An evaluation of night confinement in a high secure hospital
| Date | 22 March 2013 |
| Published date | 22 March 2013 |
| Pages | 21-31 |
| DOI | https://doi.org/10.1108/13619321311306947 |
| Author | Louise G. Braham,Jonathan F. Heasley,Sam Akiens |
| Subject Matter | Health & social care |
An evaluation of night confinement
in a high secure hospital
Louise G. Braham, Jonathan F. Heasley and Sam Akiens
Abstract
Purpose – Night confinement (NC) has been proposed as an appropriate and safe way to make cost
improvements in a high secure NHS hospital. Given potential controversy, evaluating the impact of this
change is vital. This paper aims to focus on the issue.
Design/methodology/approach – The study used a mixed methods design to assess the impact of a
three month night confinement pilot on four high secure admission wards. In total, 158 staff and
42 patients were approached to complete questionnaires and interview prior to and following the pilot.
Questionnaires were analysed using T tests, ANOVA and Mann Whitney-U to asses perceived changes
in ward climate, working environment and quality of life. Thematic and saliency analysis was used
to explore themes arising from semi structured interviews. Hospital data were collected to identify
behavioural changes.
Findings – The study found that NC had no adverse effects and incidents of self harm, other incidents
and seclusion hours dropped by a third during this period. This was contrary to staff expectations.
Research limitations/implications – Limitations include: a large number of researchers involved;
average response rate and a disproportionate number of patients on Tilt restrictions on the pilot wards.
Further evaluation is necessary if NC is to be adopted more widely.
Practical implications – This evaluation suggests that NC can contribute to providing an efficient and
effective secure mental health service.
Originality/value – This study provides a unique opportunity to assess the impact of NC on patients
and is of value to other secure units seeking effective cost improvements.
Keywords Forensic services, Cost improvements, Secure, Health services sector,
National Health Service, Patient care, Hospitals
Paper type Research paper
Introduction
National Health Service (NHS) resources are scarce, and with the Department of Health’s
(DOH) recent plans for ‘‘cost improvements’’ all NHS Trusts have to tighten their belts. This
includes high secure services. In this climate of cost improvements within the NHS (DOH,
2009) night confinement (NC) has been considered as an appropriate and safe way to
manage these practical concerns. However, the proposal to confine detained individuals in
their room over night does not come without criticisms and challenges, and it is imperative
that such patients are offered the opportunity to share their experiences.
Historically,patients in all high securehospitals in the UK were routinely locked in their rooms
between 9 p.m. and 7:30 a.m. The Special Hospital Service Authority responded to
recommendations following the inquiry into complaints at Ashworth Hospital, that the
‘‘degrading and unnecessary practice’’ of ‘ ‘slopping out’’ be abolished, and night staffing
levels be reviewed (HMSO, 1992, p. 146), by ending the practice of NC. This led to the
commencement of provision of en-suite toilet facilities and, in 1995, the adoption of a policy of
24-hour care in the high secure hospitals in England in which patients were no longer locked
DOI 10.1108/13619321311306947 VOL. 18 NO. 1 2013, pp. 21-31, QEmerald Group Publishing Limited, ISSN 1361-9322
j
MENTAL HEALTHREVIEW JOURNAL
j
PAGE 21
Louise G. Braham is Acting
Lead Psychologist,
Jonathan F. Heasley and
Sam Akiens are Assistant
Psychologists, all based at
Mental Health and National
Learning Disability
Directorate, Rampton
Hospital, Retford, UK.
To continue reading
Request your trial