Addressing substance misuse in medium secure settings in the UK and Ireland – a survey of current practice
| DOI | https://doi.org/10.1108/JFP-01-2015-0006 |
| Date | 10 August 2015 |
| Pages | 192-203 |
| Published date | 10 August 2015 |
| Author | Jeremy Sandbrook,Tom Clark,Karen Amanda Cocksedge |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Addressing substance misuse in medium
secure settings in the UK and Ireland –a
survey of current practice
Jeremy Sandbrook, Tom Clark and Karen Amanda Cocksedge
Dr Jeremy Sandbrook is
based at General Adult and
Community Forensic
Psychiatry, Cornwall
Partnership NHS Foundation
Trust, Cornwall, UK.
Dr Tom Clark is Consultant
Forensic Psychiatrist and
Honorary Senior Clinical
Lecturer in Forensic
Psychiatry, Birmingham and
Solihull Mental Health NHS
Trust, Birmingham, UK.
Dr Karen Amanda Cocksedge
is a Core Trainee CT2
at Department of Psychiatry,
Cornwall Partnership NHS
Foundation Trust,
Cornwall, UK.
Abstract
Purpose –Rates of co-morbid substance misuse are high within forensic populations. Addressing these
problems should be a priority as mental disorder with co-morbid substance misuse is associated with worse
outcomes, including rates of re-offending and violence recidivism. A study undertaken in 2006 by the Royal
College of Psychiatrists’Research and Training Unit concluded that the provision of substance misuse treatments
in medium-secure units (MSUs) at that time was inadequate. The purpose of this paper is to investigate how
services may have developed since then to inform discussion over future development and best practice.
Design/methodology/approach –A postal survey, supported by the Quality Network for Forensic Mental
Health Services, was sent to 62 MSUs across the UK and Ireland. This questioned prevalence, interventions
and staff training in substance misuse.
Findings –In total, 41 units responded (66 per cent). The data suggest rates of substance misuse within
MSUs have reduced and provision of treatment has increased in recent years. The majority of MSUs provide
a variety of interventions to address substance misuse and are internally resourced, in tune with current
national guidance. However, the data suggest many MSU staff are not receiving adequate training in
substance misuse treatments and some MSUs do not appear to have a cohesive strategy that would be
consistent with best practice.
Practical implications –This study provides an up-to-date overview of the provision of treatment for
substance misuse within MSUs.
Originality/value –There is no other source for this information, which will provide an invaluable reference
point for services seeking to develop or improve their clinical services.
Keywords Dual diagnosis, Co-morbidity, Substance misuse, Interventions, Forensic training,
Medium security
Paper type Research paper
Introduction
People with serious and enduring mental health problems have higher rates of co-morbid
problematic substance misuse compared with the general population (Regier et al., 1990;
Department of Health, 2002). Studies of forensic patients in the UK show that rates of substance
misuse are higher still within this population (Scott et al., 2004; Derry, 2008; De Burca et al.,
2013). Rates of problematic substance misuse amongst patients admitted to forensic units are
typically between 50 and 90 per cent (Oddie and Davies, 2009). Ongoing misuse of substances
following admission has also been shown to be a common problem within forensic units (Whyte
and Harrison, 2004; Durand et al., 2006).
There are several reasons why addressing these problems should be a priority for secure
services. Mental disorder with co-morbid substance misuse is associated with poorer outcomes
Received 27 January 2015
Revised 11 March 2015
Accepted 11 March 2015
The authors would like to thank
Sarah Tucker, Sarah Stubbs and
colleagues at the Royal College of
Psychiatrists Quality Network for
Forensic Mental Health for their
assistance with this project.
PAGE192
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 17 NO. 3 2015, pp. 192-203, © Emerald Group Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-01-2015-0006
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