Underlying patterns of practice in a regional forensic psychiatric service

A survey of referrers' satisfaction with a regional forensic psychiatric service: what do they want?

Aims and Method

The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.

Results

Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.

Clinical Implications

Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.

Occupational Therapists' Perspectives of the Needs of Women in Medium Secure Units

The Department of Health and Home Office (1992) formally acknowledged women in forensic provision as being a vulnerable group, with neglected needs in terms of care and treatment. It also clearly identified a role for occupational therapy in meeting these needs through involvement in multi-agency cooperation. The aim of this investigation was to ascertain if, from an occupational therapy perspective, the needs of women in medium secure care were being met.

A postal questionnaire was administered to 62 therapists working in medium secure provision in England, with a response rate of 73%. The data generated identified occupational therapists' perceptions of female client needs and the intervention available to women in medium secure care and provided a snapshot of therapists' views in relation to current issues in secure care.

The findings demonstrated that occupational therapists working in medium secure care had a good understanding of female client needs and tailored their intervention to be as gender-sensitive as possible within the limitations imposed by the environment. The study also highlighted the requirement for further research to investigate the needs of women in forensic environments from their own perspectives.

Medico-legal reports and gatekeeping: one year of referrals to a forensic service

Forensic psychiatrists and the services they provide have been subject to recent scrutiny and high public profile. This study examined part of the work of a regional and district forensic service by looking at a one-year cohort of referrals, and the factors contributing to patient admission, including requests for medico-legal reports. The sample consisted of all referrals to the East Midlands Centre for Forensic Mental Health, Leicester from 1 January 1998 to 31 December 1998. Information on referrals was collected retrospectively using a proforma to collate data from referral letters and the reports prepared by assessing clinicians. Two hundred and eighty referrals relating to 260 individuals were received. The sample characteristics were broadly similar to those reported in previous studies. The finding that 70% of those assessed were referred for medico-legal reports by courts or solicitors, and the fact that only 20% of this group finally entered the forensic service, led us to consider whether this work was legitimate use of National Health Service time. We examined this group more closely, and found that referral for a medico-legal report could be considered as a screening test for entry into the forensic services and there are good arguments for this work continuing.

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.

The outcome of psychiatric recommendations to courts

The case notes, court reports and outcomes of 699 consecutive out-patient referrals to a forensic service for court reports, related to criminal offences, were examined. The relationship between rejection of psychiatric recommendations to the court and a number of different variables was examined. Age, sex and ethnicity were found to be unrelated to rejection rates. Referrals from defence solicitors, certain offences and certain diagnoses were found to be over-represented among those cases in which such recommendations were rejected.