Characteristics and needs of long-stay patients in high and medium secure forensic-psychiatric care: implications for service organisation
A small number of people are treated in locked psychiatric hospitals. Our research project inquired about the people who spend the longest periods of time in the most secure settings. We asked the hospitals for information from their databases and casefiles and interviewed patients and carers, clinicians and managers. We included all three high security hospitals in England and 23 of the medium secure units and found 401 long stay patients resident in them.
One in five patients in high secure hospitals had been there for more than 10 years, and a similar proportion had spent more than 5 years in medium secure units. Our information showed little difference between the people in high and medium secure settings. The majority of the long stay patients in our study had criminal convictions for violence, but one in six had no convictions linked to their detention. 90% took psychiatric medication, but only 50% received psychological treatment. Patients moved from one ward to another, but did not make much progress – moving round rather than moving forward. High secure settings cost £275,000 per year, and medium secure £175,000. Despite this investment, evidence-based therapies were scarce.
Patients were often in hospital far away from home, which was hard for visitors. Relatives were supervised during visits and felt sidelined in care planning. Maintaining hope was challenging for patients, relatives and staff, especially for the people who may never leave. A stronger focus on quality of life rather than treatment may be better for this group.
National Institute for Health Research (NIHR) Health Services and Delivery Research Programme, project number 11/1024/06. Find out more about the research here.
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