Abstract

Abstract Medium secure units are one component of secure mental health care for young people across the UK. No research has previously examined the appropriateness of admissions. This is a retrospective cohort study of all patients admitted to one unit by examining clinical notes for demographic, mental health and criminological variables. Descriptive data was statistically analysed to then characterise the cohort, audit against admission criteria and examine changes over time. There were 149 admissions. All patients admitted were male, most were 17 years old and from racialized groups. Most were detained under forensic sections with a primary diagnosis of psychosis. Four of five admissions met all 4 admission criteria. There were notable changes in use of forensic sections and risk over time. Our cohort differs from previous historical and contemporaneous cohorts in terms of diagnosis, legislation determining admission and ethnic breakdown. Our analysis relies on an interpretation of existing admission criteria but it suggests that not all admissions were appropriate, raising important practical, ethical and cost benefit questions. We suggest greater transparency about admission decisions to ensure that patients are admitted to the least restrictive setting needed and that national service planning is responsive to changes in demand.

摘要

摘要 中等安全单位是英国年轻人安全心理健康护理的组成部分之一。此前没有研究检验过招生的适当性。这是一项回顾性队列研究，通过检查人口统计学、心理健康和犯罪学变量的临床记录，对入院的所有患者进行回顾性队列研究。对描述性数据进行统计分析，以描述队列的特征，根据入院标准进行审核并检查随时间的变化。录取人数为149人。所有入院患者均为男性，大多数 17 岁，来自种族群体。大多数人被拘留在法医部门，初步诊断为精神病。五名录取者中有四名符合全部 4 项录取标准。随着时间的推移，法医切片的使用和风险发生了显着变化。我们的队列在诊断、确定入院的立法和种族分类方面与以前的历史和同期队列不同。我们的分析依赖于对现有录取标准的解释，但它表明并非所有录取都是合适的，从而引发了重要的实践、道德和成本效益问题。我们建议提高入院决策的透明度，以确保患者被接纳到所需限制最少的环境中，并且国家服务规划能够对需求的变化做出反应。