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Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure

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journal contribution
posted on 2023-09-28, 15:50 authored by Marie Smothers, Charlotte Hill, Daniel Lawrence, Ruth Bagshaw, Andrew Watt


Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes.


To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery.


The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories.


Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery.


The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.





  • VoR (Version of Record)


Smothers, M., Hill, C., Lawrence, D., Bagshaw, R., & Watt, A. (2023) 'Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure', International Journal of Law and Psychiatry, 91, 101935.

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Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Ruth Bagshaw Andrew Watt

Cardiff Met Research Centre/Group

  • Applied Psychology and Behaviour Change

Copyright Holder

  • © The Authors


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