Gwen Adshead

Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This article presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital.

Violence and gun crime

Protecting children and reducing social exclusion are the priorities

Why are doctors ambivalent about patients who misuse alcohol

Alcohol misuse is common, with 4% of adults being dependent.1 Doctors have a duty not only to those patients but also to the wider community. Such patients may bring harm to others while driving a vehicle or while employed in a variety of occupations. There are clear guidelines on the actions medical practitioners should take with respect to such patients who drive motor vehicles,1 2 3 but the advice with respect to patients in potentially dangerous occupations is less specific.4nnA 57 year old man with malaise was referred to the outpatient department. He was late for his appointment as he had crashed his car in the hospital car park. He had stigmata of chronic liver disease and was anaemic. He was admitted the following …

Offending in theatre: the case of Ian Paterson

What is the psychology and motivation for doctors who do wrong?

The origins of the Prozac nation

This cultural history of pill popping will make doctors think twice before writing their next prescription for antidepressants, thinks Gwen Adshead

Men behaving madly

An elegant study of the “genderisation” of hysteria prompts Gwen Adshead to ask which of today’s psychiatric disorders will be shown by some future historian to be just as socially constructed

“You are bipolar, and I claim my £5”

One of the first things trainee psychiatrists learn is that you cannot make a diagnosis just by observing behaviour. Gwen Adshead takes the BBC to task for attempting such diagnoses on camera

Whose secret is it anyway

Why is there a duty to keep confidences? Most commentators claim that if doctors did not have such a duty, patients would not trust their doctors with clinically relevant material, and this would have bad consequences. There is nothing about the duty of confidentiality which implies absolute secrecy; it is a commitment to treating the patients information with respect. Privacy might be a better word than confidentiality, so that patients are protected from gossip (usually by health care professionals).nnConfidentiality is not an absolute principle, as the established exemptions make clear. Harm to others …