Mortality in maximum security psychiatric hospital patients

Numerous studies have mentioned to the high percentage of violent deaths in prison psychiatric hospitals, with suicide being the principal cause. The aim of this study was to analyze the circumstances related with the deaths recorded in a high security institution. Postmortem reports on all the deaths at the Alicante Psychiatric Prison between 1984 and 1997 were studied (36 cases of unnatural death and 28 of natural death). Of the violent deaths recorded 34 (94.4%) were suicides. Demographic, clinical and interpersonal variables factors were registered. In the cases of suicides, the method used, the place of death, season, month and time of suicide were analyzed. In our study, 64.7% of suicides were schizophrenic and 32.4% had inflicted self-harm previously. We found a statistically significant association between the cause of death (natural, suicide or homicide) and age, 47.1% of suicides being between the ages of 18 and 30 and 29.4% between the ages of 30 and 45. Natural causes predominated in older subjects. The prison population studied showed grave negative traits, mental illness and criminal behavior having forced them to the very edge of society. Our results were compared with the death and suicide rates of the general Spanish population.     

Characteristics of male patients admitted to an adolescent secure forensic psychiatric hospital

This paper examines the characteristics of a group of 64 young men, who were consecutively admitted to Bluebird House, an NHS mixed gender, adolescent forensic, medium secure hospital. The characteristics examined focus on the young men’s clinical presentations, as informed by the Millon Adolescent Clinical Inventory, and their ICD10 (WHO 1992) diagnoses. The paper also examines the males’ route into, and out of, Bluebird House, as well as their risk profiles, especially with regards to others, as informed by Structured Assessment of Violence Risk in Youth findings and staff recorded incidents. Correlational analysis is performed to try and understand this population, with statistically significant findings highlighted. The discussion considers the trajectory for some of these young men into adult personality disorders, their presentation and prognosis compared to their female counterparts, and how their presentation contrasts with adult male forensic populations.     

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital

Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.     

Perceived coercion and need for hospitalization related to psychiatric admission

Psychiatric hospitalization constitutes a moment of major stress to the point that occurrences of posttraumatic stress disorders have been described. Feelings of coercion are usual, whatever the legal status of admission. Patients may also consider afterwards that they needed hospitalization even if they refused it initially. A cross-sectional survey has been conducted among the inpatients of a Swiss psychiatric hospital to assess their subjective view of admission with emphasis on legal status, perceived coercion and need for hospitalization. Eighty-seven questionnaires were completed and analyzed. Results indicated that 74% of patients felt that they had been under pressure to be hospitalized, whether or not they were involuntarily admitted. Seventy percent felt their admission was necessary. More involuntary patients reported a subjective lack of improvement. Clinicians could decrease feelings of coercion of their patients while discussing need for hospitalization, legal status and subjective feeling of coercion as different dimensions. An argument is presented to favor positive pressure from social environment over legal involuntary commitment in many hospitalizations.     

Problems of female patients in a secure psychiatric hospital

Abstract

The problems experienced by a sample of 30 female offender-patients in a secure psychiatric hospital were surveyed using the Behavioral Coding System (BCS). Common problems are emotional difficulties, antisocial behaviors, auditory hallucinations, and self-injury. Problem profiles derived from medical records, key workers' reports, and patients' self reports differed. The survey revealed the necessity of revising the BCS better to identify relevant concerns in this particular population.     

A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

Medicolegal problems of elopement from psychiatric units

Elopements from psychiatric units are a frequent but usually low-grade risk. However, they are sometimes followed by harmful consequences, for which the psychiatrist and the hospital may be held liable. We describe management methods developed to reduce such liability. These include a structured observation system and procedures to return elopers to the hospital or to refer them for community-based treatment. Data on 105 elopers and 360 controls were gathered and analyzed. Acceptance of some risk of elopement is inevitable on wards that follow the principle of treatment in the "least restrictive alternative."     

Blame attribution regarding index offence on admission to secure hospital services

Abstract

Assessment by psychologists is part of the routine multi-disciplinary admission process to secure facilities for those with a diagnosis of severe mental illness and an offending history. Non-engagement with the assessment process is a common clinical phenomenon. Using a survey design, we report on the administration of the Gudjonsson Blame Attribution Inventory, (a questionnaire which elicits causal attributions about offending), where possible, to a cohort of consecutive admissions to a medium secure unit, and a maximum security hospital. Reasons for non-compliance with the assessment process are examined. The responses of those who completed a series of questionnaires are compared using unit, sex, ethnicity, diagnosis and index offence as group variables. With regard to attribution of blame for index offence, contrary to prediction, those with a history of psychosis, rather than personality disorder, obtained higher external attribution scores. The implications of these findings for the assessment of blame and guilt feelings during the early stages of admission to a secure mental health service, and possible treatment implications, are considered.     

Pregnancy in prison,mental health and admission to prison mother and baby units

Little is known about the mental health of pregnant women in prison in England or the factors which impact admissions to prison mother and baby units (MBUs). Research from the UK suggests women with more ‘stable’ backgrounds and lower prevalence of mental disorder are more likely to be admitted to prison MBUs. Eighty-five pregnant women were interviewed in eight different prisons. Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) and Edinburgh Postnatal Depression Scale (EPDS) were used to assess mental health; Severity of Dependence Questionnaire (SOD-Q) for drug misuse; Alcohol Use Identification Test (AUDIT) for hazardous drinking; and the Structured Clinical Interview for DSM-IV (SCID-II) to identify personality disorder. Fifty-one per cent of participants had depression and 57% had anxiety. Those who were working prior to imprisonment were more likely to be admitted to MBUs, and those with a prior social services involvement, diagnosis of personality disorder or history of suicidality were less likely to be admitted. The high levels of depression and anxiety can have negative impacts on both the mother and her unborn child. Factors which influence MBU admission suggest those who might benefit most from MBU placement are least likely to be admitted.     

Forensic psychiatric units in Italy from the 1960s to the present

This article addresses the long-standing continuities in the history of the Italian forensic psychiatric units and views them as the result of conflicting forces, interests, mentalities and strategies at the cross-road of forensic psychiatry, psychiatry, prison and health services. It focuses on the period from the 1960s to the present and deals with, among other issues, the long-term impact of the anti-asylum movements and the on-going debate on the ‘phasing out’ of the forensic psychiatric units.     

A profile of mentally disordered offenders admitted to inpatient psychiatric services in the United States

This research note presents data about mentally disordered offenders (MDOs) treated in inpatient psychiatric services. Data are derived from 1980 admission surveys by the Survey and Reports Branch, National Institute of Mental Health (NIMH). These data report for the first time inpatient services provided to MDOs by non-Federal general and private hospitals. A total of 31,773 MDOs were admitted, with 85% going to state and county mental hospitals. The largest group, including admissions for evaluation, was ISTs (58%), followed by mentally disordered prisoners (32%), NGRIs (8%), and MDSOs (3%). Women and whites tended to be overrepresented among MDOs as compared to prison and jail inmates. Clear diagnostic differences by legal status were found, with schizophrenia predominant among NGRIs (81%) and alcohol and drug abuse disorders more frequent among ISTs. Overall, state and county hospitals in both 1967 and 1980 were the primary locus of care for mentally disordered offenders.     

一起精神病人住院期间致人伤残案的民事责任分析

精神病人住院期间致人伤残,医院应不应该承担责任,应该承担什么样的责任,这是一个比较敏感的社会话题,也是一个严肃的法律命题.本文作者通过具体案件的剖析,有理有据地认真分析和回答了上述问题.     

一起精神病人住院期间致人伤残案的民事责任分析

精神病人住院期间致人伤残 ,医院应不应该承担责任 ,应该承担什么样的责任 ,这是一个比较敏感的社会话题 ,也是一个严肃的法律命题。本文作者通过具体案件的剖析 ,有理有据地认真分析和回答了上述问题。