1
|
Thomson L, Rees C. Long-term outcomes of the recovery approach in a high-security mental health setting: a 20 year follow-up study. Front Psychiatry 2023; 14:1111377. [PMID: 37252143 PMCID: PMC10213922 DOI: 10.3389/fpsyt.2023.1111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 05/31/2023] Open
Abstract
Background This study examined the outcomes of a descriptive, longitudinal cohort consisting of 241 patients initially examined in a population study at the high secure State Hospital for Scotland and Northern Ireland in 1992-93. A partial follow-up focusing on patients with schizophrenia was conducted in 2000-01, followed by a comprehensive 20 year follow-up that began in 2014. Aims To explore what happens to patients who required high secure care during a 20 year follow-up period. Method Previously collected data were amalgamated with newly collected information to examine the recovery journey since baseline. Various sources were employed, including patient and keyworker interviews, case note reviews, and extraction from health and national records, and Police Scotland datasets. Results Over half of the cohort (56.0%) with available data resided outside secure services at some point during the follow-up period (mean 19.2 years), and only 12% of the cohort were unable to transition out of high secure care. The symptoms of psychosis improved, with statistically significant reductions observed in reported delusions, depression, and flattened affect. Reported sadness [according to the Montgomery-Åsberg Depression Rating Scale (MADRS)] at baseline, first, and 20 year follow-up interviews was negatively correlated with the questionnaire about the process of recovery (QPR) scores at the 20 year follow-up. However, qualitative data depicted progress and personal development. According to societal measures, there was little evidence of sustained social or functional recovery. The overall conviction rate post-baseline was 22.7%, with 7.9% violent recidivism. The cohort exhibited poor morbidity and mortality, with 36.9% of the cohort dying, primarily from natural causes (91%). Conclusions Overall, the findings showed positive outcomes in terms of movement out of high-security settings, symptom improvement, and low levels of recidivism. Notably, this cohort experienced a high rate of deaths and poor physical morbidity, along with a lack of sustained social recovery, particularly among those who had negotiated a path through services and who were current residents in the community. Social engagement, enhanced during residence in low secure or open ward settings, diminished significantly during the transition to the community. This is likely a result of self-protective measures adopted to mitigate societal stigma and the shift from a communal environment. Subjective depressive symptoms may impact broader aspects of recovery.
Collapse
Affiliation(s)
- Lindsay Thomson
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- The State Hospital, Carstairs, United Kingdom
- The Forensic Mental Health Managed Care Network, Carstairs, United Kingdom
| | - Cheryl Rees
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
2
|
A Substance Use Treatment Programme for Mentally Ill Forensic Patients in an Australian Setting: A Pilot Study of Feasibility, Acceptability and Preliminary Efficacy. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
3
|
Davey Z, Jackson D, Henshall C. The value of nurse mentoring relationships: Lessons learnt from a work-based resilience enhancement programme for nurses working in the forensic setting. Int J Ment Health Nurs 2020; 29:992-1001. [PMID: 32536021 DOI: 10.1111/inm.12739] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate a mentoring programme embedded in a work-based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed-methods study that aimed to implement and evaluate the intervention. Twenty-four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor-mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor-mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work-based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem-solving, and higher levels of resilience, well-being, and self-confidence.
Collapse
Affiliation(s)
- Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Catherine Henshall
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| |
Collapse
|
4
|
Rees C, Thomson L. Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years. BJPsych Open 2020; 6:e62. [PMID: 32552922 PMCID: PMC7345667 DOI: 10.1192/bjo.2020.40] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature mortality among patients experiencing forensic care is high. This paper examines the morbidity and mortality of all Scottish high secure patients in 1992/1993 and followed up 20 years later through the context of recovery. AIMS To explore morbidity and delineate which patients are at greatest risk of premature mortality. To assess the extent of suicide and unnatural deaths. To establish which factors, if any, appear protective. METHOD Health and mortality data were extracted from national data-sets and death categorised as premature or post-expected age. Standardised mortality ratios were calculated to explore natural, unnatural and suicide deaths with Cox regression conducted to explore baseline demographics and premature death. RESULTS During a mean follow-up of 21.1 years, 36.9% (n = 89) died, at an average age of 55.6 years. Of these, 70.8% (n = 63) died prematurely. Men lost on average 14.9 years and women 24.1 years of potential life. Five lives (5.6%) were lost by suicide and three (3.4%) by unnatural means. CONCLUSIONS In contrast to other mainstream and forensic cohorts, high rates of suicide and accidental deaths were not apparent. Risk of premature mortality is high. A greater focus upon physical health by community and in-patient services is essential.
Collapse
Affiliation(s)
- Cheryl Rees
- Division of Psychiatry, University of Edinburgh, UK
| | - Lindsay Thomson
- Forensic Psychiatry, University of Edinburgh; The State Hospital, Scotland; and The Forensic Mental Health Managed Care Network, Scotland, UK
| |
Collapse
|
5
|
Henshall C, Davey Z, Jackson D. The implementation and evaluation of a resilience enhancement programme for nurses working in the forensic setting. Int J Ment Health Nurs 2020; 29:508-520. [PMID: 31930654 DOI: 10.1111/inm.12689] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 11/30/2022]
Abstract
This study aimed to implement and evaluate a work-based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre- and post-programme surveys to evaluate nurses' levels of resilience. Post-programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre- and post-intervention. Free-text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty-nine nurses participated. Levels of personal resilience (M = 4.12, SD = 0.60) were significantly higher post-programme than pre-programme (M = 3.42, SD = 0.70), (t49 = 3.80, P = 0.000, 95% CI = 0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self-awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter-professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long-term impact of resilience programmes may improve nurse retention and recruitment.
Collapse
Affiliation(s)
| | - Zoe Davey
- Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Faculty of Health, University of Technology, Sydney, Australia
| |
Collapse
|
6
|
Rees C, Pitcairn J, Thomson L. A protocol in action: Recovery approach for patients within high secure care: A 20+ year follow-up. Health Sci Rep 2018; 1:e21. [PMID: 30623056 PMCID: PMC6266563 DOI: 10.1002/hsr2.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/23/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES A person-centred approach to recovery is increasingly represented within mainstream mental health literature. Little examination of recovery among forensic mental health patients is evidenced. This study plans to address that insufficiency. METHODS This protocol paper details a novel approach to exploring recovery among a cohort of 241 patients detained under conditions of high secure care in Scotland during August 1992 to August 1993. Under discussion is the repurposing of previous research to circumnavigate length of inpatient stay commonly associated with forensic mental health care. The methodology adopted, while considering data leakage given the vulnerable participant group, will be discussed. RESULTS Repurposing and extending previous research attempts to address the file cabinet effect with 85% of health care research being wasted and future uncertainty regarding research funding in a post-Brexit era. This is an ongoing study. Ethical, confidentiality, privacy issues, and permissions are considered within the methodology. CONCLUSIONS Ethical arguments can be made for tracing and attempting contact with vulnerable groups under-represented in the literature. A well-considered methodology putting the focus on participant welfare and confidentiality at every step is essential. The reported methodology provides an opportunity to expand and re-examine previously collected data through a contemporary lens.
Collapse
Affiliation(s)
- Cheryl Rees
- Division of PsychiatryUniversity of EdinburghEdinburghUK
| | - Jamie Pitcairn
- The State Hospital and Forensic Managed Care NetworkCarstairsScotlandUK
| | - Lindsay Thomson
- Division of PsychiatryUniversity of EdinburghEdinburghUK
- The State Hospital and Forensic Managed Care NetworkCarstairsScotlandUK
| |
Collapse
|
7
|
Clarke M, Duggan C, Hollin CR, Huband N, McCarthy L, Davies S. Readmission after discharge from a medium secure unit. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.039289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodWe examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.ResultsReadmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.Clinical implicationsThe long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.
Collapse
|
8
|
Thomson A, Tiihonen J, Miettunen J, Virkkunen M, Lindberg N. Hospital-treated suicide attempts among Finnish fire setters: a follow-up study. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2016; 26:395-402. [PMID: 26282694 DOI: 10.1002/cbm.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/04/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND High rates of attempted and completed suicide have been reported among offenders, but there has been little attention in this respect to fire setters specifically. Aim Our aim was to investigate hospital-treated suicide attempts among male fire setters. METHODS For each of a consecutive series of 441 pre-trial fire setters, four controls matched for age, gender and place of birth were randomly selected from the Central Population Register. Data on hospitalisation and causes of death over a 39-year period were obtained from the Finnish national registers. RESULTS The prevalence of suicide attempts was significantly higher among fire setters than among controls. Approximately every fifth fire setter had made at least one suicide attempt which had required hospital treatment. The most common method chosen was intentional self-poisoning or exposure to noxious substances. More than 1 in 10 fire setters with at least one hospitalisation for suicide-related behaviour eventually completed suicide. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE More attention should be paid to detecting and managing suicidal behaviours among fire setters as they are a high-risk group and accurate identification of their needs in this respect may not only be life-saving but also reduce recidivism. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Jari Tiihonen
- Niuvanniemi Hospital, Finland
- Department of Psychiatry, University of Eastern Finland, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Jouko Miettunen
- Center for Clinical Neurosciences, Department of Psychiatry, University of Oulu and Oulu University Hospital, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
- Center for Life-Course and Systems Epidemiology, University of Oulu, Finland
| | - Matti Virkkunen
- Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | - Nina Lindberg
- Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| |
Collapse
|
9
|
Abstract
Abstract. Background: The role of self-management of suicidality was investigated as part of a larger qualitative study of suicidality among people with experience of mental illness in New Zealand. Aims: To understand how people self-manage suicidality, why they self-manage, and the effects that self-management may have on suicidal thoughts and behavior. Method: Twenty seven people with experience of mental illness and suicidality were interviewed. A narrative thematic analysis was performed. Results: People had either drifted into self-management (while still using or instead of using mental health services) or chosen self-management because they were unhappy with mental health services, desired independence, or had difficulty accessing services. Self-management of suicidality included: using active ways to reduce, distract, and protect themselves from suicidal thoughts and feelings; practical ways of looking after themselves; reframing thoughts; getting to know themselves better; and peer support. Conclusion: Self-management of suicidality can encourage independence and resilience, a sense of citizenship, mutuality, and achievement.
Collapse
Affiliation(s)
- Debbie H. M. Peterson
- Social Psychiatry and Population Mental Health Research Unit, University of Otago, Wellington, New Zealand
| | - Sunny C. Collings
- Social Psychiatry and Population Mental Health Research Unit, University of Otago, Wellington, New Zealand
| |
Collapse
|
10
|
Roy A, Carli V, Sarchiapone M, Branchey M. Comparisons of prisoners who make or do not make suicide attempts and further who make one or multiple attempts. Arch Suicide Res 2014; 18:28-38. [PMID: 24579918 DOI: 10.1080/13811118.2013.801816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Suicidal behavior among prisoners is a major problem. The objective of this study was to compare prisoners who have made an attempt at suicide vs non-attempters and further to compare single vs multiple suicide attempts. Among 1,537 prisoners, 200 (13%) had a lifetime history of attempting suicide and 92 (6%) had made multiple attempts. Those who had made multiple or single attempts were compared on socio-demographic, developmental, personality, forensic, and psychiatric variables. In a re-analysis we also compared non-attempters with attempters in this larger sample. The comparison showed that prisoners who had made multiple attempts had experienced significantly more childhood trauma, were more introverted, less resilient, had a history of self-mutilation, and had more suicidal ideation. Anger and hostility scores and criminal and violence histories significantly differentiated prisoners who had attempted from those who had never attempted but they did not differentiate multiple from single attempters. Having a history of multiple attempts may be indicative of more severe psychopathology in prisoners, as found in other populations. These findings may be helpful in predicting which prisoner is at increased risk of exhibiting suicidal behavior while incarcerated and after release.
Collapse
|
11
|
Abidin Z, Davoren M, Naughton L, Gibbons O, Nulty A, Kennedy HG. Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services. BMC Psychiatry 2013; 13:197. [PMID: 23890106 PMCID: PMC3727954 DOI: 10.1186/1471-244x-13-197] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/26/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings. METHODS We compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures. RESULTS SAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied. CONCLUSIONS The START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.
Collapse
Affiliation(s)
- Zareena Abidin
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland,Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Leena Naughton
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland
| | - Olivia Gibbons
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland
| | - Andrea Nulty
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland
| | - Harry G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland,Department of Psychiatry, Trinity College, Dublin, Ireland
| |
Collapse
|
12
|
Webb RT, Qin P, Stevens H, Appleby L, Shaw J, Mortensen PB. Combined influence of serious mental illness and criminal offending on suicide risk in younger adults. Soc Psychiatry Psychiatr Epidemiol 2013; 48:49-57. [PMID: 22566132 DOI: 10.1007/s00127-012-0517-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/18/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE We conducted a national epidemiological study to determine how mental illness and criminal offending combine to influence suicide risk in younger adults. METHODS Using completely interlinked registers, we generated a nested case-control study from the cohort of all Danish people born 1965 and onwards. We identified 2,384 suicides aged 15-41 years during 1981-2006, and 56,016 age and sex-matched living controls. We examined all criminal charges from 1980, and all psychiatric admissions from 1969 and outpatient episodes from 1995. Exposure odds ratios were estimated using conditional logistic regression models. RESULTS A quarter of male and 17 % of female suicides had histories of both criminal justice system contact and secondary care psychiatric treatment, with a marked elevation in risk seen compared with having neither risk factor: male odds ratio (OR) 34.0, 95 % confidence interval (CI) 29.1-39.6; female OR 72.7, CI 49.4-107.1. Among those treated for psychiatric illness, contact with the criminal justice system predicted higher risk: male OR 1.4, CI 1.1-1.7; female OR 1.7, CI 1.1-2.4, although these effects were attenuated and became non-significant with adjustment for socio-demographic risk factors. In men, risk was especially high if first criminal justice system contact occurred before first psychiatric treatment episode, and if these two challenging life events coalesced within a year of each other. CONCLUSION These younger age adults should be monitored carefully for signs of suicidal behaviour. The need for well coordinated multiagency care is indicated, and a broad range of psychiatric illnesses should be considered carefully when assessing their suicide risk.
Collapse
Affiliation(s)
- Roger T Webb
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | | | | | | | | | | |
Collapse
|