Comparative analysis of characteristics among young people discharged from adolescent medium secure psychiatric hospital

Background: Specialised forensic mental health provision for young people with mental disorders and high-risk behaviours has developed significantly in the UK. Despite this, research on the young people within secure settings remains limited. Adolescents in secure settings exhibit higher levels of mental disorders and have complex needs. This study aims to compare the demographic characteristics of patients discharged from an adolescent medium secure unit (AMSU) to different discharge destinations: community, another hospital, or custodial setting.

Methods: A retrospective study was conducted using data from 155 patients admitted to a UK AMSU from 2008 to 2021. Demographic data, clinical information and Millon Adolescent Clinical Inventory (MACI) scores were extracted from electronic health records. A descriptive statistical method was used to report observational differences in patient characteristics between discharge locations. Statistical analysis included Chi-squared tests and AVOVA testing.

Results: Patients discharged to different settings exhibited distinct demographic and clinical characteristics. Those discharged to custodial settings were predominantly male and often transferred from custodial settings. Those discharged to other hospitals were mostly females with a diagnosis of Borderline Personality Disorder. The community-discharged group had a higher frequency of admissions from other hospitals under civil sections. Multiple variables were found to be statistically significant in relation to discharge location including gender and age at discharge. Findings of the MACI were not statistically significant in relationship with discharge location.

Conclusions: The study enhances understanding of healthcare transitions from AMSUs. The influence of diagnoses, particularly personality disorders, and their connection to admission duration is explored, as is the influence of this on transitioning patients across care settings. The impact of trauma-informed, attachment focussed models of care in regards transitions from AMSUs is also examined. Despite diversity in discharge locations, self-reported personality questionnaires show consistent outcomes, demonstrating psychological similarities across groups. Further research is needed to understand post-discharge trajectories enabling targeted interventions and improved care pathways.