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Research

What helps women leave secure wards?

Lessons from research about what supports women with learning disabilities moving
on through and from the locked ward system are considered by Rebecca Fish and
Hannah Morgan at the Centre for Disability Research at Lancaster University

Background
The purpose of secure services, also known Key messages
as forensic inpatient services, is to provide
assessment, treatment and care, with ● Supportive and trusting relationships with staff and between women on the wards
rehabilitation viewed as a key outcome. are key to successful moving through and on from secure inpatient services
Research shows that people in secure ● Many of the indicators of readiness for moving on are decided by staff. It is
units tend to stay there for a long time. important that women with learning disabilities are supported to be central to
This is because the process of relocation decision-making processes about moving on from secure care
can be lengthy and complex, involving ● Moving through and on from secure services should be the primary focus of
multidisciplinary risk assessments and day-to-day life on wards. This includes focusing on learning skills so women can
collaboration between services. Despite move into the community
the ambitions of Transforming Care, NHS
England reported in March 2019 that
more than 2,200 people with learning reduce the need for observations, staff Many staff said that establishing
disabilities remain in inpatient units. built a good relationship with her, offering trusting relationships was important,
This study, which was undertaken in 2012, constant one-to-one support whenever especially when a woman might
found that staff and service users felt it was Jane asked for it. One staff member said: self-harm. Some said that incidents of
important for women to move through and self-harm and anger were not always
from inpatient settings and helped identify “Jane speaks to someone in the setbacks but could be worked around by
good practice principles for leaving secure morning, and at night-time about how adjusting their responses. They relied on
units. This offers valuable insight for services she’s feeling, whether she’s settled, having knowledge about the woman’s
in the wake of Transforming Care. does she think she’s well enough to be past to inform care:
[unsupervised] or not? So she’s in
Findings control and it’s really helped.” “Nicola achieved a hell of a lot in her
There were good examples of how women time down there – she did really well.
had been able to move on from which we Another woman, Elaine, said she had She had a few incidents. I think you
can learn. made friends in the unit and this had should set the goals, and you might
For instance, when relationships with staff helped her to move on. Previously, she have an incident, but you’ve got to learn
were positive, this was generally helpful had been in a flat on her own: from that incident – and think you
for moving on as women trusted staff to might have to do it differently the next
make changes slowly. A good example “Well I am moving on now because time, and do it another way round.
concerned Jane (not her real name), who I’m living with someone now, living with That’s what they did and she achieved a
was under 24-hour observation when she Teresa, and I’m getting on all right with lot really.”
first came to the unit. Working together to her all the time.”
Barriers to moving on
In contrast, some staff said that having
‘Moving on’ through the locked ward system for women with good relationships on the ward held some
intellectual disabilities women back, as they did not want to leave.
Other staff said that self-harm and
Aims: To find out the experiences of women and staff on three wards of a secure showing anger also held women back
unit for people with learning disabilities. from moving out of the ward. Incidents
such as these were found to be included
Methods The researcher spent 120 hours on three locked wards and interviewed in daily reports while positive things were
16 women with learning disabilities and 10 staff on these wards. Field notes and sometimes left out.
transcripts were then analysed to find references to moving on and we used these Many of the women we spoke to knew
to consider how women with learning disabilities can move on from secure care what they needed to do to move on but
had not considered their own aspirations,
Read the report Fish R, Morgan H (2019) “Moving on” through the locked ward for example, as one woman said:
system for women with intellectual disabilities. Journal of Applied Research in
Intellectual Disabilities. Published 5 April. https://onlinelibrary.wiley.com/doi/ “Do whatever they say, don’t refuse
full/10.1111/jar.12586. Accessible summary: How do Women with Learning to take our medications, do whatever
Disabilities ‘Move On’ Through Secure Units? http://wp.lancs.ac.uk/ we have to do, behave, don’t go against
cedr/2019/04/26/moving-on/ our treatment and care plans by
refusing medication or refusing to eat.

24 Vol 32 No 4 | Summer 2019 Community Living www.cl-initiatives.co.uk