Examining the need for a high level of therapeutic security at a regional forensic mental health service in Aotearoa New Zealand

Michael Jewell; Krishna Pillai; James Cavney; Nick Garrett; Brian McKenna

doi:10.1080/13218719.2023.2192261

Examining the need for a high level of therapeutic security at a regional forensic mental health service in Aotearoa New Zealand

Psychiatr Psychol Law. 2023 May 31;31(2):293-310. doi: 10.1080/13218719.2023.2192261. eCollection 2024.

Authors

Michael Jewell¹, Krishna Pillai¹, James Cavney¹, Nick Garrett², Brian McKenna^{1

2

3}

Affiliations

¹ Auckland Regional Forensic Psychiatry Services, Auckland, Aotearoa New Zealand.
² Auckland University of Technology, Auckland, Aotearoa New Zealand.
³ Centre for Forensic Behavioural Science, Swinburne University of Technology, Victoria, Australia.

Abstract

The ceiling of therapeutic security in Aotearoa New Zealand is medium security. The aim of this study is to identify and characterise a putative cohort of high-secure patients at a medium-secure regional forensic mental health service. A retrospective review of all admissions to a specific service was conducted over 3.75 years. The Dangerousness Understanding, Recovery and Urgency Manual, Triage Security Scale (DUNDRUM-1) was used to identify patients with high-secure care needs. A multiple logistic regression analysis was used to identify the local needs of this cohort. We found a significant incidence (an admission every 55 days) and prevalence (11%) of mixed-gendered and culturally diverse patients with high-secure care needs. The cohort had a high prevalence of psychosis and violent offences, and relatively short length of stay. There is also an indication that the cohort was subject to more restrictive practice. A solution is proposed to meet the needs of this cohort.

Keywords: DUNDRUM-1; Trinitarian model; forensic; high security; mental health; physical security; procedural security; relational security; restrictive practices; therapeutic security.