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COVID-19 in forensic psychiatry settings: The unique vulnerability of patients in secure services

Published online by Cambridge University Press:  13 August 2021

N. Basrak ,
N. Mulcrone ,
S. Sharifuddin ,
Z. Ghumman ,
N. Bechan ,
E. Mohamed ,
M. Murray ,
H. Rajendran ,
S. Gunnigle  and
M. Nolan
...Show all authors
N. Basrak*
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
N. Mulcrone
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
S. Sharifuddin
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
Z. Ghumman
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
N. Bechan
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
E. Mohamed
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
M. Murray
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
H. Rajendran
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
S. Gunnigle
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
M. Nolan
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
T. Quane
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
M. Terao
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
T. Hoare
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
K. Kirrane
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland
H. Kennedy
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland The Dundrum Centre For Forensic Excellence, Trinity College Dublin, Dublin, Ireland
M. Davoren
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland The Dundrum Centre For Forensic Excellence, Trinity College Dublin, Dublin, Ireland
*
*Corresponding author.

Abstract

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Introduction

Secure forensic mental health services treat patient with high rates of treatment resistant psychoses, typically schizophrenia. These groups have high rates of obesity and medical co-morbidities. Population based studies have identified high risk groups in the event of SARS-CoV-2 infection, including those with long term medical conditions.

Objectives

The aim of this study was to compare the vulnerability to serious adverse outcome in the event of COVID-19 infection in a forensic psychiatric patient population.

Methods

All patients of a complete National Forensic Mental Health Service (n=141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-AGE tool and the COVID-Risk tool.

Results

Eighty-two patients (58.2%) met criteria for obesity, 32 had type II diabetes and 28 were hypertensive. Mean chronological age was 45.5 years (SD 11.4, median 44.1), while mean COVID-AGE was 59.1 years (SD 19.4, median 58.0), mean difference 13.6 years (SD 15.6) paired t=10.9, df=140, p=0.000. Three patients (2.1%) were chronologically over 70 years compared to 40 (28.4%) with a COVID-AGE over 70 (X2=6.99, df=1, p=0.008, Fishers exact test p=0.027).

Conclusions

These risk assessments may identify the extent of increased risk among a uniquely medically vulnerable patient group. Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population based cocooning and self-isolating guidance based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Keywords

COVID-19forensic psychiatry
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S375
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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