title: The influence of admission characteristics on outcome: evidence from a medium secure forensic cohort.
abstract: OBJECTIVE
  Outcomes for any mental health service will vary with the characteristics of those admitted as well as with the clinical provision of the service itself. This study aims to explore, for a medium secure forensic service in England, temporal changes in (1) characteristics of those admitted and (2) outcome after discharge and (3) to examine whether such changes are related.
  
  
  METHODS
  Baseline characteristics and reconviction outcomes were derived from multiple data sources for 550 first admissions to a medium secure forensic unit for a 20-year period. Time to reconviction was examined using Kaplan-Meier analysis and Cox regression.
  
  
  RESULTS
  Over time, severity of admissions increased, as did discharges to prison; discharges to non-secure hospitals reduced. Risk of reconviction increased by 3.9%-4.2% for each year of admission from 1983, which was explained by the increased admission of higher-risk patients.
  
  
  CONCLUSIONS
  This medium secure service admitted patients with increasing levels of risk; reoffending rates reflect admission characteristics. Service funding decisions should take account of the characteristics of those admitted.
  
  
  CONCLUSIONS
  This study indicates that the profile of patients admitted over a 20-year period increased in severity. Over time, reconviction after discharge occurred earlier after release. This increase in reconviction was explained by the type of patient admitted.
  
  
  CONCLUSIONS
  Examination of a cohort from a single medium secure unit limits the generalizability of the findings. The study focuses on a criminological outcome measure (i.e. reconviction); other domains may be equally relevant (e.g. the relief of psychological distress). Examining an entire series of admissions introduces heterogeneity by, for example, considering the outcome of men and women together.
authors.affiliation: St Andrews Healthcare, Northampton, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gibbon
authors.forename: Nick
authors.initials: N
authors.lastname: Huband
authors.forename: Sylwia
authors.initials: S
authors.lastname: Bujkiewicz
authors.forename: Clive R
authors.initials: CR
authors.lastname: Hollin
authors.forename: Martin
authors.initials: M
authors.lastname: Clarke
authors.forename: Steffan
authors.initials: S
authors.lastname: Davies
authors.forename: Conor
authors.initials: C
authors.lastname: Duggan
mesh_terms: D000328:Adult; D003415:Crime / Q000706:statistics & numerical data; D057237:Criminals / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult