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Predicting outcome in low secure environments: A case series from one low secure unit

Published online by Cambridge University Press:  01 December 2007

M Dominic Beer ,
James Tighe ,
Kalaanithi Ratnajothy  and
David Masterson
M Dominic Beer*
Affiliation:
Consultant Psychiatrist in a Low Secure Unit in Oxleas NHS Foundation Trust in South-East London and Honorary Senior Lecturer at the Institute of Psychiatry, University of London
James Tighe
Affiliation:
Clinical Research Nurse, Bracton Centre, Oxleas NHS Foundation Trust
Kalaanithi Ratnajothy
Affiliation:
Head of Research and Development, Oxleas NHS Foundation Trust
David Masterson
Affiliation:
Clinical Audit Co-ordinator, Oxleas NHS Foundation Trust
*
Correspondence to: Dr M.D. Beer, Bracton Centre, Oxleas NHS Trust, Bracton Lane, Dartford, Kent, DA2 7AF, UK. E-mail: [email protected]
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Abstract

Aims: To measure the effectiveness of treatment in a low secure challenging behaviour unit and to identify predictors of change.

Method: Routine clinical data and outcome scores were collected on a case series of 86 patients admitted to and discharged from one low secure unit.

Results: Significant improvements were found on Health of the Nation Outcome Scale (HoNOS), Staff Observed Aggression Scale (SOAS) and the Global Assessment Scale (GAS). Improvements in GAS and HoNOS were associated with moves to a lower level of security. Patients with a history of conviction for property damage, cannabis use, who were admitted on a forensic section or with a diagnosis of personality disorder were more likely to move to a higher level of security. Increased length of stay was related to the presence of physical assault, physical health problems and anxiety symptoms.

Conclusions: Clinical outcomes and behaviour improve during admission to one low secure unit and characteristics of the type of patients who respond to this form of treatment are proposed.

Keywords

Predicting outcomeslow secure unitchallenging behaviourmental healthtreatment effectivenesslength of staydischarge placementsHoNOSGASSOAS
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 3 , Issue 2 , July 2007 , pp. 85 - 92
Copyright
Copyright © NAPICU 2007

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References

Beer, M.D., Paton, C. and Pereira, S.M. (1996) Hot beds of general psychiatry: A national survey of psychiatric intensive care units. Psychiatric Bulletin. 21: 142–144.CrossRefGoogle Scholar
Beer, M.D., Spiller, M.J., Pickard, M., Gravestock, S., McGovern, P., Leese, M., Turk, V., Brooks, D. and Bouras, N. (2005) Low secure units: factors predicting delayed discharge. Journal of Forensic Psychiatry and Psychology. 16(4): 621–637.CrossRefGoogle Scholar
Berry, W.D. and Feldman, S. (1985) Multiple Regression in Practice. London: Sage Publications.CrossRefGoogle Scholar
Coid, J.W. (1991) “Difficult to place” psychiatric patients: The game of pass the parcel must stop. British Medical Journal. 302: 603–604.CrossRefGoogle Scholar
Department of Health and Home Office (1992) Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. (Reed Report; Cmnd 2088). London: HMSO.Google Scholar
Department of Health and Social Services (1974) Revised Report for the Working Party on Security in NHS Psychiatric Hospitals. (Glancy Report). London: HMSO.Google Scholar
Emerson, E. (1995) Challenging Behaviour: Analysis and Intervention in People with Learning Difficulties. Cambridge: Cambridge University Press.Google Scholar
Endicott, J., Spitzer, R.L., Fleiss, J.L. et al. (1976) The Global Assessment Scale. Archives of General Psychiatry. 33: 766–771.CrossRefGoogle ScholarPubMed
Home Office and Department of Health and Social Security (1975) Report of the Committee on Mentally Abnormal Offenders. (Butler Report; Cmnd 6244). London: HMSO.Google Scholar
Jenicek, M. (1999) Clinical Case Reporting in Evidence-Based Medicine. Oxford: Butterworth–Heinemann. p 117.Google Scholar
Palmstierna, T., and Wisted, B. (1987) Staff observation aggression scale, SOAS: presentation and evaluation. Acta Psychiatrica Scandinavica. 76(6): 657–663.CrossRefGoogle ScholarPubMed
Pereira, S., Dawson, P. and Sarsam, M. (2006). The National Survey of PICU and Low Secure Services: 1. Patient characteristics. Journal of Psychiatric Intensive Care. 2: 7–12.CrossRefGoogle Scholar
Pereira, S.M. and Clinton, C. (eds) (2002) National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. Mental Health Policy Implementation Guide. London: Department of Health.Google Scholar
Vandenbroucke, J.P. (2001) In defense of case reports and case series. Annals of Internal Medicine. 134: 330–334.CrossRefGoogle ScholarPubMed
Wing, J., Curtis, R.H. and Beevor, A. (1999) Health of the Nation Outcome Scales. British Journal of Psychiatry. 174: 432–434.CrossRefGoogle ScholarPubMed