A Conceptual Framework for the Management of a COVID-19 Outbreak on a Secure Forensic Inpatient Unit

Responses to outbreaks of the novel coronavirus SARS-CoV-2 (COVID-19) in secure forensic settings have included several interventions, such as cohorting, assertive testing, isolation units, and infection control practices. The design of forensic facilities and the psychiatric impairment inherent to the patient population can make compliance with pandemic protocols challenging. In this study, we report on a COVID-19 outbreak on a low secure forensic inpatient unit in a large mental health hospital. For the 17 patients on the unit, we compared data from the 22-day COVID-19 outbreak period with the 30 days before the outbreak. We developed patient profiles that informed decision-making in COVID-19 outbreak management and developed a conceptual framework to identify interventions to effectively respond to and manage the outbreak. Patients had a decrease in as-needed nicotine replacement therapy during the outbreak. The average Dynamic Appraisal of Situational Aggression score increased slightly across all patients during the outbreak, though these differences were not statistically significant. Although forensic settings present challenges in outbreak management, leveraging therapeutic alliance, highlighting the importance of working together, communicating the rationale for measures, and providing staff information and tools such as a conceptual framework can support patients’ following protocols and effective management of an outbreak.

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