Leonard Sarah-Jayne, Sanders Caroline, Shaw Jennifer J
Offender Health Research Network, Centre for Mental Health and Safety, University of Manchester, UK.
NIHR School for Primary Care Research, University of Manchester, UK.
BJPsych Open. 2021 Jun 8;7(4):e111. doi: 10.1192/bjo.2021.928.
Little is known about factors that influence discharge decision-making for people admitted to medium-secure services from prison, particularly for those who are returned to prison following treatment.
To explore the organisational influences on care pathways through medium-secure services for those admitted from prison.
We recruited 24 clinicians via purposive and snowball sampling; 13 shared their experiences via a focus group, and 11 shared their experiences via individual semi-structured interviews. A thematic analysis was conducted, producing three overarching themes: maintenance of throughput and service provision, class of two systems, and desirable and undesirable patients.
Data indicated external factors that direct and, at times, limit clinicians' pathway decisions, including commissioning criteria and legal status under the Mental Health Act 1983 and within the criminal courts system (i.e. whether on remand or sentenced). These factors also influence how clinicians view the role and function of medium-secure services within the wider forensic mental health system, and therefore the types of patients that are deemed 'appropriate' for continued treatment when making discretionary pathway decisions.
There remains a deficit in adequate resources to meet the mental health needs of prisoners who are admitted to medium-secure services. To meet the clinical need of all admissions, criteria for prolonged treatment in medium-secure services needs to be reconsidered, and it is likely that provision for the medium-secure hospital estate will need to increase substantially if effective rehabilitation of those who transfer from prison is to take place.
对于影响从监狱转入中等安全级服务机构人员出院决策的因素，我们知之甚少，尤其是那些接受治疗后返回监狱的人员。
探讨对从监狱转入中等安全级服务机构人员护理路径的组织影响。
我们通过立意抽样和滚雪球抽样招募了24名临床医生；13名通过焦点小组分享了他们的经验，11名通过个人半结构化访谈分享了他们的经验。进行了主题分析，得出三个总体主题：维持吞吐量和服务提供、两种系统类别以及理想和不理想的患者。
数据表明，外部因素指导并有时限制临床医生的路径决策，包括委托标准以及根据1983年《精神健康法》和刑事法院系统内的法律地位（即是否还押或已判刑）。这些因素还影响临床医生如何看待中等安全级服务在更广泛的法医精神卫生系统中的作用和功能，因此在做出自由裁量路径决策时影响被视为“适合”继续治疗的患者类型是什么。
在满足转入中等安全级服务机构囚犯心理健康需求方面，资源仍然不足。为满足所有入院患者的临床需求，需要重新考虑中等安全级服务机构延长治疗的标准，如果要对从监狱转来的人员进行有效康复，中等安全级医院设施的供应可能需要大幅增加。
