Thames Valley Forensic Mental Health Service Low Secure Unit Length of Stay Audit

Abstract

Aims and hypothesis Commissioning changes, and LSUs becoming a more integral part of the care pathway in the Thames Valley Forensic Mental Health Service (TVFMHS), may have led to an impact on patient management. We re-audited the length of stay in low secure units (LSU) across the TVFMHS between December 2014 and November 2017, and compared this to the prior three-year period. Background The TVFMHS has two inpatient LSUs, Woodlands House and Wenric House. Together they manage 42 patients, male and female. The main findings of the previous audit (December 2011 to November 2014 – period 1) included that demographically the patients at both units were similar, and close to 90% of patients had been diagnosed with a severe and enduring mental illness (SMI). The average length of stay was slightly higher at Wenric than Woodlands House, although the median stay in both units was identical at 24 months. Methods Electronic records of discharges between December 2014 and November 2017 (period 2) were reviewed by various clinicians. Data collected included length of stay in months, age, sex, diagnosis, admission source, discharge destination, index offence, Mental Health Act Section and regarding any readmissions post discharge. Results The majority of discharges (87%) still have a primary diagnosis of a SMI. There had been a large increase in the total number of discharges in period 2; 82 compared to 36 in period 1. The mean length of stay across both units has reduced to just over two years. Median stay has reduced from 24 to 16.5 months. There has been an increase in the number of patients being admitted to both units directly from the community. There were some differences between units in terms of discharge destination, and an increase in patients managed on criminal, as opposed to civil, sections. Conclusions There has been a large increase in the number of discharges, and a reduced length of stay, in LSU in the TVFMHS for the three years from December 2014 compared to the three years prior. Additional recommendations included that the audit be repeated in a further three years to monitor long term trends. Both wards should develop referral criteria to seek to further reduce both length of stay and the likelihood of non-progressive discharge.Other inpatient units within the TVFMHS should consider collating similar data. Further work would be of benefit to identify factors predictive of positive outcomes for patients detained in LSU.