Strong patient-staff relationships are key to reducing conflict in high-security psychiatric hospitals

2021 ◽  
Keyword(s):  
Psychiatric Hospitals ◽  
High Security ◽  
Staff Relationships

Redeveloping Secure Psychiatric Services for Women

2005 ◽  
Vol 45 (4) ◽  
pp. 331-339 ◽  
Author(s):  
Stuart D M Thomas ◽  
Mairead Dolan ◽  
Jenny Shaw ◽  
Samantha Thomas ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Psychiatric Hospitals ◽  
Antisocial Behaviour ◽  
Care Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Suitable Alternative ◽  
High Security ◽  
Risk Treatment ◽  
The Individual

Historically, a substantial proportion of women have been unduly detained in conditions of high security in England due to the lack of suitable alternative facilities. There have been no studies that have comprehensively examined the individual needs of these women in relation to their placement needs. A cross sectional survey was undertaken of the individual and placement needs of all females detained in the three high security psychiatric hospitals (HSPHs) in England on 18th October 1999. Whilst there are clearly differences in accommodation needs among the women, those requiring lower secure services are significantly less likely to have needs in relation to violence (OR 0.29, 95% CI 0.14-0.62) and drugs (OR 0.29, 95% CI 0.12-0.67) when length of stay is taken into account. They also have lower security, treatment and dependency needs than women still requiring HSPH treatment. A significant reorganisation of services is required. There is a need to gain further understanding of the relationships between traumatic histories, clinical presentation and antisocial behaviour and how these impact on assessed risk, treatment and care needs and outcome. The special needs of these women should be considered a priority when developing treatment and care packages.

Care quality commission inspections of high-security hospitals

2020 ◽  
Vol 22 (2) ◽  
pp. 83-96
Author(s):  
Sana Rabab ◽  
Jack Tomlin ◽  
Nick Huband ◽  
Birgit Völlm
Keyword(s):  
Good Practice ◽  
Psychiatric Hospitals ◽  
Care Quality ◽  
Care Plan ◽  
Healthcare Provision ◽  
Systematic Analysis ◽  
Content Type ◽  
High Security ◽  
Care Quality Commission ◽  
Over Time

Purpose Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018. Design/methodology/approach In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis. Findings Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process. Practical implications These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates. Originality/value This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

scholarly journals Ethnic differences among patients in high-security psychiatric hospitals in England

2006 ◽  
Vol 188 (4) ◽  
pp. 380-385 ◽  
Author(s):  
Morven Leese ◽  
Graham Thornicroft ◽  
Jenny Shaw ◽  
Stuart Thomas ◽  
Rajesh Mohan ◽  
...  
Keyword(s):  
Legal Status ◽  
Unmet Needs ◽  
Psychiatric Hospitals ◽  
Individual Treatment ◽  
Treatment Needs ◽  
Mean Values ◽  
Admission Rates ◽  
High Security ◽  
Black Patients ◽  
African Patients

BackgroundBlack (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England.AimsTo describe the socio-demographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group.MethodA total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed.ResultsBlack patients in HSPHs are over-represented by 8.2 times (range 3.2–24.4, 95% CI 7.1–9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P < 0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40, 95% CI 0.06–0.73).ConclusionsCompared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.

Defining the needs of patients with intellectual disabilities in the high security psychiatric hospitals in England

2004 ◽  
Vol 48 (6) ◽  
pp. 603-610 ◽  
Author(s):  
S. D. Thomas ◽  
M. Dolan ◽  
S. Johnston ◽  
H. Middleton ◽  
M. A. Harty ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Psychiatric Hospitals ◽  
High Security

The security, clinical and social needs of patients in high security psychiatric hospitals in England

2004 ◽  
Vol 15 (2) ◽  
pp. 208-221 ◽  
Author(s):  
Mari-Anne Harty ◽  
Jenny Shaw ◽  
Stuart Thomas ◽  
Mairead Dolan ◽  
Lisa Davies ◽  
...  
Keyword(s):  
Psychiatric Hospitals ◽  
Social Needs ◽  
High Security

Re-visiting the need for High Security Psychiatric Hospitals in England

2004 ◽  
Vol 15 (2) ◽  
pp. 197-207 ◽  
Author(s):  
Stuart Thomas ◽  
Mairead Dolan ◽  
Graham Thornicroft
Keyword(s):  
Psychiatric Hospitals ◽  
High Security

scholarly journals Vulnerabilities of High-Security Forensic Psychiatry Residences in Italy during the COVID-19 pandemic: a qualitative survey and a proposal for recovery and prevention

2020 ◽  
Author(s):  
Andrea Pozza ◽  
Fabio Ferretti ◽  
Fulvio Carabellese ◽  
Giacomo Gualtieri ◽  
Alessandra Masti ◽  
...  
Keyword(s):  
Mental Health ◽  
Forensic Psychiatry ◽  
Criminal Responsibility ◽  
Negative Impact ◽  
Psychiatric Hospitals ◽  
Recovery Process ◽  
Vulnerable Groups ◽  
Stressful Event ◽  
Prevention Strategies ◽  
High Security

Abstract Italy is the first European country severely hit by the COVID-19 pandemic after the outbreak in Wuhan. In our healthcare context, the closing of forensic psychiatric hospitals in 2014 completed the long transition from a containment approach for offenders with severe mental disorders to a model oriented to recovery and community reintegration. High-Security Forensic Psychiatry Residences (REMS) were implemented by regional health authorities. Within these settings, inpatients with severe psychiatric disorders who committed a criminal offense, without criminal responsibility but still considered socially dangerous, are held, and treated. The current COVID-19 emergency represents a severe stressful event which has a potentially negative impact on the recovery process of the inpatients and on the work-related health of the psychiatric professionals. The present paper consists of two sections. In the first one, we discuss the organizational and clinical issues emerged in the forensic psychiatry system in Italy. We identify vulnerable groups and processes and suggest long-term prevention strategies at both clinical and organizational levels. Within the second section, we present the findings of a qualitative exploratory survey conducted in four different REMS immediately after the stop of the lockdown. Based on a qualitative approach, this survey explored the COVID-19 effects on mental health of REMS inpatients and healthcare workers. Thematic analysis showed five key themes: “Intervention and prevention strategies during the lockdown decision making”; “Inpatients’ reactions to the pandemic”; “Psychological reactions of the healthcare staff”; “Recovery process and relations with community mental health services”; “Lessons for the future learned from the COVID-19”.

Route of discharge for special (high-security) hospital patients with personality disorder

1999 ◽  
Vol 175 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Sophie Davison ◽  
Elizabeth Jamieson ◽  
Pamela J. Taylor
Keyword(s):  
Personality Disorder ◽  
Hospital Discharge ◽  
Psychiatric Hospitals ◽  
Considerable Proportion ◽  
High Security ◽  
Hospital Patients ◽  
Special Hospital

BackgroundA considerable proportion of patients with personality disorder are discharged directly to the community from special (high-security) hospitals.AimsTo examine whether patients with personality disorder discharged directly to the community are more likely to be re-convicted than those transferred to psychiatric hospitals of lesser security.MethodRe-conviction data for a f ive-to nine-year follow-up were collected for a four-year (1988–1991) special hospital discharge cohort of patients with personality disorder.ResultsIndividuals discharged directly to the community were not significantly more likely to be re-convicted than those transferred to less secure psychiatric hospitals. However, patients discharged to the community without formal conditions of supervision were more likely to be re-convicted than those discharged to the community with conditions or those transferred to other psychiatric hospitals.ConclusionsFormal supervision after discharge may be more important than actual destination in influencing the likelihood of re-conviction.

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