Linking the past and the present: service users’ perspectives of how adverse experiences relate to their admission to forensic mental health services

Purpose This study aimed to explore how forensic mental health service users make sense of their past adverse experiences. Secondly, it aimed to explore whether service users considered their adverse experiences to be related to their current stay in a forensic mental health setting. Design/methodology/approach Interpretative phenomenological analysis was used to analyse interviews with eight service users in low and medium secure care. Six of the participants were male and two were female. Findings Four super-ordinate themes emerged from the data: “Living amongst adversity”; “Managing adverse experiences”; “Making sense of going into secure care”; and “Coping with the past in the present”. All participants referred to multiple adverse experiences throughout their lives and used harmful coping strategies to manage these. Individual differences in how they related their past experiences to their detention in secure care were evident. Practical implications Author guidelines state that this section is optional. Implications for clinical practice are discussed at length in the discussion section. Originality/value This study offers an insight into the way in which forensic mental health service users make sense of their past traumas in relation to their current admission to secure services. To the best of the authors’ knowledge, no research has previously addressed this from the perspective of service users.

Services for Juveniles With Emotional Disturbances in Secure-Care Settings: An Exploratory Analysis of Racial Disparities and Recidivism

This study examines associations between recidivism rates and groups/programs for legally mandated education, behavioral, and mental health services that court-ordered juvenile youth (“juveniles”) with identified Emotional Disturbance or related conditions receive in secure-care juvenile facilities. Using statewide agency data in Minnesota, this exploratory analysis investigates whether there are racial/ethnic and county disparities in residential placements or secure-care settings via programs and groups for court-ordered juveniles ( n = 1,092). The study also considers whether program and group placements contribute to racial/ethnic patterns of recidivism. This study finds that recidivism rate differences by program/group level are largely attributed to differences in racial/ethnic compositions. Findings suggest placements lack strong effects on recidivism, and assignments may perpetuate inequalities. In addition, from this exploratory analysis examination, this article offers considerations for future research-to-practice partnerships to strengthen legally and policy-mandated program and service delivery with practices that increase training to juvenile justice system professionals, access to secure-care setting services, and transition services for juveniles.

Young men and young women in secure care: gender differences in the placement of those with mental health needs

Background The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. Methods The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher’s exact tests. Results Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. Conclusions No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.

“My Whole Family Is Not Really My Family”—Secure Care Shadows on Family and Family Practices Among Young Adults and Their Family Members

This study based in Sweden explores family practices and family displays among young adults with a history of secure care, which limits and restricts contacts and therefore causes fundamental changes in relationships. Almost 10 years after institutional placement, narrations of 11 young adults and 11 nominated family members reveal ongoing struggles between imagined and lived realities of family. These struggles are revealed by memories and emotions evoked by the context of secure care and show how deeply the secure care penetrated their family lives. By using the metaphor of shadows, shadows of recalled horror of secure care (reflecting family displacement) and the pressure to make family work (reflecting restricting practices in secure care where only (birth) family were considered as family and relations of (natural) importance) are discerned. We call for more attention to the perversity of secure care arrangements, at both policy and institutional levels.

A review of patients discharged from Shannon Clinic- are shorter stays in secure hospitals associated with poorer patient outcomes?

AimsShannon Clinic was established as the regional secure unit in Northern Ireland in 2005 and provides medium secure care to Northern Ireland's population of 1.8 million. Previous research has shown that inpatient admissions are shorter when compared to other secure units. Northern Ireland has less secure beds per population than the other UK nations, which can be a driver for shorter hospital stays. This review was undertaken to examine if shorter inpatient stays were associated with poorer outcomes.MethodAll the discharges from Shannon Clinic to the Southern Health and Social Care Trust were reviewed over a period of 10 years (2009-2019). The outcome measures examined were mortality, readmission rate and reoffending rate. Crude rates for these were calculated. To allow for comparison, these rates were compared to the systematic review findings of Fazel et al (2016), which was an international review examining patient outcomes following discharge from secure hospitals.DUNDRUM 1 Triage Security scores for the patient group were also reviewed, to ensure a sample representative of patients needing medium secure care.Result41 patients had been discharged during this period. DUNDRUM 1 Triage Security scores ranged from 2.44 to 3.2.The average length of admission was 415.5 days. This is shorter than the average reported by Fazel et al (2016).The crude rates for all of the variables calculated (mortality, readmission to hospital and reoffending) for patients discharged from Shannon to the trust were less of those reported in the systematic review by Fazel et al (2016).ConclusionThis review suggests that patient outcomes are not negatively impacted by shorter inpatient stays in secure hospitals. A possible reason for this is the regional model of care approach, which helps ensure continuity and safe management of the transition between secure care and the community. In addition, there is close multidisciplinary working with supported living providers in the trust area to ensure patients' needs are met.Following this initial review, there are now plans to review discharge outcomes for all patients discharged during this period. There are five trust areas in total in Northern Ireland so this will allow for comparison across the region.The review has also been used within the unit to develop information leaflets for patients at admission and posters for display in the unit. We hope this will provide clarity to patients about secure care and a sense of optimism from the start of their admission.

Ensuring Failure?

Historically, the regulation of girls through institutionalization has been guided by bourgeois norms of femininity, including virtue, domesticity, and motherhood. Using a Foucauldian perspective on the production of subjects in Swedish secure care, I investigate whether or not middle-class norms of femininity, centered today around self-regulation, still guide the regulation of working-class girls. By analyzing data from an ethnographic study, I show that even though secure care is repressive, it is also permeated with the aim of producing self-regulating subjects corresponding with discourses on ideal girlhood. However, since working-class girls are rarely made intelligible within such discourses, thereby making the position of self-regulatory subject inaccessible, the care system leaves them to shoulder the responsibility for resolving a situation that is shaped by structures beyond their control.

Young Men and Young Women in Secure Care: Gender Differences in the Placement of Those With Mental Health Needs

Background The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems.MethodsThe detained census population of English young people was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher’s exact tests. To control for Type 1 errors, the False Discovery rate approach was used. SPSS (V25) was used for statistical analysis.Results Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the pattern of young men and women’s secure care placement. This different pattern of placement continued to differ by gender when the nature of the mental health diagnosis was taken into account.Conclusions No definitive explanation is evident for the significantly different, placement patterns of young men and young women with the same, mental health diagnoses but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables out with the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.

Clinical and criminal profile of internet offenders with ASD

Purpose Autism-specific characteristics have been associated with internet criminal activities. Internet and non-internet offenders differ on a series of demographic, psychological and offending variables. However, the clinical and criminal presentation of individuals with autism spectrum disorder (ASD) in forensic secure care settings has been underexplored. This paper aims to explore the profiles of internet offenders with ASD admitted to a secure psychiatric unit. Design/methodology/approach This study provides the results of a service evaluation of individuals with ASD. The demographic, clinical and criminal characteristics of a small sample of internet offenders with ASD admitted to secure care are described and discussed. Findings Internet offenders present in secure care with high rates of comorbid disorders, histories of violence and traumatic experiences, mood disorders and difficulties with relationships. Of the 24 internet offenders discussed, 18 of them committed an offence of a sexual nature involving children. Originality/value This paper highlights the potential risks for individuals with ASD in using the internet and the possible difficulties associated with detecting this because of rapid advancements in technology.

Assessing the risk of self-harm: the impact of safety interventions on the predictive validity of risk assessment in secure care

Purpose Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention. Design/methodology/approach Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database. Findings START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without. Practical implications The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm. Originality/value To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.