Pillay Selena M, Oliver Brid, Butler Louise, Kennedy Harry G
University of Dublin,Trinity College,Central Mental Hospital,Dundrum,Dublin 14,Ireland.
Central Mental Hospital,Dundrum,Dublin 14,Ireland.
Ir J Psychol Med. 2008 Dec;25(4):123-127. doi: 10.1017/S0790966700011228.
It was hypothesised that patients admitted to forensic mental health facilities are stratified along the pathway through care according to levels of need. Level of risk and psychopathology should vary with different levels of security.
Seventy-five men in a forensic hospital were interviewed by three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) - clinical and risk items, The Health of the Nation Scales - Secure (HoNOS-SECURE), PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version).
The mean scores on a variety of clinical measures were higher in admission/high security areas and progressively lower in rehabilitation and pre-discharge areas. As patients moved through the pathways of care, they improved in a number of areas including psychiatric morbidity, risk, function, unmet needs. The following results stratified significantly; the HCR-20 summated clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet needs on the CANFOR.
The data indicate that the theoretical organisation of the units of the hospital into high, medium and low security units to form a coherent pathway through care is reflected in practice. This is a transparent route out of secure care in which restrictions are proportionate to risk and supports proportionate to need. It is unclear whether alternative models, consisting of a series of generic unstratified units for admission and discharge, all at the same level of therapeutic security, allow for the provision of treatment programmes and relational interventions appropriate to the patient's stage of recovery and rehabilitation.
研究假设为，入住法医精神卫生机构的患者会根据需求水平在护理路径上分层。风险水平和精神病理学特征应随安全级别不同而变化。
三名经过培训的临床医生使用HCR - 20（历史临床风险评估）——临床和风险项目、国民健康量表——安全版（HoNOS - SECURE）、阳性与阴性症状量表（PANSS）、功能总体评定量表（GAF）以及坎伯韦尔需求评估法医版（CANFOR），对一家法医医院的75名男性患者进行了访谈。
在入院/高安全区域，各项临床指标的平均得分较高，而在康复和出院前区域则逐渐降低。随着患者在护理路径上的进展，他们在多个方面有所改善，包括精神疾病发病率、风险、功能、未满足的需求。以下结果有显著分层：HCR - 20临床和风险总分（F = 9.2，自由度 = 5，p < 0.001）、HoNOS安全版（F = 18.2，自由度 = 5，p < 0.001）、PANSS（阳性、一般和总分）、GAF、CANFOR上工作人员和患者未满足的需求。
数据表明，医院将病房分为高、中、低安全级别病房以形成连贯护理路径的理论架构在实践中得到了体现。这是一条从安全护理中出院的透明途径，其中限制与风险相称，支持与需求相称。尚不清楚由一系列通用的、未分层的入院和出院病房组成的替代模式，所有病房处于相同的治疗安全级别，是否能提供适合患者康复和恢复阶段的治疗方案及关系干预措施。
