What is the evidence for the need for specialist treatment of people with acquired brain injury in secure psychiatric services?

What is the evidence for the need for specialist treatment of people with acquired brain injury in secure psychiatric services?

Status: Complete

Briefing Paper: We have produced a 4-page Briefing Paper which summarises the project and the main findings

In May 2019, the Exeter HS&DR Evidence Synthesis Centre were asked to review the evidence about mental health services for people with acquired brain injury for NHS England.

This page provides some information about the background of this project and how the team carried out the research.

Background
People living with an ABI are more likely to experience mental health difficulties, and are at increased risk of engaging in offending behaviour or drug use and present a higher risk of harm to others and/or themselves. One study estimates that over 60 per cent of the UK prison population have a brain injury.  Delivering services for people with an ABI can be complex as differences in the aetiology and severity of the injury can lead to variations in level of functioning and range of potential needs across different individuals. The needs of individuals with severe difficulties may mean secure inpatient services are best equipped to care for them. However, the availability of secure ABI rehabilitation settings is limited in the UK and the restrictiveness of the setting could constitute an infringement of the human rights of the patient if the referral is not appropriately justified (Human Rights Act, 1998). It is important that the assessment, care and/or treatment needs of the patient, match with the availability and referral to an appropriate service.

Aims of our project
Our aim was to systematically review the evidence that could inform the arrangements for the specialist care of adults with ABI who may require secure psychiatric services.

Research questions
1. Is there evidence to support the differentiation between different groups of adult patients with ABI as a criterion influencing the most appropriate care setting for treatment of adults with ABI?

2. Is there evidence to support the use of diagnostic, disease- or symptom-severity assessment criteria in influencing the most appropriate setting for care and treatment of adults with ABI?

3. Is there evidence to support the use of risk assessment tools in influencing the most appropriate setting for care and treatment of adults with ABI?

What we did
We carried out a systematic review of the evidence. This is a transparent and unbiased process, bringing together the findings of all the available relevant studies to find out what is already known about arrangements for the specialist care of adults with ABI who may require secure psychiatric services

How we did it
We searched seven bibliographic databases. These searches were supplemented with citation searching; inspecting relevant reviews; searching trial registry platforms, searching relevant websites; liaising with clinical experts and affiliation searches.

We sought evidence about adults with non-degenerative ABI placed in, eligible for referral to, or being assessed for eligibility for referral to secure psychiatric services in any high-income country published in English from 2000 onwards. Eligibility for referral to secure services was based on assessment or observation of challenging behaviours. Psychometric studies of tools used in assessments were also eligible for inclusion.

Study selection, data extraction and quality appraisal were completed independently by two reviewers, with disagreements resolved through discussion.

For more detailed information about how we did this, please see our project protocol.

Sharing our results
We shared our results with NHS England and prepared a Briefing Paper.

Alternatively, you may like to read the full report.

If you have any feedback or comments about this review, please email: Jo Thompson Coon j.thompson-coon@exeter.ac.uk, Liz Shaw e.h.shaw@exeter.ac.uk or Michael Nunns m.p.nunns@exeter.ac.uk