Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

Abstract

There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This article presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital.

Keywords:

• Forensic service user need
• high secure hospital care
• multidisciplinary clinical service provision
• recovery
• social inclusion
• length of stay

The authors represent the multidisciplinary working group involved in this work. They would like to extend thanks to contributors to the work of the group, including Mark Ashby, and to those who helped with various stages of data collection, including Gemma Dakin, Marilyn Drue, Vicky Vallentine and Siobhan Windley. Thanks also to two anonymous reviewers who provided helpful comments on an original version of this article and to Darren Lumbard for assistance in preparing this manuscript.