Social demographics and clinical characteristics of referred adult mental health patients to an Australian secure extended care unit: A 5-year retrospective study

Introduction: Secure Extended Care Units (SECU) offer low-secure, long-term inpatient rehabilitation for patients with severe mental illnesses. Limited research is available about the profile of patients referred to such units. Objective: This study aimed to explore the sociodemographic and clinical characteristics of patients referred to Austin Health SECU over a 5-year period in Australia. Methods: A retrospective study design was used to investigate 121 consecutive referrals. The 98 first-time patient referrals were included in the primary analysis. Descriptive statistics were used with non-parametric comparisons (Chi-square and Fisher’s exact test where appropriate). Results: Most of the total sample were single males of European ancestry, between 25 and 34 years old, with 10 years or less of education and receiving disability benefits. Schizophrenia was the predominant diagnosis, with 50% having a comorbid personality trait/disorder; substance use was high (82.6%). More than three-fourths had a history of trauma. Physical comorbidity was high (80%), with hepatitis C positivity at 20%. Treatments like Clozapine and Electroconvulsive therapy (ECT) were low. The Median Health of Nations Outcome Scale (HoNOS) was 20 (IQR: 14, 23) and the Life Skills Profile (LSP) was 22.5 (IQR: 16.25, 27). Conclusions: Referrals showed a high level of psychosocial-physical complexity, with a range of patient needs, service goals, and high psychiatric and interpersonal risk before the referral. The study discusses the need for medium and high-secure beds and a new model of care that integrates Community Care Units (CCU). A trauma-informed approach that creates holistic treatment plans and includes patients and families is indicated. The study makes a case for Universal screening of patients for Bloodborne Hepatitis and treatment for this cohort in an inpatient setting.