

Health Serv Deliv Res

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BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…In addition, patients presenting to accident and emergency (A&E) departments are 'treatment seekers' and therefore motivated to seek help at the time of the act. On the other hand, patients in secure institutions often self-harm in secret (Uppal 2009): they tend to use high-risk methods of self-harm and often refuse to be helped. The risk of assaults on staff by patients when they try to prevent and manage such acts is well known (Uppal 2009), with a major impact on staff morale and capacity to care (Howard League of Penal Reforms 2003).…”

Section: Self-harm and Suicide In Prisons And Secure Hospitalsmentioning

confidence: 99%

“…On the other hand, patients in secure institutions often self-harm in secret (Uppal 2009): they tend to use high-risk methods of self-harm and often refuse to be helped. The risk of assaults on staff by patients when they try to prevent and manage such acts is well known (Uppal 2009), with a major impact on staff morale and capacity to care (Howard League of Penal Reforms 2003). Finally, in most cases, no one other than the patient is responsible for the…”

Section: Self-harm and Suicide In Prisons And Secure Hospitalsmentioning

confidence: 99%

Short-term management of repeated self-harm in secure institutions

Sarkar¹

2011

Adv. psychiatr. treat

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SummaryThe challenge of managing repeated self-harm and the high risk of morbidity and mortality are compounded in forensic patients, where there are additional risks of harm to others, absconding and security breaches. There is an urgent need for clinically sound, practice-based and theoretically grounded strategies for managing these associated risks. This is essential as available UK guidelines appear inadequate for this group of patients. This article promotes a pragmatic approach to assessing the risk of self-harm clinically to arrive at hierarchical risk judgements. It further suggests an algorithmic approach to managing these risks and provides testable strategies that can be adapted for use in various secure institutions.

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Recorded incidents in a high‐secure hospital: A descriptive analysis

Abstract: These findings can inform prevention and management of violence and self-harm. Dealing with such a large number of incidents is time consuming, even if they are not especially serious. Attention to environmental, as well as individual, issues is recommended.

Cited by 47 publications

References 14 publications

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

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

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Short-term management of repeated self-harm in secure institutions

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