Description and evaluation of a novel service for “difficult to manage” psychiatric in-patients

Abstract

Purpose – A new service was developed to provide transitional care between acute and secure services for people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is to evaluate the work of the service by examining referrals made, strategies employed for each referral, and patient outcomes, as well as investigating issues in the service's development and implementation. Design/methodology/approach – A retrospective descriptive study by review of 38 case notes, and qualitative interviews of 47 staff within the service and those referring to the service. Findings – In the first eight months, 38 patients were referred due to violence, aggression and management problems. Most interventions provided by the service involved working with referring staff, rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security. Interviews showed the team's aims needed to be more clearly established, but that ward staff found the service to be a useful and productive resource. Research limitations/implications – The study is descriptive and retrospective, but showed that the service provided appropriate interventions for managing patients with serious mental illness and challenging behaviour. Practical implications – A transitional service may have value in keeping patients in the least restrictive setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective management. Originality/value – The service under study was novel, and may be useful in facilitating successful transfer from, or preventing admission to, secure services.