A new study has highlighted the challenges surrounding the readmission of patients from medium-secure psychiatric services. The research, conducted over an 18-year period in Wales, found that nearly one-third of patients discharged from medium-secure care were readmitted within two years, with a significant number recalled due to breaches in discharge conditions. The findings, published in the journal Criminal Behaviour and Mental Health, suggest the need for further examination of how patients are monitored and supported after discharge to prevent relapses that lead to readmission.
The study, based on the records of 137 patients discharged from a medium-secure hospital in South Wales between 1999 and 2017, found that 31% were readmitted within two years. Many of these patients had breached legal conditions set at discharge, indicating the complex nature of mental health recovery for those who have spent time in secure care.
Most readmissions involved a return to medium-secure settings, with 67% of readmitted patients going back to the same level of care. This suggests that patients discharged from medium-secure hospitals often struggle with reintegration into lower-security settings or the community.
The study’s findings raise concerns about the support provided to patients after their release from secure environments. Factors such as the severity of the initial offence, childhood experiences, and previous drug misuse were all associated with a higher likelihood of readmission. However, inpatient progress during their time in hospital, measured through the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) scales, showed little relationship with whether patients were readmitted.
This discovery calls into question the effectiveness of some current approaches to patient discharge and post-discharge care. The DUNDRUM scales, used to assess treatment progress, did not independently predict the likelihood of readmission, highlighting the need for further research into external factors that influence patient outcomes once they leave secure care.
The report suggests that readmission may not always indicate failure but could reflect an essential response to the fluctuating needs of patients with severe mental disorders. Still, with significant NHS resources invested in medium-secure services, the study underscores the importance of improving post-discharge support to ensure long-term recovery and reduce the need for re-hospitalisation.
Forensic mental health services in the UK are costly, with medium-secure units alone consuming around 10% of the total NHS mental health budget. Each bed costs over £175,000 annually, making the prevention of readmission not just a clinical priority but an economic one as well.
The research emphasises that the transition from medium-secure care to lower levels of security or community living is fraught with difficulties. It is clear that additional focus on the discharge environment and community care provisions is necessary to support patient recovery effectively.
