Annie Bartlett1, Nadia Somers1, Matthew Fiander1, Mari Anne Harty1. 1. Annie Bartlett, MRCPsych, PhD, Nadia Somers, MSc, Matthew Fiander, PhD, Department of Population, Health Sciences and Education, St George's, University of London, London; Mari Anne Harty, FRCPsych, PhD, Shaftesbury Clinic, Springfield University Hospital, London, UK.
Abstract
BACKGROUND: Care pathways for women needing expensive, secure hospital care are poorly understood. AIMS: To characterise women in low and medium security hospitals in England and Wales and to compare populations by security and service provider type. METHOD: Census data from all specialist commissioning areas. Sociodemographic, clinical, medico-legal, criminological and placement needs data were requested on all women in low and medium secure hospital beds. Parametric tests were used for continuous data and chi-square or Fisher's exact tests for categorical data. Thematic analysis was used for free text data. RESULTS: The independent sector is the main service provider. A third of all women (n = 1149) were placed outside their home region despite spare local National Health Service (NHS) capacity. The independent sector provides for women with relatively rare disorders, including intellectual disability. The NHS admits most serious offenders. One in 20 are detained because of self-harm alone. CONCLUSIONS: Patient-specific factors (notably the diagnosis of personality disorder) and organisational inadequacy (commissioner and service provider) contribute to placements that compromise rehabilitation. Responses should include local solutions for women whose main risk is self-harm and a national approach to women with highly specialist needs. Royal College of Psychiatrists.
BACKGROUND: Care pathways for women needing expensive, secure hospital care are poorly understood. AIMS: To characterise women in low and medium security hospitals in England and Wales and to compare populations by security and service provider type. METHOD: Census data from all specialist commissioning areas. Sociodemographic, clinical, medico-legal, criminological and placement needs data were requested on all women in low and medium secure hospital beds. Parametric tests were used for continuous data and chi-square or Fisher's exact tests for categorical data. Thematic analysis was used for free text data. RESULTS: The independent sector is the main service provider. A third of all women (n = 1149) were placed outside their home region despite spare local National Health Service (NHS) capacity. The independent sector provides for women with relatively rare disorders, including intellectual disability. The NHS admits most serious offenders. One in 20 are detained because of self-harm alone. CONCLUSIONS:Patient-specific factors (notably the diagnosis of personality disorder) and organisational inadequacy (commissioner and service provider) contribute to placements that compromise rehabilitation. Responses should include local solutions for women whose main risk is self-harm and a national approach to women with highly specialist needs. Royal College of Psychiatrists.