The Clinical Profile of Young People Accessing a Low Secure Adolescent Unit

Abstract

Purpose – The first NHS forensic low secure unit for adolescents, the Westwood centre, opened in 2004. This paper seeks to focus on service utilisation and initial outcomes for the young people admitted in the first 45 months compared with young people accessing a neighbouring open adolescent unit. Design/methodology/approach – In order to understand service utilisation and initial outcomes, the clinical profiles of young people admitted in the first 45 months were evaluated. This included demographics, locality, admission status, length of stay, medication use, presenting problem, diagnosis, previous and discharge destination. The profiles of young people accessing the low secure unit were then compared with young people accessing a neighbouring open adolescent unit. Clinical profiles were ascertained from available healthcare records and service data. These were inspected and analysed using descriptive statistics . Findings – Thirty (54 per cent) of the 56 Westwood young people were male, the mean age at admission was 16.3 years and mean length of stay was 202 days. Twenty-five (44 per cent) young people had a discharge diagnosis related to psychosis, the remainder having primary problems relating to emotional and/or conduct problems. 26 (47 per cent) were discharged to another hospital setting and 20 (35 per cent) returned to their home of origin. Young people accessing the low secure unit were significantly older at admission and there was a trend for a higher proportion of females to be admitted to the open setting. In addition, the low secure unit had a greater proportion of young people with psychotic disorders and longer lengths of stay. Case examples illustrate a pilot of initial outcomes. Research limitations/implications – There were time differences in comparison of low secure and open unit and retrospective use of health care records. Practical implications – Clinical profiling is useful as a basis to consider clinical outcomes, pathways, utilization of a service, service/training needs and development. Comparisons between inpatient units provide further evidence to the areas above and help dispel myths that may otherwise guide decisions, e.g. about which diagnoses or gender affecting length of stay. Most young people progress positively from the low secure service onto open or community settings. Improving future outcomes for young people include such as through diversion from custody, length of admission, reduced symptoms/risks and planned progress to suitable community placements or home. Originality/value – The paper provides a clinical profile of young people accessing a low secure setting in comparison to an open unit. This has relevance to other secure and inpatient adolescent units and is important in considering pathways and outcomes.