Forensic-psychiatric services are costly and very restrictive for patients. Clinical experience and the limited research available indicate that some patients stay for too long in these settings. A proportion of patients may, however, require long-term, potentially life-long, secure forensic-psychiatric care but their needs may not be met by existing service provision designed for faster throughput. Here we report the initial findings of a three year study on long-stay patients in forensic care conducted in England.

The overall objective of this project is to improve the quality and cost-efficiency of the care and management of patients who stay for prolonged periods in secure forensic-psychiatric settings.

1. 1. Estimate the number of long-stay patients in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care)

2. 2. Describe their characteristics, needs, care pathways and reasons for prolonged stay

3. 3. Identify patients’ perceptions of their treatment pathways, long-term needs, service provisions and quality of life

4. 4. Develop recommendations following the exploration of international models for this patient group

This project uses a mixed-methods approach including analysis of administrative data, case file reviews, patient interviews, interviews with clinicians and commissioners and a Delphi survey.

Initial findings indicate that up to 25% of the forensic population fulfill criteria for long-stay, a much greater number than originally estimated.

The high number of long-stay patients in high and medium secure services calls for specific service provision for this patient group, which we will explore further.