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Characteristics of patients exhibiting severe challenging behaviour in low secure mental health and mild learning disabilities units

Published online by Cambridge University Press:  15 September 2005

Dominic Beer ,
Vicky Turk ,
Phyl McGovern ,
Shaun M Gravestock ,
David Brooks ,
Louisa Barnett  and
David Orr
Dominic Beer
Affiliation:
Honorary Senior Lecturer, Guy's, King's, St. Thomas' & Institute of Psychiatry
Vicky Turk
Affiliation:
Consultant Clinical Psychologist in Learning Disabilities
Phyl McGovern
Affiliation:
Specialist Clinical Audit Co-ordinator, Bracton Centre
Shaun M Gravestock
Affiliation:
Consultant Psychiatrist, Oxleas NHS Trust/Honorary Senior Lecturer in Learning Disabilities, University of London
David Brooks
Affiliation:
Consultant Psychiatrist in Learning Disabilities, South London & Maudsley NHS Trust
Louisa Barnett
Affiliation:
Assistant Psychologist
David Orr
Affiliation:
Assistant Psychologist, Oxleas NHS Trust, Kent, UK

Abstract

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Aims: (1) To ascertain characteristics of patients in low secure units; (2) To examine whether standard 5 of the National Service Frameworks was being followed; (3) To investigate reasons for any delays in discharge and how these could be addressed.

Method: Audit survey of National Service Frameworks for Mental Health standard 5 patients being treated in least restrictive environment as close to their home as possible by case notes, interviews with ward manager and questionnaires.

Results: Patients in mental health units had greater numbers of admissions to hospital than those from learning disabilities units. They had more contact with the criminal justice system and had spent time in prison. The main diagnosis was schizophrenia.

Patients in learning disabilities units were more likely to be Black Caribbean or African and to have had special needs at school. They exhibited current higher risk to others and to self, by deliberate and non-deliberate self-harm. They had diagnoses of mild learning disabilities and autism. About a third of both groups of patients were assessed as being able to move to a lower level of security. The most suitable facility for these patients was an open unit in the community staffed by nurses.

Conclusion: For a third of the patients standard 5 of the National Service Frameworks was not met because they were not ‘in the least restrictive environment’. Open community facilities staffed by nurses over 24 hours was the most appropriate unit for a majority of these patients.

Keywords

Challenging behaviournational service frameworks for mental healthlow secure mental health unitslow secure mild learning disabilities units
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 1 , September 2005 , pp. 29 - 35
Copyright
© 2005 NAPICU

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