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 Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario

2017 ◽  
Vol 63 (6) ◽  
pp. 378-386 ◽  
Author(s):  
Alyson L. Mahar ◽  
Alice B. Aiken ◽  
Heidi Cramm ◽  
Marlo Whitehead ◽  
Patti Groome ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Services ◽  
Retrospective Cohort ◽  
Care Physician ◽  
Health Related

Objective: A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. Method: This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health–related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. Results: The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health–related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health–related reason (5.1% had at least 1 ED visit). Conclusion: Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.

scholarly journals Assessment of personality disorder

2009 ◽  
Vol 15 (5) ◽  
pp. 389-397 ◽  
Author(s):  
Penny J. M. Banerjee ◽  
Simon Gibbon ◽  
Nick Huband
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Personality Disorders ◽  
Assessment Instruments ◽  
Department Of Health

SummaryIn 2003 the Department of Health, in conjunction with the National Institute for Mental Health in England, outlined the government's plan for the provision of mental health services for people with a diagnosis of personality disorder. This emphasised the need for practitioners to have skills in identifying, assessing and treating these disorders. It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This article reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.

scholarly journals Eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder in adults with serious mental illness within forensic and rehabilitation services: a study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Susanna Every-Palmer ◽  
Tom Flewett ◽  
Shaystah Dean ◽  
Oliver Hansby ◽  
Atalie Colman ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Controlled Trial ◽  
Routine Care ◽  
Forensic Mental Health ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
Emdr Therapy

Abstract Background Eye movement desensitization and reprocessing (EMDR) is an evidenced-based treatment for posttraumatic stress disorder (PTSD). Forensic mental health services provide assessment and treatment of people with mental illness and a history of criminal offending, or those who are at risk of offending. Forensic mental health services include high, medium, and low-security inpatient settings as well as prison in-reach and community outpatient services. There is a high prevalence of PTSD in forensic settings and posttraumatic experiences can arise in people who violently offend in the context of serious mental illness (SMI). Successful treatment of PTSD may reduce the risk of relapse and improve clinical outcomes for this population. This study aims to assess the efficacy, risk of harm, and acceptability of EMDR within forensic and rehabilitation mental health services, as compared to treatment as usual (routine care). Methods This is a single-blind, randomized controlled trial comparing EMDR therapy to the waiting list (routine care). Adult forensic mental health service users (n = 46) with SMI and meeting the criteria for PTSD will be included in the study. Participants will be randomized after baseline assessment to either treatment as usual plus waiting list for EMDR or to treatment as usual plus EMDR. The EMDR condition comprises nine sessions, around 60 min in length delivered weekly, the first of which is a case conceptualization session. The primary outcomes are clinician and participant-rated symptoms of PTSD, and adverse events. Secondary outcomes include psychotic symptoms, social functioning, level of disability, self-esteem, depressive symptoms, post-trauma cognitions, and broad domains of complex posttraumatic difficulties. A trained assessor blinded to the treatment condition will assess outcomes at baseline, 10 weeks, and 6 months. Additionally, grounded theory qualitative methods will be used to explore participant experience of EMDR for a subset of participants. Discussion This study will contribute to the currently limited evidence base for EMDR for PTSD in forensic settings. It is the first randomized clinical trial to assess the efficacy, risk of harm, and acceptability of EMDR for PTSD in people with SMI in either forensic, mental health inpatient, or custodial settings. Trial registration Australia and New Zealand Clinical Trials Network, ACTRN12618000683235. Registered prospectively on 24 April 2018.

The Current Situation in Psychiatry and its Effects on the Delivery of Mental Health Services in the Next Decade

1971 ◽  
Vol 2 (2) ◽  
pp. 138-145 ◽  
Author(s):  
William J. Horvath
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Treatment ◽  
Additional Data ◽  
Current Knowledge ◽  
Medical Model ◽  
Behavioral Disorder ◽  
Treatment Alternative

As long as mental illness is regarded as primarily a behavioral disorder, current and foreseeable manpower shortages in psychiatry make it necessary to increase the participation of nonmedical personnel in the treatment process. The controversy between those advocating behavioral treatment and those favoring the medical model cannot be resolved due to the fact that our current knowledge of the biologic roots of mental illness is inadequate. A breakthrough in research in this area could resolve the argument and solve the manpower problem by transferring psychiatric disorders into physiologic disease susceptible to medical treatment. Alternative models for the delivery of mental health services can be developed to allow for different possibilities in the outcome of research. Additional data is needed, especially on the costs and effectiveness of future therapies, before an evaluation of programs can be carried out.

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