An investigation of patients admitted to Medium Secure Psychiatric Care over a 30 year period: Examining contemporary admission characteristics, reconviction, mortality and readmission outcomes.

AimsThe aim of this thesis is to add to the knowledge base surrounding the admission characteristics and outcomes of patients admitted to Medium Secure Psychiatric Care. Outcomes of focus include reconviction following discharge, mortality and readmission to psychiatric care.MethodThe background characteristics of a contemporary cohort of patients admitted to Arnold Lodge Medium Secure Unit between July 1, 2003 and June 30, 2013 were obtained from medical records at Arnold Lodge. External data sources were used to obtain outcome data for this contemporary cohort and a cohort of patients admitted between July 1983 and June 30, 2013. The external sources used were the Police National Computer for reconviction data from the Ministry of Justice, Hospital Episode Statistics from NHS Digital to examine readmission outcomes and mortality data from the Office for National Statistics. This project obtained Section 251 support to permit the processing of confidential patient information without consent.ResultsThe contemporary cohort of patients admitted to the unit between July 1, 2003 and June 30, 2013 (n = 314) presented with high levels of criminality and complex mental health needs. Prior to the census date of June 30, 2013, 909 patients were admitted to Arnold Lodge. The average length of follow-up for this 30-year admissions cohort was 13.3 years. Findings indicated that 135 patients had died (14.9%), 61.5% of whom (n = 83) had died from natural causes: 369 patients (43.8%) were reconvicted. Having a higher number of previous convictions and being younger when admitted to Arnold Lodge predicted reconviction following discharge. Five hundred and ten patients (60.1%) were readmitted to a psychiatric hospital at some point during the follow-up period.ConclusionPatients discharged from medium secure psychiatric care are at long-term risk of experiencing adverse outcomes. As such, they require ongoing support.</div

Long-term outcomes after discharge from medium secure care: still a cause for concern?

People admitted to medium secure psychiatric care are recognised to still be at risk of experiencing adverse outcomes upon discharge. However, little is known about the outcomes of patients admitted more recently to medium secure care or the long-term outcomes of people many years after discharge. The aim of this study was to assess the mortality, conviction and readmission outcomes of a cohort of first admissions discharged from an English medium secure psy-chiatric unit between July 1983 and June 2013. Data on background character-istics were obtained from medical records. Outcome data were obtained from multiple sources for 843 patients discharged prior to the census date of 30 June 2013. The risk of death from both natural and unnatural causes was much higher than that of the general population. Of those patients that were discharged, 369 patients (43.8%) were convicted of an offence during the follow-up period, two-thirds of which were convicted within the first 5 years following discharge. Five hundred and ten patients (61.6%) were readmitted to psychiatric care. Patients discharged from medium secure care are at long-term risk of experiencing premature death, conviction and readmission to secure and non-secure psychiatric care.</p