Pub Date : 1999-07-26DOI: 10.1080/09585189908403682
D. Reiss, D. Grubin, C. Meux
Abstract In England and Wales most patients with the legal classification of psychopathic disorder who are compulsorily detained in hospital receive treatment in one of the three high-security ‘Special Hospitals’. The aim of this study was to describe their psychopathology and examine its relationship with institutional performance. The sample consisted of 89 young male patients with this legal classification who had received treatment in Broadmoor Hospital. All subjects' hospital medical records were examined and the data used to calculate scores on Hare's Revised Psychopathy Checklist (PCL-R), to diagnose DSM-III-R personality disorders, and to quantify aspects of behaviour whilst in hospital. A score of 25 or above on the PCL-R was found to be associated with the diagnoses of borderline, antisocial and narcissistic personality disorder, lack of improvement in social functioning, continued need for seclusion or special care, and discharge to a resource in the community rather than to a hospital. The fin...
{"title":"Institutional performance of male ‘psychopaths’ in a high-security hospital","authors":"D. Reiss, D. Grubin, C. Meux","doi":"10.1080/09585189908403682","DOIUrl":"https://doi.org/10.1080/09585189908403682","url":null,"abstract":"Abstract In England and Wales most patients with the legal classification of psychopathic disorder who are compulsorily detained in hospital receive treatment in one of the three high-security ‘Special Hospitals’. The aim of this study was to describe their psychopathology and examine its relationship with institutional performance. The sample consisted of 89 young male patients with this legal classification who had received treatment in Broadmoor Hospital. All subjects' hospital medical records were examined and the data used to calculate scores on Hare's Revised Psychopathy Checklist (PCL-R), to diagnose DSM-III-R personality disorders, and to quantify aspects of behaviour whilst in hospital. A score of 25 or above on the PCL-R was found to be associated with the diagnoses of borderline, antisocial and narcissistic personality disorder, lack of improvement in social functioning, continued need for seclusion or special care, and discharge to a resource in the community rather than to a hospital. The fin...","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72598774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402136
M. McCartney, M. Collins, B. Park, E. Larkin, C. Duggan
Abstract Disturbed interpersonal functioning is believed to be a cornerstone of personality disorder. We sought to determine differences in interpersonal functioning between patients detained under the Mental Health Act classifications of psychopathic disorder and mental illness. An observer-rated scale of interpersonal behaviour (CIRCLE) was administered to a mixed gender, Rampton Hospital sample of 92 patients classified as having psychopathic disorder and 92 matched patients classed as suffering from mental illness. Three-quarters of the initial sample (136 patients) were successfully assessed. Satisfactory inter-rater reliability was achieved (intra-class correlation coefficients between 0.72 and 0.55), although some potential for rater bias was identified. We found statistically significant differences between the two groups for four of the eight octants of the interpersonal circle and the two groups were typically represented in opposing halves of the interpersonal circle. The significant difference...
{"title":"The assessment and meaning of the legal classification of offenders in a special hospital using observer ratings of interpersonal style","authors":"M. McCartney, M. Collins, B. Park, E. Larkin, C. Duggan","doi":"10.1080/09585189908402136","DOIUrl":"https://doi.org/10.1080/09585189908402136","url":null,"abstract":"Abstract Disturbed interpersonal functioning is believed to be a cornerstone of personality disorder. We sought to determine differences in interpersonal functioning between patients detained under the Mental Health Act classifications of psychopathic disorder and mental illness. An observer-rated scale of interpersonal behaviour (CIRCLE) was administered to a mixed gender, Rampton Hospital sample of 92 patients classified as having psychopathic disorder and 92 matched patients classed as suffering from mental illness. Three-quarters of the initial sample (136 patients) were successfully assessed. Satisfactory inter-rater reliability was achieved (intra-class correlation coefficients between 0.72 and 0.55), although some potential for rater bias was identified. We found statistically significant differences between the two groups for four of the eight octants of the interpersonal circle and the two groups were typically represented in opposing halves of the interpersonal circle. The significant difference...","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81580471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402142
N. Gorsuch
Abstract Ten highly disturbed women on the psychiatric wing of HMP Holloway, who had experienced difficulty in obtaining beds in NHS secure facilities, were interviewed and completed the Millon Clinical Multiaxial Inventory II (MCMI-II). The results of the interviews and the MCMI-II, which both showed extreme ambivalence in the women's relationships, are discussed in terms of attachment theory. It is suggested that the ‘treatability’ criterion of the Mental Health Act is used to exclude from forensic psychiatric services women who are challenging to work with and who do not fit easily into a medical model. It is argued that ‘help’, as opposed to ‘treatment’, is a meaningful concept within the terms of the Act and that the gap in service provision through which these women fall could be filled by ‘attachment-minded’ services that have ‘help’ as their primary aim.
{"title":"Disturbed female offenders: helping the 'untreatable'","authors":"N. Gorsuch","doi":"10.1080/09585189908402142","DOIUrl":"https://doi.org/10.1080/09585189908402142","url":null,"abstract":"Abstract Ten highly disturbed women on the psychiatric wing of HMP Holloway, who had experienced difficulty in obtaining beds in NHS secure facilities, were interviewed and completed the Millon Clinical Multiaxial Inventory II (MCMI-II). The results of the interviews and the MCMI-II, which both showed extreme ambivalence in the women's relationships, are discussed in terms of attachment theory. It is suggested that the ‘treatability’ criterion of the Mental Health Act is used to exclude from forensic psychiatric services women who are challenging to work with and who do not fit easily into a medical model. It is argued that ‘help’, as opposed to ‘treatment’, is a meaningful concept within the terms of the Act and that the gap in service provision through which these women fall could be filled by ‘attachment-minded’ services that have ‘help’ as their primary aim.","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85154070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402141
N. Morant, B. Dolan, D. Fainman, M. Hilton
Abstract This paper presents descriptive quantitative data on the first 12 months of operation of an innovative outreach service for people with severe personality disorders (SPD). Between November 1995 and November 1996, 156 patients were referred to the service for outpatient treatment, inpatient preparatory work, post-inpatient follow-up and advice on management. The psychological and psychiatric characteristics of these patients are described using a range of standardized self-report scales. Scores indicate high levels of personality disorders, especially borderline personality disorder and associated behavioural and social problems. The various clinical activities of the service are described. These include the provision of individual and group psychotherapies, referrals for specialist inpatient admission and the provision of specialist advice on management to local referrers. Evidence suggests that the service is successfully achieving its aims in providing a specialist community service for people ...
{"title":"An innovative outreach service for people with severe personality disorders: Patient characteristics and clinical activities","authors":"N. Morant, B. Dolan, D. Fainman, M. Hilton","doi":"10.1080/09585189908402141","DOIUrl":"https://doi.org/10.1080/09585189908402141","url":null,"abstract":"Abstract This paper presents descriptive quantitative data on the first 12 months of operation of an innovative outreach service for people with severe personality disorders (SPD). Between November 1995 and November 1996, 156 patients were referred to the service for outpatient treatment, inpatient preparatory work, post-inpatient follow-up and advice on management. The psychological and psychiatric characteristics of these patients are described using a range of standardized self-report scales. Scores indicate high levels of personality disorders, especially borderline personality disorder and associated behavioural and social problems. The various clinical activities of the service are described. These include the provision of individual and group psychotherapies, referrals for specialist inpatient admission and the provision of specialist advice on management to local referrers. Evidence suggests that the service is successfully achieving its aims in providing a specialist community service for people ...","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77826181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402145
A. Mowbray
{"title":"Respect for the private lives of transsexuals","authors":"A. Mowbray","doi":"10.1080/09585189908402145","DOIUrl":"https://doi.org/10.1080/09585189908402145","url":null,"abstract":"","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72749132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402144
J. Atkinson, H. Gilmour, J. Dyer, Fiona Hutcheson, L. Patterson
Abstract Extended leave of absence (ELOA) is defined as leave of absence over 6 months and could be unlimited in Scotland until 1996. Patients have previously been detained under s.18 of the Mental Health (Scotland) Act 1984. A retrospective evaluation of use of ELOA was carried out using data held by the Mental Welfare Commission for Scotland. Records were used to describe reasons for using ELOA, support and service use. Over the period 1988–94 there were 534 people who had at least one episode of ELOA over 6 months and, of these, 250 had at least one episode of ELOA over 12 months. A diagnosis of schizophrenia occurs in 73% of patients. Lack of insight and threat of stopping medication are the most common reasons for using ELOA. Although threat to others is recorded more often than threat to self, self-neglect is recorded more often than either. The outcome of ELOA by year results in 30% of patients being discharged and 23% recalled to hospital. Of the total, 75% receive good support from at least one r...
{"title":"Retrospective evaluation of extended leave of absence in Scotland 1988-94.","authors":"J. Atkinson, H. Gilmour, J. Dyer, Fiona Hutcheson, L. Patterson","doi":"10.1080/09585189908402144","DOIUrl":"https://doi.org/10.1080/09585189908402144","url":null,"abstract":"Abstract Extended leave of absence (ELOA) is defined as leave of absence over 6 months and could be unlimited in Scotland until 1996. Patients have previously been detained under s.18 of the Mental Health (Scotland) Act 1984. A retrospective evaluation of use of ELOA was carried out using data held by the Mental Welfare Commission for Scotland. Records were used to describe reasons for using ELOA, support and service use. Over the period 1988–94 there were 534 people who had at least one episode of ELOA over 6 months and, of these, 250 had at least one episode of ELOA over 12 months. A diagnosis of schizophrenia occurs in 73% of patients. Lack of insight and threat of stopping medication are the most common reasons for using ELOA. Although threat to others is recorded more often than threat to self, self-neglect is recorded more often than either. The outcome of ELOA by year results in 30% of patients being discharged and 23% recalled to hospital. Of the total, 75% receive good support from at least one r...","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80207432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402149
K. Rix, M. Agarwal
Abstract A 21-year-old man attacked a fellow patient in a hospital ward and was convicted of inflicting grievous bodily harm. Before sentencing, oral evidence was given by a consultant psychiatrist to the effect that the risk of his causing serious harm to the public was low. Nevertheless a restriction order was imposed. He appealed successfully against this imposition. The appeal was upheld on the basis that there was insufficient evidence that he would cause serious harm to the public and that the trial judge, in construing s.41 of the Mental Health Act 1983, had fallen into the trap of applying the adjective ‘serious’ to the noun ‘risk’ rather than to ‘harm’. This case is considered against the background of the Butler Committee recommendations, which led to the wording of s.41, and in the light of the leading case of Birch, which drew attention to this particular trap.
{"title":"Risk of serious harm or a serious risk of harm? A trap for judges","authors":"K. Rix, M. Agarwal","doi":"10.1080/09585189908402149","DOIUrl":"https://doi.org/10.1080/09585189908402149","url":null,"abstract":"Abstract A 21-year-old man attacked a fellow patient in a hospital ward and was convicted of inflicting grievous bodily harm. Before sentencing, oral evidence was given by a consultant psychiatrist to the effect that the risk of his causing serious harm to the public was low. Nevertheless a restriction order was imposed. He appealed successfully against this imposition. The appeal was upheld on the basis that there was insufficient evidence that he would cause serious harm to the public and that the trial judge, in construing s.41 of the Mental Health Act 1983, had fallen into the trap of applying the adjective ‘serious’ to the noun ‘risk’ rather than to ‘harm’. This case is considered against the background of the Butler Committee recommendations, which led to the wording of s.41, and in the light of the leading case of Birch, which drew attention to this particular trap.","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80222043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402134
P. Mullen
{"title":"The abuse of children in care: The Grundy reports from Queensland","authors":"P. Mullen","doi":"10.1080/09585189908402134","DOIUrl":"https://doi.org/10.1080/09585189908402134","url":null,"abstract":"","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82659378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402135
P. Power
{"title":"Community treatment orders: The Australian experience","authors":"P. Power","doi":"10.1080/09585189908402135","DOIUrl":"https://doi.org/10.1080/09585189908402135","url":null,"abstract":"","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76926190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-04-01DOI: 10.1080/09585189908402138
R. Brook, M. Dolan, P. Coorey
Abstract Absconding by Special Hospital patients frequently precipitates alarmist media reporting or internal inquiries, yet available studies indicate that absconding is rare and the risk to the public is minimal. The present study set out to examine the significance of previously identified clinical factors and specific absconder profiles in risk assessment, by comparing the frequency of key variables in a group of Special Hospital absconders and non-absconders. The results confirmed that absconding was rare with minimal risk to the public. The majority of absconding incidents occurred from trips outside the hospital. Factors predictive of a high risk of absconding were a previous history of absconding, acting-out behaviour and a previous history of assault. Clinical teams correctly identified 61% of cases as high risk prior to the absconding episode, but the false positive rate was 20%. More detailed databases with larger sample sizes and systematic data collection should assist in the development of a...
{"title":"Absconding of patients detained in an english special hospital","authors":"R. Brook, M. Dolan, P. Coorey","doi":"10.1080/09585189908402138","DOIUrl":"https://doi.org/10.1080/09585189908402138","url":null,"abstract":"Abstract Absconding by Special Hospital patients frequently precipitates alarmist media reporting or internal inquiries, yet available studies indicate that absconding is rare and the risk to the public is minimal. The present study set out to examine the significance of previously identified clinical factors and specific absconder profiles in risk assessment, by comparing the frequency of key variables in a group of Special Hospital absconders and non-absconders. The results confirmed that absconding was rare with minimal risk to the public. The majority of absconding incidents occurred from trips outside the hospital. Factors predictive of a high risk of absconding were a previous history of absconding, acting-out behaviour and a previous history of assault. Clinical teams correctly identified 61% of cases as high risk prior to the absconding episode, but the false positive rate was 20%. More detailed databases with larger sample sizes and systematic data collection should assist in the development of a...","PeriodicalId":47524,"journal":{"name":"Journal of Forensic Psychiatry & Psychology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86810712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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