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

Arnold Lodge, East Midlands Centre for Forensic Mental Health, Leicester

Martin Clarke, BSc

Department of Health Sciences, University of Leicester, and Arnold Lodge, East Midlands Centre for Forensic Mental Health, Leicester

Clive Hollin, PhD

Department of Psychology, University of Leicester

Conor Duggan, BSc, PhD, MD, FRCPsych

Division of Forensic Mental Health, University of Nottingham, Arnold Lodge and East Midlands Centre for Forensic Mental Health, Leicester, UK

Correspondence: Professor Conor Duggan, Division of Forensic Mental Health, University of Nottingham, Arnold Lodge, East Midlands Centre for Forensic Mental Health, Cordelia Close, Leicester, LE5 0LE, UK. Email: conor.duggan{at}nottshc.nhs.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

Background There are few long-term follow-up studies of patients discharged from medium secure units in the UK, even though these units were introduced over 20 years ago.

Aims To describe mortality, rates of reconviction at different time periods; violent behaviour (not leading to conviction), readmission and employment, after discharge from a medium secure unit.

Method Of 595 first admissions over a 20-year period, 550 discharged cases were followed-up. Multiple data sources were used.

Results Fifty-seven (10%) patients had died, of whom 18 (32%) died by suicide, and the risk of death was six times greater than in the general population. Almost half (49%) of those discharged were reconvicted and almost two-fifths (38%) of patients were readmitted to secure care.

Conclusions Community psychiatric services need to be aware that those discharged from medium secure care are a highly vulnerable group requiring careful follow-up if excess mortality, high levels of psychiatric morbidity and further offending are to be prevented.

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Highlights of this issue

Sukhwinder S. Shergill
BJP 2007 191: A2. [Full Text]