Risk stratification and the care pathway.

Area of Science:

• Forensic Psychiatry
• Mental Health Services Research
• Clinical Psychology

Background:

• Forensic mental health facilities manage patients with complex needs, including risk and psychopathology.
• Patient care pathways are theorized to be stratified by security levels, reflecting varying patient needs.

Purpose of the Study:

• To investigate if patients in forensic mental health facilities are stratified by care pathway and security level.
• To determine if risk and psychopathology levels correlate with different security levels.

Main Methods:

• Seventy-five male patients in a forensic hospital were assessed.
• Clinicians used the Historical Clinical Risk Assessment (HCR-20), Health of the Nation Scales - Secure (HoNOS-SECURE), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), and Camberwell Assessment of Need Forensic Version (CANFOR).

Main Results:

• Mean scores on clinical measures were higher in high-security admission areas and decreased in rehabilitation and pre-discharge units.
• Patients showed significant improvement in psychiatric morbidity, risk, functioning, and unmet needs as they moved through the care pathway.
• Stratification by security level was significant across HCR-20, HoNOS-SECURE, PANSS, GAF, and CANFOR measures.

Conclusions:

• The study supports the theoretical organization of forensic units into high, medium, and low security, forming a coherent care pathway.
• This structured pathway allows for proportionate restrictions based on risk and support based on need, facilitating transparent progression out of secure care.
• The effectiveness of unstratified models in providing appropriate treatment for patients at different recovery stages remains unclear.