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How effective is high-support community-based step-down housing for women in secure mental health care? A quasi-experimental pilot study

Authors


W. Barr, Health and Community Care Research Unit, University of Liverpool, Thompson Yates Building, Brownlow Hill, Liverpool L69 3GB, UK, E-mail: wallybarr@yahoo.co.uk

Abstract

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  • • In the past decade UK government policy has been to develop alternative care for women detained in secure psychiatric hospital.
  • • This study evaluated the relative benefits of supportive accommodation, comparing female patients in community step-down housing and a control group in secure hospital who were on the waiting list for a place in the houses.
  • • The study provides evidence in favour of the further development of high-support step-down community housing for women in secure psychiatric care. This may provide greater personal freedom and enhanced relational security for the women concerned while also facilitating improvements in their psychological well-being, with no increased risk to the women themselves or to the wider community.
  • We conclude that community reintegration rates could be improved further by the expanded development of step-down community services for women in forensic psychiatric care.

Abstract

In the past decade UK government policy has been to develop alternative care for women detained in secure psychiatric hospital. This study evaluated the relative benefits of community-based step-down housing. Comparisons were made between female patients in community step-down housing and a control group in secure hospital who were on the waiting list for the houses. For each woman in the sample, a range of assessments was conducted on three separate occasions over a 12-month period. We noted a gradual improvement over time in women in both settings. However, by the final assessment psychological well-being and security needs were significantly better in the community group (P < 0.05). Although risks for violence and social functioning were also somewhat better in this group throughout the study, no statistically significant differences between the groups were found in these areas at any assessment time. This study has generated evidence in support of the further development of high-support step-down community housing for women in secure psychiatric care. This initiative may provide greater personal freedom and enhanced relational security for the women concerned while also facilitating improvements in their psychological well-being, with no increased risk to the women themselves or to the wider community.

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