Description and evaluation of a novel service for “difficult to manage” psychiatric in-patients
| Pages | 69-78 |
| Date | 09 February 2015 |
| Published date | 09 February 2015 |
| DOI | https://doi.org/10.1108/JFP-05-2013-0036 |
| Author | Adrian J. Hayes,Daniel Pratt,Jenny Shaw |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Description and evaluation of a novel
service for “difficult to manage”
psychiatric in-patients
Adrian J. Hayes, Daniel Pratt and Jenny Shaw
Dr Adrian J. Hayes is an
Academic Clinical Fellow,
based at the University of
Oxford, Oxford, UK and Oxford
Health NHS Foundation Trust,
Oxford, UK.
Dr Daniel Pratt is a Lecturer in
Clinical Psychology, based at
School of Psychological
Sciences, University of
Manchester, Manchester, UK.
Jenny Shaw is a Professor,
based at Centre for Mental
Health and Risk, University of
Manchester, Manchester, UK.
Abstract
Purpose – A new service was developed to provide transitional care between acute and secure services for
people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is
to evaluate the work of the service by examining referrals made, strategies employed for each referral, and
patient outcomes, as well as investigating issues in the service’s development and implementation.
Design/methodology/approach – A retrospective descriptive study by review of 38 case notes, and
qualitative interviews of 47 staff within the service and those referring to the service.
Findings – In the first eight months, 38 patients were referred due to violence, aggression and
management problems. Most interventions provided by the service involved working with referring staff,
rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security.
Interviews showed the team’s aims needed to be more clearly established, but that ward staff found the
service to be a useful and productive resource.
Research limitations/implications – The study is descriptive and retrospective, but showed that the
service provided appropriate interventions for managing patients with serious mental illness and challenging
behaviour.
Practical implications – A transitional service may have value in keeping patients in the least restrictive
setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective
management.
Originality/value – The service under study was novel, and may be useful in facilitating successful transfer
from, or preventing admission to, secure services.
Keywords Challenging behaviour, Health service configuration, Liaison, Secure services,
Psychiatric in-patients, Difficult to manage
Paper type Research paper
Introduction
Admissions to forensic mental health units have been rising over recent years in England
and Wales (Rutherford and Duggan, 2007). Admissions can be either as a transfer from prison,
as an alternative to prison or directly from the community. While there has been a great deal of
research into the process by which patients are referred and admitted from prison and courts,
relatively little has focused on those admitted from general psychiatric services. This is an
interesting group of patients who may exhibit aggressive or violent behaviours during
admission, and who staff in general psychiatry find difficult to manage. Some authors have
suggested that the increase in admissions seen across Europe is due in part to rising numbers
of “difficult” as opposed to “dangerous” patients (Schanda et al., 2009), with staff in general
psychiatric units unable or unwilling to manage patients with challenging behaviour.
Aggression and violence are common in general psychiatric hospitals though this is
predominantly limited to verbal aggression (Cornaggia et al., 2011), and violence has been
Thanks to Greg Taylor for data
collection on this project.
DOI 10.1108/JFP-05-2013-0036 VOL. 17 NO. 1 2015, pp. 69-78, CEmerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAGE 69
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