Sharon Riordan

Possible Predictors of Outcome for Conditionally Discharged Patients – A Preliminary Study:

Conditional discharge for restricted hospital order patients is by and large a successful process. The present study aimed to identify variables among a cohort of conditionally discharged patients in the West Midlands that would predict whether an individual was more likely to be readmitted to hospital, involved in a serious incident, to be recalled to hospital or given an absolute discharge. A retrospective case note analysis was undertaken. Logistic regression analysis was used to identify variables that could predict outcome. Patients were six times more likely to be readmitted to hospital if they misused drugs and nine times more likely if they self-harmed. They were also six and four times more likely to be involved in a serious incident if they misused alcohol and drugs respectively. Patients were five times more likely to be recalled to hospital if they did not have close social support and were four and a half times more likely to get an absolute discharge if they lived in supported accommodation. Conditional discharge is an effective model of community care for restricted hospital order patients. Addressing the problems caused by drug and alcohol misuse, self-harming behaviour, recognising the importance of a close social support network and developing more appropriate housing for these individuals will help make the process more successful.

Conditionally discharged restricted patients and the need for long-term medium security

In the context of a larger investigation of follow-up of a specific group of mentally disordered individuals, the study described here examined the characteristics of all 55 people conditionally discharged for the first time from a medium secure unit in the West Midlands over a 13-year period. A retrospective case note analysis was undertaken. The findings illustrate that these patients are a distinct group. They were mainly single men who had committed a grave offence. The majority had an extensive criminological history with early onset of offending and chronic mental illness. Fifty per cent of those with a criminal record had received at least one custodial sentence prior to the index offence. Co-morbid substance misuse was common, as was a history of self-harm. There were high levels of previous contact with psychiatric services and compulsory in-patient treatment. Most were detained under the Mental Health Act category of mental illness. A quarter had been transferred from a special hospital prior to conditional discharge into the community. The characteristics of this sample demonstrate clearly the need for the provision of long-term medium secure facilities and allied services.

Conditional discharge: the role of the social supervisor ‐ a preliminary study

The process of statutory community aftercare for restricted hospital order service users is acknowledged as successful. Previous research examining the attitudes of forensic psychiatrists to the use of restriction orders has indicated that they view them as a useful clinical tool in some circumstances, particularly where there is evidence of previous breakdown of follow‐up. This study, as part of a larger project examining the effectiveness of statutory community aftercare, focused on the attitudes of social supervisors to the process of conditional discharge and their role within it. The findings showed that social supervisors agree that there are positive and negative aspects to the process. They overwhelmingly agreed that the legal framework ensured that service users continued engagement with psychiatric services, leading to enhanced compliance with treatment and follow‐up, but recognised that, at times, the role, because of its control aspect, created tension in the social worker‐service user relationship. Social supervisors suggested that investment should be made into providing appropriate accommodation for this group of people and, where appropriate, access to drug and alcohol misuse services.

Multiple contacts with diversion at the point of arrest

A diversion at the point of arrest (DAPA) scheme was set up in five police stations in South Birmingham in 1992. In a study of all referrals made over a four-year period a sub group of multiple contact individuals was identified. During that time four hundred and ninety-two contacts were recorded in total, of which 130 were made by 58 individuals. The latter group was generally no different from the single contact group but did have a tendency to be younger. This research highlights the need for a re-evaluation of service provision and associated education of police officers and relevant mental health care professionals.

MAPPA and detained patients: views from professionals about referral

Recent research indicates a positive correlation between Multi-Agency Public Protection Arrangements (MAPPA) and reduction in reoffending. Multi-Agency Public Protection Arrangements were introduced in 2001 to assist with the supervision of dangerous offenders by improving collaboration between agencies involved in their management. Since then there has been research into the value of MAPPA, but this has focused on offenders in the community. Many patients detained in psychiatric hospitals have committed MAPPA eligible offences and current Government guidance does not assist those concerned in the care and treatment of this small but significant group. In this pilot study this quantitative research looks at the views of professionals in relation to MAPPA and identified that a revision of the National MAPPA Guidance to take account of the specific issues for offender-patients would be helpful to staff who manage them and that additional training to those staff may also be of benefit.

Diversion of Mentally Disordered Offenders ‐ to what and when?

Provision of comprehensive diversion services for the mentally disordered who come into conflict with the law offers benefits for patients and all those involved in the process, including the police, crown prosecution service and other agencies. It gives access to the most appropriate disposal for this vulnerable group. This case study of a man who had multiple contacts with the diversion services in Birmingham illustrates the particular difficulties associated with diversion from custody for mentally disordered individuals, particularly where there are multiple problem areas. Examination of the case suggests that in spite of inter‐agency commitment to the philosophy of diversion, in some instances a period spent in custody is unavoidable.

Forensic learning disability nursing: what's it really like?

Purpose – The purpose of this paper is to explore the lived experiences of learning disability nurses working within forensic services, and their views on their practice as a speciality. Design/methodology/approach – A qualitative, semi-structured interview-based design was used and participants voices were examined through interpretive phenomenological analysis. Findings – Nurses explored a range of topics related to their practice and overall, five superordinate themes were developed. Forensic nursing as being both the same and different to generic nursing, the journey, and the emotional challenge of forensic nursing, the balancing act of everyday practice and the role of language within forensic nursing practice. Originality/value – Very little research has examined the views of learning disability nurses within the forensic field. This study gives both a voice to these nurses and suggests areas of interest both for research and for clinicians to consider in their practice.