Background

Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes.

Aims

To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery.

Methods

The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories.

Results

Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery.

Conclusions

The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.

中文翻译：

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中等安全服务中恢复的预测因素：威尔士政府心理健康 (2010) 措施的影响

背景

迄今为止的研究未能检验 MSU 在促进康复方面的有效性，或心理健康政策可能对该过程的影响。检查住院期间短期临床结果的预测因素以及政策变化的影响可以为未来的政策、治疗计划提供信息，并可以改善服务用户的结果。

目标

研究服务使用者的入院特征和住院时间是否可以预测中等安全护理出院时的康复状态，以及以康复为中心的政策变化（引入心理健康（威尔士）措施（2010））是否对康复或关系产生影响服务用户特征和恢复之间的关系。

方法

该研究对 2007 年至 2017 年间威尔士密歇根州立大学 ( n  = 198)的医疗记录中获得的定量数据进行了回顾性分析。DUNDUM-4 量表评估恢复情况，而 DUNDUM-2 评估入院时的安全需求。服务用户准入特征包括 HCR-20 分量表分数、之前的安全级别转换、不良童年经历、药物滥用历史。

结果

住院时间较短和动态 HCR-20 临床分量表得分较高与康复结果较差相关。尽管政策发生了变化，入院特征和康复之间的关系仍然存在。实施以恢复为重点的立法与改善恢复有关。

结论

研究结果表明，治疗应侧重于动态风险因素，以改善服务使用者的结果，并强调为某些人提供长期中期安全服务的必要性。需要进一步研究来评估 MSU 的成功以及 DUNDRUM-4 在英国安全服务中的有效性。