An exploration of MDT views on key factors to consider when determining a service users required level of security
| Pages | 38-49 |
| DOI | https://doi.org/10.1108/JFP-10-2018-0039 |
| Published date | 31 January 2019 |
| Date | 31 January 2019 |
| Author | Zulaikha Khan,Arun Chidambaram,Michaela Thomson,Courtney Hurst |
| Subject Matter | Health & social care |
An exploration of MDT views on key
factors to consider when determining a
service users required level of security
Zulaikha Khan, Arun Chidambaram, Michaela Thomson and Courtney Hurst
Abstract
Purpose –The purpose of this paper is to identify what key factors multi-disciplinary teams (MDT) deem as
most important when making the decision to move service users from one level of security (including low,
medium and high secure services) to another. The researchers used the findings from this study to further
develop a tool; the assessment for level of security tool (ALS), which aims to structure and streamline this
decision-making process.
Design/methodology/approach –Data from 18 interviews (MDT staff) were analysed using the Delphi
technique (Dalkey and Helmer, 1963). This revealed a range of factors discussed when considering service
users moves. Participants were asked to rate these factors in accordance with the Delphi which resulted in
the removal of certain less important factors based on their scores. The researchers then compared these
factors of relevance with a checklist of 16 items previously proposed by a consultant psychiatrist within the
trust. This comparison allowed the researchers to highlight any similarities and differences present.
Findings –Findings from staff interviews revealed a range of 20 clinical factors perceived as essential to this
process including procedural, relational and physical security aspects. However, variations were evident
between the MDT priorities (20 items) and the originally proposed list. This emphasised the need for a tool
which facilitates a holistic and streamlined approach.
Practical implications –The findings from this research have resulted in the development of the ALS tool
comprising of 18 key factors.
Originality/value –It is envisaged the development of the ALS tool will not only facilitate and structure the
decision-making process but also ensure a person-centred approach. This is because the ALS allows for a
holistic approach based on an array of factors deemed important to that particular service user. Furthermore,
the ALS tool contributes towards the paucity of published structured professional judgement tools needed to
make such decisions.
Keywords Risk, Mental health, Learning disability, Forensic, Inpatient, Transfers, Multi-disciplinary team
Paper type Research paper
Literature review
Secure psychiatric inpatient facilities within the UK operate within three levels of security, low,
medium and high, under which individuals are detained. This is based on individual security
needs and risk profiles (Crichton et al., 2004) whilst holding only the necessary restriction needed
for safe and effective treatment (Davoren et al., 2015). Security levels, however, are not rigidly
defined and currently there is no succinct definition to differentiate between them. Instead, levels
are identified and characterised according to three key domains; relational security (i.e.
staff–patient ratios/positive and safe relationships), procedural security (i.e. policies/procedure
for controlling risk) and physical security (i.e. design, operation and maintenance of fittings) (DoH,
1992, 1994; Tilt et al., 2000; Kennedy, 2002).
The critical decision of whether an individual is rightly detained or requires transfer to a
different security level as a result of changes in security needs is a decision that falls to the
multi-disciplinary team (MDT) (Freestone et al., 2015). MDT’s have the fundamental responsibility
Received 15 October 2018
Revised 2 January 2019
Accepted 9 January 2019
Zulaikha Khan is based at
GM Specialist Support Team,
Mersey Care NHS Foundation
Trust, Liverpool, UK.
Arun Chidambaram is based at
Forensic Psychiatry Service,
Mersey Care NHS Foundation
Trust, Liverpool, UK.
Michaela Thomson is based at
Research and Development
Department, Mersey Care NHS
Foundation Trust,
Liverpool, UK.
Courtney Hurst is based at
GM Specialist Support Team,
Mersey Care NHS Foundation
Trust, Liverpool, UK.
PAG E 38
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 21 NO. 1 2019, pp. 38-49, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-10-2018-0039
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