A survey on takeaways in a secure unit

Physical health monitoring of long-term detained psychiatric patients in secure care has attracted much attention in the past few years. ¹ The rate of coronary heart disease in patients with schizophrenia is almost three times higher than in the general population and is thought to be a greater contributor to mortality in this group of patients than suicide. ² Patients on antipsychotic medication seem to have a worse metabolic profile. ³ Metabolic syndrome has been described as a risk factor associated with the development of coronary heart disease and includes central obesity, impaired glucose tolerance, hypertriglyceridaemia, hypercholesterolaemia and hypertension.

For long-stay patients in secure hospitals a combination of antipsychotic medication, poor diet, sedentary lifestyle, lack of exercise and leave, smoking and illness effects are all likely to contribute to weight gain and metabolic syndrome.

As part of a wider consultation exercise promoting healthy lifestyles, concern has been raised about the number of takeaways ordered by detained patients within a National Health Service (NHS) medium secure unit and how this may contribute to metabolic syndrome. A survey monitored the number of takeaways delivered to the unit over a 21-day period.

In total, 326 individual takeaways at the overall cost of £2736 were consumed at an average of £8.40 per order (range £3–23). The figures included ‘group bookings’ from two wards within the learning disability directorate that have two designated takeaway nights per week.

It was estimated that around three-quarters of patients ordered a takeaway during the study period: 29 patients consumed at least one takeaway a week and 16 patients consumed at least two per week; 4 patients consumed a takeaway every other day and 1 patient consumed 15 takeaways in total. There was no clear distribution between acute and rehabilitation wards and there were no obvious gender differences. The mean number of takeaways per ordering patient was five. At least half of the takeaways were curries.

The wide range of cost and high average cost probably reflected group bookings registered to a patient and so underestimated the total number of takeaways. This was confirmed at a unit meeting with patient representatives who felt that a takeaway should on average cost around £5 and that sharing takeaways or group bookings registered to a patient occurred frequently. If extrapolated over a year, a patient would spend on average £727 on takeaways. The annual cost for all patients in the unit would be £47 423.

Possible ways of reducing ‘excessive takeaways,’ though this amount is undefined, include individual care plans or designated ‘takeaway nights,’ which is the current policy within the learning disability directorate. Although the average number of takeaways per patient was five within a 21-day period and could potentially increase to six if takeaways were ordered twice a week, as per the learning disability model, it was felt that the average number of takeaways calculated was a gross underestimation. An outright ban could be enforced on security grounds. The issue of restricting patient choice, patient autonomy, poor-quality hospital food and infringement on human rights have been raised as counterarguments.