1. Long Term Medium Secure Patients A London Perspective
Dr Bradley Hillier, SpR in Forensic Psychiatry, South Thames Forensic Training Scheme
Treasurer, International Association Forensic Psychotherapy
Co-Authors: Dr Paul Gilluley, (Director of Forensic Services, East London NHS FT) Dr Mary-Anne Harty (Associate Medical Director, Forensic Service, South West London NHS MHT), Dr Doreen Attard (Consultant Forensic Psychiatrist, SABP/Priory Thornford Park), Dr Stephen Attard (Lead Clinician, Male Secure Service, St Andrew’s Hospital Group, Northampton)
With thanks to Drs Adrian Lambourne and Sarah White for statistical analyses

3. Outline of Presentation
Background
Motivation
Methodology
Results
Conclusions and Implications
Q&A

4. Background

5. Medium Secure Evolution in UK (1)
Emery, Glancy and Butler Committee / Reports
Aims
To manage people in levels of security appropriate to their needs
To enable individuals stepping down from supraregional high security to re-integrate with local area and re-settle.
Joined-up care
To be discharged to community within 2-4 years
Beyond this regarded as “Long Term”

6. Medium Secure Evolution in UK (2)
Reinforced by Best Practice Guidance for Medium Secure Services 2007 (Dept of Health)
“criteria for care by a forensic service within medium security probably best calculated on a matrix of positions on a number of dimensions reflecting qualities such as illness/disorder activity, history of seriousness and frequency of violent or other dangerous behaviour, likelihood of repetition, imminence of that repetition, the extent to which any threat posed is specific or general, capacity to escape and insight and capacity for co-operating with treatment and supervision to name but a few...different MSUs can cater for groups with different needs...including Long-Term Medium Secure Care...these different patient groups will require different skills and expertise to meet their need and may require different mixes of environmental, procedural and relational security”

7. The Current Study
Quantify the current need for long-term medium secure services in the London region
Characterise the demographics and other features of the patient population
Attempt to identify factors associated with prolonged length of stay that may pose barriers to discharge as identified
Consider the implications for service provision and therapeutic model that the findings suggest

8. Methodology
Multi-site, cross sectional descriptive data collection with view to service improvement, future planning
3 regions of London with total population of 4.6m

9. Data Collection Tool Demographic Information
Offence Information, Referral Source and MHA Status
Diagnoses
Substance Misuse Problems
Physical Health, Staff Support and Care Needs
Current medication (incl Clozapine/Depot)
Patient’s future

10. Results: Demographics
Totals: N= 105, 90 M 15 F
Ages (yrs)
Hospital
Stay (yrs)
Male
Female
Total Group
Mean 44 40
43.7
Median 42
Range
24-76
25-52
Male
Female
Total
Mean
9.4
8.01
9.3
Median
7.5
6.4
Range
3.7-16

11. Results: Ethnicity

12. Results: Detention Status

13. Results: Index Offence

14. Results: Primary Diagnosis

15. Results: Substance Misuse

16. Results: Medication

17. Results Staff Support Needs

18. Results: Problems Preventing Discharge

19. Results: Future Prediction

20. Questions that are raised
Why are patients who are too unwell for discharge with psychosis after 4 yrs not prescribed clozapine?
Why are there predictions that a significant minority may be back in prison in 5 years?
Are opportunities being missed earlier in the duration of a patient stay?

21. Different offender groups and the model used, differing needs, cross sectional analysis.