Leonard Sarah, Webb Roger T, Doyle Michael, Shaw Jennifer
Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom.
Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, United Kingdom.
Front Psychiatry. 2022 Jun 29;13:881279. doi: 10.3389/fpsyt.2022.881279. eCollection 2022.
Little is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS "prison-transfer" patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too "high risk" to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community.
(a) To describe the characteristics of prison-transfers who receive an RMO directed discharge from MSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge.
Prospective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk--20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community.
Persons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending.
MSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered.
对于从监狱转入中等安全级服务机构（MSSs）的人员，我们了解甚少，包括影响临床路径及后续出院的特征和因素。我们最近发表了第一项研究，以确定MSSs“监狱转来”患者被送回监狱的情况。特别令人担忧的是，发现四分之一的监狱转来患者被负责的医务人员（RMOs）送回监狱，原因是他们不配合治疗或被认为风险过高而无法继续留在该服务机构，而在考虑通过社区护理途径出院时，这些情况是不可接受的。进一步探究从监狱转入MSSs的人员特征，并调查与出院到社区的人员相比，那些被送回监狱的人员在这些特征上可能存在哪些差异，这很重要。
（a）描述从MSSs获得RMO指导出院的监狱转来人员的特征；（b）按出院目的地（监狱返回和社区出院）比较这些特征。
前瞻性队列比较研究：在6个月期间，从英格兰和威尔士的33个国民保健服务中等安全级单位中，所有在RMO指导下出院的监狱转来患者。通过全面审查患者健康记录提取患者人口统计学、临床和法律特征数据，还从临床医生处获取旁证信息。这些信息用于完成《历史、临床及风险——20项》（HCR - 20v3）和《保护因素结构化评估》（SAPROF）。将被送回监狱的人员与出院到社区的人员进行比较。
与出院到社区的人员相比，被送回监狱的人员在出院时是弱势群体，在MSSs的住院时间明显更短。超过一半被送回监狱的人员住院时间不足6个月。被送回监狱的人员在出院时心理调适方面的问题明显更多，未来暴力风险更高，减轻后续复发和再犯罪风险的保护因素患病率更低。
英格兰和威尔士的MSSs将弱势群体送回监狱，而不是提供足够的后续护理服务。需要重新考虑MSSs在接收监狱转来人员方面的作用和责任。
