Outcomes from the National High Secure Learning Disability Service: findings and challenges
| Pages | 116-123 |
| Date | 05 May 2015 |
| Published date | 05 May 2015 |
| DOI | https://doi.org/10.1108/AMHID-06-2014-0023 |
| Author | Catrin Morrissey,Ben Hobson,Emma Faulkner,Tamsin James |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Outcomes from the National High
Secure Learning Disability Service:
findings and challenges
Catrin Morrissey, Ben Hobson, Emma Faulkner and Tamsin James
Dr Catrin Morrissey is Lead
Psychologist at National High
Secure Learning Disability
Service, Rampton Hospital,
Retford, Nottingham, UK.
Dr Ben Hobson, Emma
Faulkner and Tamsin James
are based at National High
Secure Learning Disability
Service, Rampton Hospital,
Retford, Nottingham, UK.
Abstract
Purpose –The “outcomes revolution”in healthcare has yet to impact strongly on secure intellectual disability
(ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for
this population, and to explore some of the challenges of conducting such research. It further describes some
illustrative routine outcome data from the National High Secure Learning Disability Service.
Design/methodology/approach –Routinely collected outcome measures (length of stay; violent incidents;
Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed
for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013.
Findings –The median length of stay of those discharged during the study period (n ¼27) was around
9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual
return to high security. There did not appear to be a treatment effect over two to three years using staff-rated
global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced
significantly over a longer period of four years in treatment.
Research limitations/implications –There are identified challenges to research design and outcome
measurement which need to be addressed in any future cross-service studies.
Originality/value –There are relatively few published outcome studies from forensic ID services. None of the
studies have used clinical measures of changes or patient-rated outcome measures.
Keywords Intellectual disability, Forensic, Hospital, Outcome, Learning disability, High secure
Paper type Research paper
Introduction
Service-level outcomes are defined as the effect of services on patients, as opposed to their
process or outputs (Richardson and Cotton, 2011). At the time of writing, the “outcomes
movement”in the National Health Service (Department of Health, 2013) has not yet impacted
particularly strongly in secure forensic ID services. There are currently no core agreed common
outcome measures with which to evaluate the impact of services, although the Royal College
of Psychiatrists (2013), Faculty of Psychiatry of Intellectual Disability has recently recommended
a minimum data set of variables is collected across secure services in the three key areas of
effectiveness, patient experience and safety. A review by Alexander et al. (2011) identified only
eight UK studies which related specifically to service-level outcomes at the point of discharge
(short term) or follow up (long term), from forensic intellectual disability (ID) services. Of these two
were from high-secure services, four from medium-secure services and two from low-secure
services. The most common outcome measures employed in these studies were duration of
stay, direction of care pathway, re-admission to hospital, institutional aggression, reoffending
(or offence-like behaviour) or reconviction. At the time of the Alexander et al. review there were no
published service-level outcome studies using patient-based outcome measures, such as
Received 19 June 2014
Revised 5 February 2015
Accepted 2 March 2015
The opinions expressed in this
article are those of the authors,
and do not necessarily reflect
those of affiliated institutions.
PAGE116
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 9 NO. 3 2015, pp.116-123, © Emerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-06-2014-0023
To continue reading
Request your trial