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Adshead G, Pyszora N, Wilson C, Gopie R, Thomas D, Smith J, Glorney E, Moore E, Tapp J. Everything moves on: referral trends to a leavers' group in a high secure hospital and trial leave progress of group graduates. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2017; 27:112-123. [PMID: 27104779 DOI: 10.1002/cbm.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 04/21/2015] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Moving on from high secure psychiatric care can be a complex and potentially stressful experience, which may hinder progression. A leavers' group in a UK high secure hospital is offered to support patients with this transition. AIMS The aims of this study are to investigate characteristics of patients referred for the leavers' group and compare outcomes for leavers' group graduates with those for patients who never attended a leavers' group for any reason. METHODS A retrospective quasi-experimental design was applied to data extracted from various records sources - within and outside the high security hospital. RESULTS About one-fifth of patients who left the hospital on trial leave during the study were referred to the leavers' group (N = 109). Referred patients were significantly more likely to have either been admitted from another high-security hospital or transferred from prison for treatment and have a diagnosis of paranoid schizophrenia. Patients not referred had a significantly higher rate of previously refusing to participate in groups. There was a tendency for rate of return from trial leave for group graduates to be lower than that of patients who did not attend the leavers' group, but this just failed to reach statistical significance (rate ratio [RR] = 1.04; CI 0.97-1.11). CONCLUSIONS A leavers' group appeared to be a valued therapy option for people who had spent a long time in high secure psychiatric care, or those who continued to require hospital treatment beyond prison tariffs. There was a low return rate from trial leave, which made the evaluation of this outcome difficult. A detailed study into both the reasons for return from trial leave and successes would provide further information on ideal preparation for moving on. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gwen Adshead
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
| | - Natalie Pyszora
- Community Forensic Mental Health Service, Graylands Campus, Brockway Road, Mount Claremont, WA 6010, Australia
| | - Claire Wilson
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
| | - Ramesh Gopie
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
| | - Deryk Thomas
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
| | - Julia Smith
- School of Law, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Emily Glorney
- School of Law, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Estelle Moore
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
| | - James Tapp
- Centralised Groupwork Service, Newbury Therapy Unit, Broadmoor Hospital, Crowthorne, Berkshire, RG45 7EG, UK
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Sedgwick O, Young S, Das M, Kumari V. Objective predictors of outcome in forensic mental health services-a systematic review. CNS Spectr 2016; 21:430-444. [PMID: 26797162 DOI: 10.1017/s1092852915000723] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This systematic review aimed to examine whether neurobiological methods, or other methods independent of clinical judgment, have been investigated to assist decision making in forensic mental health services and, if so, whether this may be a useful strategy for predicting outcomes. OVID-Medline, Embase, and PsychInfo (inception-January 2015) were searched, limiting to English and human studies, using terms relating to "predict," "outcome," "psychiatry," and "forensic" to identify primary research articles reporting on predictors of outcome in forensic mental health services not reliant on clinical judgment/self-report. Fifty studies investigating demographic, neuropsychological/neurophysiological, and biological predictors were identified, reporting on 3 broad outcomes: (i) inpatient violence, (ii) length of stay, (iii) reoffending. Factors associated positively, negatively, and showing no relationship with each outcome were extracted and compiled across studies. Of various demographic predictors examined, the most consistent associations were between previous psychiatric admissions and inpatient violence; a more "severe" offense and a longer length of stay; and young age and reoffending. Poor performance on tests of cognitive control and social cognition predicted inpatient violence while a neurophysiological measure of impulsivity showed utility predicting reoffending. Serum cholesterol and creatine kinase emerged as biological factors with potential to predict future inpatient violence. Research in this field is in its infancy, but investigations conducted to date indicate that using objective markers is a promising strategy to predict clinically significant outcomes.
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Affiliation(s)
- Ottilie Sedgwick
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
- National Institute for Health Research Biomedical Research Centre for Mental Health, Institute of Psychiatry and South London and Maudsley NHS Trust, London, UK
| | - Susan Young
- Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
- Centre for Mental Health, Faculty of Medicine, Imperial College London, London, UK
| | - Mrigendra Das
- Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre for Mental Health, Institute of Psychiatry and South London and Maudsley NHS Trust, London, UK
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The utility of the Historical Clinical Risk-20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security--a UK perspective. BMC Psychiatry 2010; 10:76. [PMID: 20920217 PMCID: PMC2954996 DOI: 10.1186/1471-244x-10-76] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/29/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Structured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting. METHODS The sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria. RESULTS The mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy. CONCLUSIONS Although the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.
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