Sex differences in patients admitted to a regional secure unit

Area of Science:

• Forensic Psychiatry
• Clinical Psychology
• Mental Health Services Research

Background:

• Secure units manage individuals with complex mental health needs requiring containment.
• Understanding demographic and diagnostic differences in secure care is crucial for service planning.

Purpose of the Study:

• To analyze gender-based differences in diagnoses, offenses, and transfer pathways within a Regional Secure Unit.
• To investigate factors influencing transfer to special hospitals and maximum security settings.

Main Methods:

• Retrospective case note review of all admissions over a 12-year period.
• Analysis of demographic data, psychiatric diagnoses, and offense types.
• Examination of transfer destinations and patient flow.

Main Results:

• Females had a higher proportion of personality disorder diagnoses.
• Women were less likely to have prosecuted offenses but more likely to be charged with fire-setting.
• Patients with personality disorder were more frequently transferred to special hospitals.
• Women were nearly three times more likely than men to be transferred to maximum security, independent of personality disorder diagnosis.
• Men exhibited a net outflow from special hospitals, while women showed a net inflow.

Conclusions:

• Gender significantly influences admission characteristics and transfer pathways in secure psychiatric settings.
• Specific offense types (e.g., fire-setting) and diagnoses (e.g., personality disorder) are associated with different patient trajectories.
• Disparities in maximum security transfers for women warrant further investigation into underlying systemic or clinical factors.