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Use of an extra care area in a medium secure setting for women: Findings and implications for practice

Published online by Cambridge University Press:  13 November 2009

Clive G Long*
Affiliation:
St Andrew’s Healthcare, St Andrew’s Hospital, Northampton, UK
Pheon Silaule
Affiliation:
St Andrew’s Healthcare, St Andrew’s Hospital, Northampton, UK
Naomi Collier
Affiliation:
St Andrew’s Healthcare, St Andrew’s Hospital, Northampton, UK
*
Correspondence to: Dr C.G. Long, St Andrews Healthcare, Billing Road, Northampton, NN1 5DG. Tel: 01604 616307; E-mail: [email protected]
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Abstract

An evaluation of the Extra Care Area (ECA) in a medium secure psychiatric facility for women is described. A retrospective case note audit over an 18 month period concluded that the ECA was used infrequently for the most disturbed service users who had previously been frequently secluded. Ongoing self harm and aggression in ECA was a feature of some cases raising the possibility that admission may be counter productive for some, particularly when it is combined with a lack of occupational stimulation. Service users valued the opportunity for reflection in a low stimulus environment and there were no repeat admissions. A number of initiatives to improve multidisciplinary care planning, documentation, therapeutic engagement and service user involvement to reduce risk have been actioned. Of particular importance is the need to begin ‘discharge planning’ at the first point of entry to avoid prolonged stays, isolation from peers and dependence on both individual staff attention and a special status living arrangement.

Type
Review
Copyright
Copyright © NAPICU 2010

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References

Adams, J. and Clark, T. (2008) Hot beds of forensic psychiatry: Psychiatric intensive care units within medium-security. Journal of Psychiatric Intensive Care. 4: 5963.CrossRefGoogle Scholar
Barkham, M. and Mellor-Clark, J. (2000) Rigor and relevance: The Role of practice-based evidence in psychological therapies. In: Roland, N., Gars, S. (eds). Evidence-Based Counselling and Psychological Therapies. London: Routledge.Google Scholar
Bartlett, A., Johns, A., Fiander, M. and Jhawar, H. (2007) Report of the London forensic units benchmarking study. London: NHS.Google Scholar
Brusca, R.M., Nieminen, G.S., Carter, R. and Repp, A.C. (1989) The relationship of staff contact and activity to the stereotyping of children with multiple disabilities. Journal of the Association for Persons with Severe Handicaps. 14: 127136.CrossRefGoogle Scholar
Carr, E.G. (1977) The motivation of self injurious behaviour: A review of self hypotheses. Psychological Bulletin. 84: 800816.CrossRefGoogle ScholarPubMed
Collins, M. and Davis, S. (2005) The securing needs profile: A multidimensional approach to measuring security needs. International Journal of Forensic Mental Health. 4: 3952.CrossRefGoogle Scholar
Cordall, J. (1999) Angry women mentally disordered offenders: A need to do more? British Journal of Nursing. 8: 658663.CrossRefGoogle Scholar
Dawson, P., Kingsley, M. and Pereira, S. (2005) Violent patients within psychiatric intensive care units: Treatment approaches, resistance and the impact upon staff. Journal of Psychiatric Intensive Care. 1: 4553.CrossRefGoogle Scholar
Department of Health (2002) Mental Health Policy Implementation Guide: National minimum standards for general adult services. London: DoH.Google Scholar
Dolan, M. and Lawson, A. (2001) Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit. Psychiatric Bulletin. 25: 296299.CrossRefGoogle Scholar
French, B.C., Knapp, R.G., Cusack, K.J.et al. (2005) Patient’s reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services. 56: 11231133.Google Scholar
Gaskin, C.J., Elsom, S.J. and Happell, B.(2007) Interventions for reducing the use of seclusion in psychiatric facilities. British Journal of Psychiatry. 191: 298303.CrossRefGoogle ScholarPubMed
Kasmi, Y. (2007) Characteristics of patients admitted to psychiatric intensive care units. Irish Journal of Psychiatric Medicine. 24: 7578.CrossRefGoogle ScholarPubMed
Linehan, M. (1993) Cognitive-Behavioural Treatment of Borderline Personality Disorder. New York: The Guilford Press.Google Scholar
Long, C.G., Fulton, B. and Hollin, C.R. (2008) The development of a ‘best practice’ service for women in a medium-secure psychiatric setting: Treatment components and evaluation Clinical Psychology and Psychotherapy. 15: 304319.CrossRefGoogle Scholar
Long, C.G., Mason, F., Mochty, U. and Craig, L. (2009) Women referred for medium-secure inpatient care: A population study over a six-year period. Paper presented at the Sixth Annual Conference of Research in Medium-Secure Units. Institute of Psychiatry, London Jan. 29th 2009.Google Scholar
Matson, J.L. and Boisjoli, J.A. (2007) Multiple versus single maintaining factors of challenging behaviours as assessed by the QABF for adults with intellectual disabilities. Journal of Intellectual and Developmental Disability. 32: 3944.CrossRefGoogle ScholarPubMed
McMurran, M., Charlesworth, P., Duggan, C. and McCarthy, L. (2001) Controlling angry aggression : A pilot group intervention with personality disordered offenders. Behavioural and Cognitive Psychotherapy. 29: 473483.CrossRefGoogle Scholar
Muir-Cochrane, E.G. and Holmes, C.A. (2001) Legal and ethical aspects of seclusion: An Australian perspective. Journal of Psychiatric and Mental Health Nursing. 8: 501506.CrossRefGoogle ScholarPubMed
Nijman, H., Joost, M.L.G. and Campo, M.D. (2002) Situational determinants of inpatient self-harm. Suicide and Life Threatening Behaviour. 32: 167175.CrossRefGoogle ScholarPubMed
Schreiner, G.M., Grafton, C.G. and Sevia, J.A. (2004) Decreasing the use of mechanical restraints and locked seclusion. Administration and Policy in Mental Health. 31: 449463.CrossRefGoogle ScholarPubMed
Sigafoos, J. and Kerr, M. (1994) Provision of leisure activities for the reduction of challenging behaviour. Behavioural Interventions. 1: 4353.CrossRefGoogle Scholar