Medium secure mental health care for young people: decisions to detain

Abstract

Abstract Medium secure units are one component of secure mental health care for young people across the UK. No research has previously examined the appropriateness of admissions. This is a retrospective cohort study of all patients admitted to one unit by examining clinical notes for demographic, mental health and criminological variables. Descriptive data was statistically analysed to then characterise the cohort, audit against admission criteria and examine changes over time. There were 149 admissions. All patients admitted were male, most were 17 years old and from racialized groups. Most were detained under forensic sections with a primary diagnosis of psychosis. Four of five admissions met all 4 admission criteria. There were notable changes in use of forensic sections and risk over time. Our cohort differs from previous historical and contemporaneous cohorts in terms of diagnosis, legislation determining admission and ethnic breakdown. Our analysis relies on an interpretation of existing admission criteria but it suggests that not all admissions were appropriate, raising important practical, ethical and cost benefit questions. We suggest greater transparency about admission decisions to ensure that patients are admitted to the least restrictive setting needed and that national service planning is responsive to changes in demand.

KEYWORDS:

• Adolescence
• development
• mental health
• forensic psychiatry

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Copyright to be registered with the journal.

Data availability statement

The data sets generated during and/or analysed during this study are available from the corresponding author on reasonable request.

Ethics Statement

This service evaluation was registered and approved as a service evaluation by the Clinical Effectiveness and Audit Department of West London NHS Trust. Informed consent from patients or their families was not required as the data used in the study were routinely collected clinical data that was fully anonymised.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.