Quality in provision of forensic psychiatric services: room for improvement

Experiences of restrictiveness in forensic psychiatric care: Systematic review and concept analysis

Mentally disordered offenders may be sent to secure psychiatric hospitals. These settings can resemble carceral spaces, employing high levels of security restricting resident autonomy, expression and social interaction. However, research exploring the restrictiveness of forensic settings is sparse. A systematic review was therefore undertaken to conceptualize this restrictiveness. Eight databases were searched for papers that address restrictive elements of secure forensic care in a non-cursory way. Fifty sources (empirical articles and policy documents) were included and subject to thematic analysis to identify 1) antecedent conditions to, 2) characteristic attributes, 3) consequences and 4) 'deviant' cases of the developing concept. The restrictiveness of forensic care was experienced across three levels: individual, institutional and systemic. Restrictiveness was subjective and included such disparate elements as limited leave and grounds access, ownership of personal belongings and staff attitudes. The manner and extent to which these are experienced as restrictive was influenced by two antecedent conditions; whether the purpose of forensic care was to be more caring or custodial and the extent to which residents were perceived to be risky. We argue that there must be a reflexivity from stakeholders between the level of restrictiveness needed to safely provide care in a therapeutic milieu and enable the maximum amount of resident autonomy.

A survey of referrers' satisfaction with a regional forensic psychiatric service: what do they want?

Aims and Method

The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.

Results

Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.

Clinical Implications

Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.

Capturing perceptions: Prisoners assess their health services ‐ Australia, 2001 and 2004

There is little literature on patient satisfaction related to prisoner health services; the little that does exist refers to specific services, or to sub‐groups of prisoner‐patients. We describe a general assessment of prisoner health services conducted on two separate occasions each with a collective sample of 210 participants, three years apart, using the same instrument. We utilised the World Health Organization Rapid Cluster Sample Survey on both occasions. We conclude that prisoners are interested informants for the health services provided to them. They have valid concerns about the confidentiality of their medical records. Programs and work routines have major impacts on accessibility of prison‐based health services. Given the lack of choice in service‐providers for prisoners, greater flexibility is required by health and custodial agencies to accommodate these two competing areas of activity. We demonstrated that a health service targeting an ‘at risk’ population can respond to inadequacies in service provision. Finally, we confirmed that the World Health Organization Rapid Cluster Sample Survey methodology is an efficient and effective means of assessing health services to discrete populations.

Job satisfaction amongst nurses in an interim secure forensic unit in Wales

All grades of nursing staff in a recently established interim secure forensic unit completed the Index of Work Satisfaction (IWS; n = 40). High levels of job satisfaction were achieved on four of the IWS subscales: (i) professional status; (ii) interaction; (iii) doctor-nurse relationship; and (iv) autonomy. Moderate levels of satisfaction were found on two of the subscales, task requirements and administration, while the salary subscale was the major area of dissatisfaction across the group. The high level of overall satisfaction in this area of psychiatric nursing may be regarded as a significant achievement in the development of new clinical services in what is regarded as a stressful area of nursing. Measures of job satisfaction may be useful benchmarks for evaluating future changes and developments in the service and for monitoring and improving the clinical work environment.