Specialist forensic psychiatric inpatient services are for older adults who pose a risk to themselves or others, and are experiencing mental illness (Shah, 2006). There is a lack of information on the outcomes of older forensic inpatients. The purpose of this paper is to investigate the progress of older adults from admission to exit.

The Health of Nation Outcome Scales (HoNOS) is a measure of health and social functioning and the HoNOS-secure scale additionally assesses the need for secure care. The Short-Term Assessment of Risk Treatability (START) is designed to facilitate risk assessment and inform and improve risk management. Routinely collected data on age, gender, hospitalisation days, ICD-10 diagnosis, and HoNOS-secure and START entry and exit scores were extracted from an anonymous database. Outcomes for 56 older patients (aged 55 and over) were compared to 465 younger adult patients.

Younger patients significantly improved on all four HoNOS factors (severe disturbance, emotional wellbeing, socio-economic status, and personal wellbeing) and most START factors, but the older patients did not significantly improve on any HoNOS or START factor.

Research limitations/implications
Data analysed are from a single provider of secure services. Male patients were overrepresented in the sample.

Practical implications
The benefits of specialist old age psychiatric forensic services need to be established through further investigation of patient outcomes using appropriate measures. A study interviewing patients and clinicians is required to understand and facilitate progress on a broad range of recovery, clinical, social, wellbeing, quality of life, and risk factors.

The findings indicate that older patient’s needs may not being met or that there may be a lack of potential for progress on the measures employed.

Chris Griffiths, Alessandra Girardi
Journal of Forensic Practice, 2018