Difficulties in the pathway from high to medium secure services for personality-disordered patients

Abstract

Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n = 68) and a Dangerous and Severe Personality Disorder service (n = 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group.

Keywords:

• medium secure units
• high security hospital
• personality disorder
• transitions

Acknowledgements

The funding for this research was obtained from the East-Midlands Specialised Commissioning Group.

Notes

1. Since this study was undertaken, the original Mental Health Act (1983) has been amended (Mental Health Act, 2007) and the role of RMO has been replaced by the role of Responsible Clinical (RC).

2. A patient is initially referred to his regional secure unit. This unit is defined as the patient's catchment area medium secure unit. First, this unit will decide if the patient is suitable to progress to conditions of medium security. They will then decide if they are willing to admit the patient to their unit. If a patient is considered suitable for progression to a conditions of medium security by their regional secure but is rejected admission to this unit, their RMO (with the support of the commissioners) is likely to refer the patient to a medium secure unit within the independent sector, or in some cases to a different NHS medium secure unit.

3. Length of detainment in Rampton Hospital prior to referral to a regional secure unit is lower in the DSPD sample because it has been operating for a shorter time period than the PD service.

4. Graphical representation of the delays encountered by patients revealed that these data were not normally distributed for either the PD or DSPD sample. For this reason, nonparametric descriptive statistics are reported.

5. Of the 68 patients in the PD sample, two patients had been transferred to supported accommodation in the community. Prior to this, these patients had been referred to medium secure units. When the data from these patients were included in the dataset, the median length of delay was 18 months (IQR = 26 months, range = 4–93 months).

6. One specific regional secure unit returned 45% of the transfers to their unit during the later years of our 10-year study. All transfers to this unit were subsequently removed from the dataset reported the text due to their influence on the data. With these cases in the dataset, the rate of returned patients increased from 10% within the period 1997–2003, to 29% between 2005 and 2007.