Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of forensic mental health services.

2015 ◽  
Vol 38 (1) ◽  
pp. 16-23 ◽  
Author(s):  
James R. P. Ogloff ◽  
Diana Talevski ◽  
Anthea Lemphers ◽  
Melisa Wood ◽  
Melanie Simmons
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Substance Use Disorders ◽  
Antisocial Personality Disorder ◽  
Antisocial Personality ◽  
Forensic Mental Health

scholarly journals Security needs among patients referred for high secure care in Broadmoor Hospital England

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Hannah Kate Williams ◽  
Madhri Senanayke ◽  
Callum C. Ross ◽  
Rob Bates ◽  
Mary Davoren
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cohort Study ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Final Decision ◽  
Forensic Mental Health ◽  
Vulnerable Group ◽  
Secure Care

Background Security needs among patients referred to forensic mental health services have rarely been systematically studied. Aims To ascertain security needs among patients referred to a high secure hospital, Broadmoor High Secure Hospital, England. We also aimed to compare the security needs for those referred to mental illness services with those referred to personality disorder services in the hospital. Method A retrospective complete cohort study of all referrals to Broadmoor Hospital over a 2-year period was conducted. All referred patients (n = 204) were assessed for need for high secure care by two Broadmoor clinicians. The final decision on need for admission was taken by a multidisciplinary admission panel. Independent of the panel, researchers rated need for security using the DUNDRUM-1 triage security scale. Results Those admitted to Broadmoor Hospital had higher triage security scores than those declined (F = 4.209, d.f. = 1, P = 0.042). Referrals to the personality disorder pathway had higher security needs than those referred to the mental illness pathway high secure service (F = 6.9835, d.f. = 1, P = 0.0089). Overall security needs among referrals to Broadmoor were extremely high, both by comparison with previous needs identified in UK medium secure services and international medium and high secure services. Conclusions High secure patient cohorts represent a uniquely vulnerable group within mental health services, with extremely high security needs identified in this study. This has significant implications for services given the high levels of resources needed to provide therapeutically safe and secure care and treatment to this group.

Advancing research in adult secure mental health services in England

2021 ◽  
pp. 002580242110669
Author(s):  
Howard Ryland ◽  
Louise Davies ◽  
Jeremy Kenney-Herbert ◽  
Michael Kingham ◽  
Mayura Deshpande
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Learning Disability ◽  
Personality Disorders ◽  
Forensic Mental Health ◽  
Policy Makers ◽  
People With Mental Illness ◽  
Low Volume

Forensic mental health services in high income countries are typically high cost and low volume, providing care to people with mental illness, personality disorders, learning disability and autism deemed to pose a risk to others. Research into how forensic mental health services work as a whole system is limited. Such research is urgently needed to guide policy makers and ensure that services operate effectively.

scholarly journals “Who needs secure services for personality disorder?” Results of an expert Delphi study with professional staff

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zoe Foyston ◽  
Celia Taylor ◽  
Mark Freestone
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Delphi Study ◽  
Professional Staff ◽  
Free Text ◽  
Forensic Mental Health ◽  
Increased Risk

Abstract Background Personality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD. Method A modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning. Results Fifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual’s presenting need, the overall clinical picture and formulation in their free text responses. Conclusions Professionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.

scholarly journals Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Helle Wessel Andersson ◽  
Solfrid E. Lilleeng ◽  
Torleif Ruud ◽  
Solveig Osborg Ose
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Census Data ◽  
Current Treatment ◽  
Cross Sectional ◽  
Specialized Mental Health

Abstract Background Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes. Methods We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation. Results The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends. Conclusion Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.

Mechanisms of impulsivity in bipolar disorder and related illness

2010 ◽  
Vol 19 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Alan C. Swann
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Personality Disorder ◽  
Substance Use Disorders ◽  
Antisocial Personality Disorder ◽  
Suicide Attempts ◽  
Affective State ◽  
Rapid Response ◽  
Antisocial Personality ◽  
Course Of Illness

SummaryAims – Impulsivity is a multifaceted aspect of behavior that is prominent in psychiatric disorders and has serious behavioral consequences. This paper reviews studies integrating behavioral and physiological mechanisms in impulsivity and their role in severity and course of bipolar and related disorders. Methods – This is a review of work that used questionnaire, human behavioral laboratory, and neurophysiological measurements of impulsivity or related aspects of behavior. Subjects included individuals with bipolar disorder, substance-use disorders, antisocial personality disorder, and healthy controls. Results – Models of impulsivity include rapid-response impulsivity, with inability to reflect or to evaluate a stimulus adequately before responding, and reward-based impulsivity, with inability to delay response for a reward. In normal subjects, rapid-response impulsivity is increased by yohimbine, which increases norepinephrine release. Impulsivity is increased in bipolar disorder, whether measured by questionnaire, by measures of rapid-response impulsivity, or by measures of ability to delay reward. While affective state has differential effects on impulsivity, impulsivity is increased in bipolar disorder regardless of affective state or treatment. Impulsivity, especially rapid-response, is more severe with a highly recurrent course of illness or with comorbid substance-use disorder, and with history of medically severe suicide attempt. In antisocial personality disorder, rapid-response impulsivity is increased, but rewardbased impulsivity is not. In general, impulsivity is increased more in bipolar disorder than in antisocial personality disorder. In combined bipolar disorder and antisocial personality disorder, increased impulsivity is associated with substance-use disorders and suicide attempts. Conclusions – Impulsivity is associated with severe behavioral complications of bipolar disorder, antisocial personality disorder, and substance-use disorders.

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