Secure Extended Care Unit: an exploration of social demographics and clinical characteristics of referred adult mental health patients in Australia

Thesis

Background and Aims: Secure Extended Care Units (SECU) are low-secure, long-term inpatient rehabilitation for patients with severe mental illnesses. Limited research is available. This study explored the sociodemographic, clinical characteristics and predictors of acceptance in an Australian SECU program over a 5-year period.

Methods: A retrospective study design was used to investigate 121 consecutive referrals. The 98 first-time patient referrals were included in the main analysis. Descriptive statistics was used with non-parametric comparisons (Chi-square and Fisher exact test where appropriate). Logistic regression was done to assess the influence of covariates.

Results: Most of the Total sample were single males of European ancestry between 25-34 years old with ten years or less of education and receiving disability benefits. Schizophrenia was the predominant diagnosis, with 50% having a personality trait/disorder; substance use was high (82.6 %). More than three-fourths had a history of trauma. Forty-four per cent had a previous forensic admission, with seventy per cent convicted in the past for violence. Physical comorbidity was high (80%), with hepatitis C positivity at 20 per cent. Low service utilisation, like the National Disability Insurance Scheme (NDIS) was noted. Clozapine and Electroconvulsive therapy (ECT) were underutilised. The Median Health of Nations Outcome Scale (HoNOS) was 20 (IQR 14, 23) and the Life Skills Profile (LSP) was 22.5 (IQR 16.25,27). Inpatient setting was the only predictor that influenced acceptance into the program (OR 3.168, 95% CI: 1.129-8.913, p=0.029).

Conclusions: Referrals showed a high level of psychosocial-physical complexity, with a range of patient needs, service goals, and high forensic involvement prior to the referral. The study discusses the need for medium and high-secure beds and a new model of care that integrates NDIS and Community Care Units (CCU). A trauma-informed approach that creates holistic treatment plans that include patients and families is indicated.

Authors: Das, P

• Alternative title: SECU Study
• DOI: 10.5287/ora-8rqdz7mgd
• Type of award: MSc
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: english
• Keywords: low secure unit; severe mental illness; rehabilitation; non forensic
• Subjects: rehabilitation psychiatry; mental health; Hospital wards