The first three years of an inpatient adolescent forensic service.

Bluebird House opened in February 2008. It was built to fill the gap of inpatient adolescent forensic services covering the South and South-West of England. This article describes the development of this highly specialized unit in its first three years.

Incidents in an adolescent forensic secure inpatient service.

There has been increased research in recent years on incidents within adolescent inpatient psychiatric units, although findings to date have been somewhat inconsistent. We analysed all reported incidents by 37 consecutively discharged patients from a mixed sex adolescent forensic hospital. Findings include a very high overall rate of incidents. A small number of female patients with emerging emotionally unstable personality disorder accounted for the majority of violent incidents and other incidents. Almost all the patients assaulted someone during their admission. Patients on civil sections of the Mental Health Act had just as many incidents as patients on forensic sections. The vast majority of assaults were on staff. Peak times for incidents were the end of each day when education sessions were timetabled and the beginning of the night shift.

Trends in the number of restricted patients in England and Wales 2003-2016: Implications for forensic psychiatry services.

This paper uses data produced by the Ministry of Justice to look for trends in the numbers of various categories of patients detained under the Mental Health Act in England and Wales between 2003 and 2016. Specifically, we have focussed on patients detained with Ministry of Justice restrictions in place. The number of 'restricted' patients, who are largely detained in secure psychiatric hospitals, has risen substantially during this period. If this trend continues, there will be the need for further expansion of secure psychiatric beds in the years ahead. Factors driving the increased number of restricted patients are discussed in this paper.

The 'honeymoon effect' and 'gate fever' in a secure forensic adolescent psychiatric hospital: Do they exist?

There is limited research that comments on whether there are recurring patterns for incidents or significant events during inpatient admissions to psychiatric units. This is even more so the case for an adolescent population. This study looked at 30 consecutive female patient admissions to Bluebird House, a medium secure adolescent unit in the South of England, to identify whether both the 'honeymoon effect' (low incident rate in the first 28 days following admission) and 'gate fever' (high incident rate in the last 28 days prior to discharge) were identifiable phenomena. Analysis of the incident rate found that in our secure adolescent population, the number of incidents both in the first week and at the first 28 days was higher in comparison to the whole admission. We also did not find a consistent increase in incidents in the final 28 days of the admission.

Attitudes of psychiatrists towards forensic psychiatry: a survey.

Forensic psychiatry has been rapidly expanding in recent years and more NHS forensic beds are planned. This study aimed to examine the attitudes of psychiatrists towards forensic psychiatry. A questionnaire was given to psychiatrists attending a regional Royal College of Psychiatrists conference. In addition forensic psychiatrists were surveyed in the two local regional secure units. Ninety-eight psychiatrists, including twenty-four forensic psychiatrists, completed the questionnaire. Forensic and non-forensic psychiatrists tended to agree with the expansion in forensic beds. Non-forensic psychiatrists wanted a lower threshold for admission to secure units. Forensic psychiatrists disagreed. Non-forensic psychiatrists tended to feel that forensic psychiatry has been over-funded compared with other psychiatric services. They also commented that forensic services should integrate more closely with other non-secure psychiatric services and should offer more community forensic services rather than concentrating care on in-patients. Forensic services should consider what services they provide and try to meet the desires of secondary services, such as more community forensic services and greater integration with other psychiatric services.

The future of medium secure forensic psychiatry in Britain: a survey.

The number of National Health Service (NHS) secure psychiatric beds is increasing. This survey asked forensic services about their plans for expansion. The survey indicated a large increase in medium secure provision over the next five years. The increase in the number of patients being detained in secure settings raises questions about whether there is in Britain an on-going process of 'reinstitutionalisation' of the mentally ill.

Assessing decision-making capacity: a survey of psychiatrists' knowledge.

We aimed to survey the knowledge of psychiatrists on the assessment of decision-making capacity. Ninety-two psychiatrists of all grades and three other doctors attending a regional conference were marked on their verbal response to the question 'What are the key elements in the assessment of a patient's capacity?' On average, participants mentioned three out of the five elements in testing decision-making capacity. Scores were negatively correlated with age (Pearson's coefficient 0.275, sig 0.007). Section 12 status and grade had no impact on knowledge. Most psychiatrists of all grades have a reasonable knowledge of assessing decision-making capacity. Over a third of participants mentioned two or fewer of the five points, suggesting inadequate knowledge. Assessing decision-making capacity needs to be emphasised in training throughout psychiatrists' careers--not just at the start.

Vitamin D status of adolescent inpatients in a secure psychiatric hospital.

OBJECTIVE: The objective of the study was to use routinely collected data on vitamin D levels of adolescents detained in a secure psychiatric hospital to see if this at-risk group for vitamin D deficiency do in fact have low vitamin D levels. METHODS: Vitamin D blood levels were collated from clinical records of inpatients admitted to Bluebird House, a medium secure adolescent unit, since 2012. Corresponding data were gathered to include gender, ethnic status and age. Blood levels were assessed on admission to the unit and after treatment with vitamin D supplementation, if indicated. RESULTS: Only 3 out of the 35 patients (8.6%) had adequate vitamin D levels (serum 25-hydroxyvitamin D [25-OHD] > 50 nmol/l). A total of 23 patients (65.7%) had levels consistent with deficiency (25-OHD < 30 nmol/l) with the remaining 9 patients (25.7%) showing levels indicating possible deficiency (25-OHD 30-50 nmol/l. CONCLUSIONS: Vitamin D levels were low in our sample of young people admitted to a secure psychiatric hospital. This is the first published study of vitamin D levels in a secure adolescent psychiatric hospital. The results point to the need for routine prescription of vitamin D to adolescents held in secure conditions such as hospitals, secure children's homes and youth offender institutes.

Toward a neuropsychological theory of antidepressant drug action: increase in positive emotional bias after potentiation of norepinephrine activity.

OBJECTIVE: Antidepressants that increase serotonin or norepinephrine in the brain are effective in treating depression, but there is no neuropsychological account of how these changes relieve depressive states. Cognitive theories suggest that biases in information processing lead depressed patients to make unrealistically negative judgments about themselves and the world. METHOD: A single dose of the noradrenergic antidepressant reboxetine or placebo was administered to 24 healthy volunteers. Effects on emotional processing were assessed through facial expression recognition, emotional categorization, and emotional memory. RESULTS: On the three measures, reboxetine biased perception toward positive, rather than negative, information in the absence of changes in nonemotional performance or mood. CONCLUSIONS: These results suggest that a single dose of an antidepressant can increase the processing of positively valenced material in nondepressed volunteers. Antidepressants may therefore work in a manner similar to that of psychological treatments that aim to redress negative biases in information processing.

Aripiprazole use combined with depot antipsychotic medication: two cases demonstrating its ability to reduce prolactin levels in an adolescent forensic hospital.

Many patients maintained on depot medication have raised prolactin levels, which can lead to a range of long-term medical problems. The addition of aripiprazole can reduce prolactin levels and restore sexual function in these patients. The cases described demonstrate the potential role of aripiprazole in a forensic setting.

Changing patterns of suicide in a poor, rural county over the 20th century: a comparison with national trends.

Rural suicide rates have been shown to be disproportionately high in several countries. This study compares suicide rates in Cornwall with the rest of England and Wales over a 90-year period (1911-2001). Age and sex standardised mortality ratios were calculated for suicide and undetermined death for Cornwall standardised to England and Wales. From 1911 until the start of the Second World War, suicide rates were lower in Cornwall than England and Wales. Since the 1960s suicide rates in Cornwall have risen significantly above England and Wales. We have shown that the suicide rate in a poor, rural area has increased disproportionately compared to England and Wales over the last 35 years. This change has occurred in both sexes. Prior to this period the suicide rate was lower or about the same as that in England and Wales.