What changes for patients in medium secure care?
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This thesis examines changes in medium secure care over the past two decades in the context of developments in legislation and the forensic care pathway. Chapter two provides a baseline of medium secure care between 1997/98 based on an existing cohort of 958 patients across England and Wales and enables comparisons with later chapters. A secondary analysis was conducted to show the relationship between patient characteristics with medium secure service provision and reconviction up to six years following discharge. A logistic regression revealed that criminogenic factors strongly predicted reconviction without improvement with the addition of clinical and social factors, although the criminogenic profile of patients was not associated with decisions regarding the discharge pathway or allocation of restriction orders for patients. All remaining empirical chapters include longitudinal, retrospective studies that investigated a cohort of 285 forensic patients discharged from a Welsh medium secure hospital between 1999 and 2017. Chapter three presents a study that revealed changes in medium secure care over time that included: more high-risk patients with experiences of social deprivation admitted to medium security, an increase in restrictive practice and greater recovery outcomes for patients. Chapter four includes astudy that explored the factors that navigated the clinical decision-making of where patients were discharged from medium security and included: self-care and activities of daily living, engagement with family and social networks, the leave status of patients and a diagnosis of a psychotic related disorder. Chapter five presents a study that showed no significant change in the readmission rate(up to six years)following discharge from medium secure care between 1999 and 2017. Logistic regression showed that the number of previous psychiatric admissions was a hazard of readmission. A discussion of each empirical chapter and an integration of the findings concludes the thesis
PhD Thesis - School of Sport and Health Sciences
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