Date Published: 14 October 2005

Review of Adult Mental Health Medium Secure Units in Wales (UK)

The Healthcare Inspectorate Wales (HIW) and the Health Commission Wales (HCW) published their report of the review into adult mental health medium secure units across Wales on 10 October 2005.

The joint review was requested by Ann Lloyd, Director of the Welsh Assembly Government's Health and Social Care Department, following the independent external review published in November 2004 into the homicide committed in March 2003 by Paul Khan, a mental health service user.

The main purpose of the review was to consider the adequacy of discharge planning arrangements for patients with mental health problems from the four mental health medium secure units in Wales, as well as reviewing the quality of services and patient care within these units.

The review acknowledges several examples of good practice in terms of each unit's clinical governance arrangements, for example, patients being involved in their own care and treatment and the extensive training opportunities for staff.

However, the review highlights distinct weaknesses in patient discharge planning arrangements. In particular, it found that risk factors and relapse indicators for individual patients were only clearly identified in less than half of the cases reviewed. There was also little evidence regarding the provision of clear plans for patient re-admission should it become necessary following discharge. The review recommends that the four Welsh units should proactively plan in collaboration with general mental health services and social services across Wales for situations when patients may relapse and ensure that there are adequate arrangements for the timely recall of patients where necessary.

The review emphasises that there was no discharge which gave immediate concern and that work has already begun with the units to ensure the issues raised are addressed.

Dr Peter Higson, HIW's Chief Executive, said:

" There is clearly a need for stronger arrangements within Wales to ensure the continuity of high standards of care and treatment for patients with mental health problems following discharge.

_ The recommendations from this review will help the mental health medium secure units to plan and manage improvements to discharge arrangements, to ensure that they are appropriate and robust."

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