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Hill C, Bagshaw R, Watt A. Readmission after discharge from a medium secure service between 1999 and 2017: A retrospective cohort study. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:360-372. [PMID: 38898662 DOI: 10.1002/cbm.2346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Previous research into outcomes after treatment in medium secure psychiatric hospitals has mostly relied on pre-millennium data. AIMS To examine patient and inpatient service-related factors associated with readmission within 2 years following discharge to the community or open conditions from conditions of medium security. METHODS A retrospective cohort study of 137 patients discharged either to the community or to open conditions from one 64-bed South Wales Regional Medium Secure Hospital Unit between July 1999 and November 2017 was completed using data from healthcare records to document demographics, diagnosis and nature of index offences together with researcher-completed ratings of inpatient progress using the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) Programme Completion and DUNDRUM Recovery scales. Binary logistic regression analyses were used to identify independent associations between inpatient progress according to these measures and readmission. RESULTS Forty-three patients (31%) were readmitted within 2 years of discharge and 23 (17%) in breach of legal conditions on discharge. Most readmitted patients (n = 29, 67%) returned directly to medium secure care. There were significant binary level associations between readmission and severity of the index offences (lower), number of adverse childhood experiences (higher), history of drug misuse (more likely) and number of previous psychiatric admissions (higher). Binary logistic regression confirmed that these relationships were not independent. No inpatient service-related variables, according to DUNDRUM scale scores, showed an independent association with readmission within 2 years post-discharge. CONCLUSIONS The proportion of medium security hospital patients who were readmitted within 2 years of discharge aligns with estimates found in earlier national research using the same follow-up period. Since levels of inpatient progress bore little if any relationship to longer term outcomes, our findings highlight the need for investigating factors in the discharge environment that are linked to readmission. It is possible that readmission may indicate effective monitoring and responsive care to the changing needs of patients, but a better understanding of this is essential.
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Affiliation(s)
- Charlotte Hill
- Cardiff School of Sport and Health Sciences, Llandaff Campus, Cardiff Metropolitan University, Cardiff, UK
| | - Ruth Bagshaw
- Cardiff School of Sport and Health Sciences, Llandaff Campus, Cardiff Metropolitan University, Cardiff, UK
- Department of Psychology, Forensic Mental Health, Bridgend, UK
| | - Andrew Watt
- Cardiff School of Sport and Health Sciences, Llandaff Campus, Cardiff Metropolitan University, Cardiff, UK
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Smothers M, Hill C, Lawrence D, Bagshaw R, Watt A. Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101935. [PMID: 37717488 DOI: 10.1016/j.ijlp.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes. AIMS To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery. METHODS The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories. RESULTS Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery. CONCLUSIONS The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.
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Affiliation(s)
- Marie Smothers
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| | - Charlotte Hill
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Daniel Lawrence
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; Psychology Department, Priory Healthcare, Llanarth Court, Monmouthshire, UK.
| | - Ruth Bagshaw
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Andrew Watt
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
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Cavaliere VS, Glassman M, DiPaula BA, Mackowick M, Wehring HJ, Liu F, Chen S, Park J, Love RC, Richardson CM, Vyas G, Kearns AM, Kelly DL. Anti-aggressive effects of clozapine in involuntarily committed black patients with severe mental illness. Schizophr Res 2022; 243:163-169. [PMID: 35358857 DOI: 10.1016/j.schres.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients with severe mental illness are falsely characterized as aggressive by the media, perpetuating stigma. While exaggerated, some patients with severe mental illness are more aggressive without treatment. Clozapine may have a unique anti-aggressive effect in patients with schizophrenia-related disorders, independent of antipsychotic or sedative effects. Limited data in forensic and involuntary committed patients is currently available. PURPOSE This study evaluates clozapine's effects on hostility and aggression in court-ordered Black patients. METHODS This study analyzes a subgroup of Black patients from a larger prospective 24-week open-label clozapine study. All patients were involuntarily committed and enrolled from two participating state psychiatric hospitals. The primary outcome measured was total use of 'as needed' (PRN) or 'immediate need' (STAT) medications for aggression/hostility. Secondary outcomes included number and duration of seclusion and restraint (S/R) episodes, and changes in Brief Psychiatric Rating Scale (BPRS) hostility factor score. RESULTS Sixty-nine patients were included in our analysis. Significant reductions were noted in PRN/STAT medication use over time (χ2 = 6.90; p = 0.008) and the BPRS hostility factor score was reduced by 30% over the 24 weeks (F = 4.34, df = 62, p = 0.002). CONCLUSIONS Treatment with clozapine effectively reduced hostility and aggression within this cohort of involuntarily committed Black patients with mental illness compared to baseline. Specifically, it helped lower the total number of PRN/STAT medication administrations and improved clinician-rated hostility factor scores on the BPRS. Our findings are pertinent as data in forensic settings is lacking and Black patients have been infrequently included in large prospective clinical trials with clozapine. GOV IDENTIFIER NCT02404155.
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Affiliation(s)
- Vincent S Cavaliere
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Bethany A DiPaula
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Marie Mackowick
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Jaeboon Park
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Raymond C Love
- University of Maryland School of Pharmacy, 20 N Pine St, Baltimore, MD 21201, USA
| | - Charles M Richardson
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Gopal Vyas
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Ann Marie Kearns
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Catonsville, MD 21228, USA.
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Rossetto I, Clerici M, Franconi F, Felthous AR, Carabellese F, Di Vella G, Gandellini MG, Parente L, Carabellese F. Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study. Front Psychol 2021; 12:708873. [PMID: 34744870 PMCID: PMC8563585 DOI: 10.3389/fpsyg.2021.708873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
The main objective of this study was to compare readmitted (RW) and non-readmitted (NRW) female psychiatric patients after being conditionally or unconditionally released from Italian inpatient forensic psychiatry services, in order to identify variables that were significantly linked with readmission. This study included all patients who were discharged from the female Residences for the Execution of the Security Measure (REMS) of Castiglione delle Stiviere from January 2008 to June 2015 who were not readmitted until December 31, 2018 (48). In addition, data were collected on female patients who were discharged from the same REMS before 2008 and readmitted from January 2008 to December 2018 (42). A key finding of our study was that the readmission into a female REMS was positively associated with the presence of substance use disorders (SUD) and a primary diagnosis on Axis II. To a lesser extent, younger age, being unconditionally discharged when first released, having had a shorter length of inpatient stay and having committed a crime against property for the first REMS admission was also variables that were apparently linked with readmission. The present research continues the previous research on gender-specific mentally ill offenders. Hence, the decision to proceed separately with a sample of men only and one of women only. For all these reasons, young female patients with personality disorder and SUD perhaps should remain longer in REMS and be released with conditions. In most European countries, the length of stay depends on the clinical condition and risk assessment, with some exceptions where the courts set a maximum length of stay at the outset, as in Italy. All the factors listed above influence the risk assessment. Finally, from integrating these findings into the increasing international literature on conditional release and considering the recent changes in the Italian forensic treatment model, we recommend continuing research on individual risk and protective factors as well as risk assessment instruments on conditionally and unconditionally released inpatients with genders studied separately.
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Affiliation(s)
- Ilaria Rossetto
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | | | - Filippo Franconi
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | - Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Fulvio Carabellese
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | | | - Lia Parente
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
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Bjørkly S, Wærstad JM, Selmer LE, Wærp J, Bjørnstad M, Leinslie JV, Eidhammer G, Douglas KS. Violence after discharge from forensic units in the safe pilot study: a prospective study with matched pair design. Psychol Res Behav Manag 2019; 12:755-766. [PMID: 31695530 PMCID: PMC6717845 DOI: 10.2147/prbm.s214270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/05/2019] [Indexed: 11/23/2022] Open
Abstract
Objective This paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose. Methods Patients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group. Results We found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group. Conclusion We discuss this in terms of a possible gap between the development and implementation of plans.
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Affiliation(s)
- Stål Bjørkly
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde N-6402, Norway
| | - Jon Magnus Wærstad
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - Lars Erik Selmer
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - Johnny Wærp
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - Martin Bjørnstad
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - John Vegard Leinslie
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - Gunnar Eidhammer
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway
| | - Kevin S Douglas
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway.,Department of Psychology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada.,Centre for Research and Education in Forensic Psychiatry, Bergen Health Trust, Bergen 5021, Norway
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