Long-term outcomes after discharge from medium secure care: a cause for concern

There are few long-term follow-up studies of patients discharged from medium secure units in the UK, even though these units were introduced over 20 years ago.

To describe mortality, rates of reconviction at different time periods; violent behaviour (not leading to conviction), readmission and employment, after discharge from a medium secure unit.

Of 595 first admissions over a 20-year period, 550 discharged cases were followed-up. Multiple data sources were used.

Fifty-seven (10%) patients had died, of whom 18 (32%) died by suicide, and the risk of death was six times greater than in the general population. Almost half (49%) of those discharged were reconvicted and almost two-fifths (38%) of patients were readmitted to secure care.

Community psychiatric services need to be aware that those discharged from medium secure care are a highly vulnerable group requiring careful follow-up if excess mortality, high levels of psychiatric morbidity and further offending are to be prevented.