Voluntary and coercive covert trading behaviour on low and medium secure psychiatric units: a cross-sectional study

Abstract

Little is known about covert trading behaviour in secure hospital settings. This study evaluated the nature, prevalence, and frequency of covert voluntary trading behaviour (VTB) and of coercive trading behaviour (CTB) between patients in secure psychiatric units. Ninety-six eligible patients in 18 low or medium secure wards across South London anonymously completed a questionnaire exploring their experiences of covert trading behaviour (including exchanging, lending, borrowing, or gifting personal property, money, or services) during their current hospital admission. About 70.2% reported engaging in some form of unauthorised VTB (38.3% ≥5 different behaviours). VTB was more commonly reported by male (74.7%) than female (36.3%) participants (odds ratio (OR) = 4.93, 95% confidence intervals (CI) = 1.28,19.05, p = 0.021). Engagement in any CTB behaviour was reported by fewer patients (31.9%). Participants were significantly more likely to report themselves as victims of coercive behaviours (8.6%–14.0% across different behaviours) rather than instigators (1.1%–5.5% across behaviours). Involvement in CTB was more common in patients reporting VTB (39.4%) compared to those not involved in VTB (14.3%; OR = 3.90, CI = 1.21,12.54). Covert patient trading appears commonplace in secure psychiatric inpatient settings and VTB participation may be linked with CTB engagement. Hospital policies to better monitor and regulate patient trading may help to reduce the incidence of CTB.