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Risk stratification and the care pathway

Published online by Cambridge University Press:  13 June 2014

Selena M Pillay ,
Brid Oliver ,
Louise Butler  and
Harry G Kennedy
Selena M Pillay
Affiliation:
University of Dublin, Trinity College, Central Mental Hospital, Dundrum, Dublin 14, Ireland
Brid Oliver
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Louise Butler
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Harry G Kennedy*
Affiliation:
University of Dublin, Trinity College
*
National Forensic Mental Health Services, Central Mental Hospital, Dundrum, Dublin 14, Ireland. Email:harry.kennedy@ireland.com
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Abstract

Objectives: It was hypothesised that patients admitted to forensic mental health facilities are stratified along the pathway through care according to levels of need. Level of risk and psychopathology should vary with different levels of security.

Method: Seventy-five men in a forensic hospital were interviewed by three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) – clinical and risk items, The Health of the Nation Scales – Secure (HoNOS-SECURE), PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version).

Results: The mean scores on a variety of clinical measures were higher in admission/high security areas and progressively lower in rehabilitation and pre-discharge areas. As patients moved through the pathways of care, they improved in a number of areas including psychiatric morbidity, risk, function, unmet needs. The following results stratified significantly; the HCR-20 summated clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet needs on the CANFOR.

Conclusions: The data indicate that the theoretical organisation of the units of the hospital into high, medium and low security units to form a coherent pathway through care is reflected in practice. This is a transparent route out of secure care in which restrictions are proportionate to risk and supports proportionate to need. It is unclear whether alternative models, consisting of a series of generic unstratified units for admission and discharge, all at the same level of therapeutic security, allow for the provision of treatment programmes and relational interventions appropriate to the patient's stage of recovery and rehabilitation.

Keywords

Care pathwayRisk stratification
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 4 , December 2008 , pp. 123 - 127
Copyright
Copyright © Cambridge University Press 2008

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