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PubMed2005

Patients with affective disorders admitted to maximum secure care (1999--2003).

The State Hospital, Carstairs, is a special secure psychiatric facility for Scotland and Northern Ireland. This study describes the background, illness and offence (where appropriate) characteristics of 25 patients admitted between 1999 and 2003 with a diagnosis of any affective disorder. Patients were, on average, 37 years old and had a lengthy history of psychiatric contact. Patients with an affective disorder were more likely to be admitted under civil proceedings, following a transfer from hospital, as opposed to being admitted under criminal procedure. Sixty per cent were discharged to prison, court or local hospitals within one year of their admission to special secure care. Significant violence during an episode of mania or hypomania (even in the presence of psychotic symptoms) appears rare. Recurrent unipolar depression resistant to first and second line treatments in women, and lithium withdrawal mania in male bipolar patients were the most common clinical problems. Treatments aimed at reducing co-morbid substance misuse, and improving compliance with mood stabilisers, appear important in managing this patient group.

Adult↗
PubMed2005

Taking chances: risk assessment and management in a risk obsessed society.

Two earlier contributions to this journal on the topic of 'dangerous behaviour' are updated in the light of recent theoretical and practical developments in the assessment and management of risk in criminal justice and psychiatry. Such assessment and management need to be viewed against the background of current over-preoccupation with avoiding the hazards of daily living.

Child↗
PubMed2006

The mental health needs of people with a learning disability detained in police custody.

Few research studies examine the prevalence or mental health needs of people with a Learning Disability (LD) detained in police custody. This paper describes the population of detainees with an LD who presented to an inner city inter-agency police liaison service during a three-year period. Two forensically trained Community Mental Health Nurses (CMHNs) screened all custody record forms (n=9014) for evidence of a mental health problem or LD. The CMHNs interviewed positively screened detainees (n=1089) using a battery of measures designed to assess mental health status, risk-related behaviour and alcohol or drug abuse. Almost one-in-ten of those interviewed (95/1089) were judged to have a possible or definite LD. Fifty-two per cent were cases on the General Health Questionnaire (GHQ) whilst 61% attained 'above threshold' Brief Psychiatric Rating Scale (BPRS) scores. The majority (63%) had a history of causing harm to others while 56 per cent had a history of self-harm. More than half (56%) regularly consumed harmful levels of alcohol while one-in-four (27%) reported abusing drugs. Higher than expected numbers of detainees have a learning disability and most have complex mental health needs. A police liaison service offers a way of identifying people with LD and connecting them with appropriate health and social care agencies.

Adult↗
PubMedDate not supplied

An outline of the forensic nursing role.

Nurses working within secure institutions are agents for both therapy and custody. With its distinctive client group, predominantly institution-based care, exceptional knowledge base and clinical focus on mental disorder and deviance, forensic nursing can justifiably claim the status of a specialty.

Dangerous Behavior↗
PubMed2001

The new Mental Health Act: a guide for clinicians.

The White Paper proposals for a new Mental Health Act have recently been published. This article examines the controversial changes in this proposal and their implications for doctors.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

To certify or not to certify: clinical social work decisions and involuntary hospitalization.

This research compares, on a variety of clinical and contextual factors, case episodes in which Clinical Social Workers decided to certify patients for involuntary hospitalization with those episodes where they decided not to certify them. A cross-sectional exploratory design was developed, and descriptive data was collected using a modified critical incident technique and a structured interview schedule. Among certified cases, the dangerousness of the patient was the major reason for certification, especially dangerousness to others. Lack of dangerousness to others and use of alternatives to involuntary hospitalization were major factors in the decision not to certify. Schizophrenic disorders were most frequently identified in certified patients; depressive and neurotic conditions in non-certified cases.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

Warning research: an integrative perspective.

We developed an integrative perspective on the empirical evidence supporting the influence of particular variables on the warning process based on a broad review of the warning literature. The warning process is described in terms of the following four components: notice, encode, comprehend, and comply. Relevant variables are classified as person variables (characteristics of the individual interacting with the warning) and warning variables (characteristics of the warning itself or the context in which the warning appears). This integrative perspective yields general principles about the variables that influence the warning process and serves as a resource for warning developers and as a guide to facilitate effective analysis of warnings. We also identify aspects of the warning process that are not well understood, directions for effective methods of intervention, and a research agenda for future efforts. Actual or potential applications of this research include improving the design of warnings.

Cognitive Science↗
PubMed2004

Threats of violence in group-oriented day treatment.

Threats of violence in a group-oriented day treatment program are examined regarding the patient's motivation to make threats, and what occurs among patients and staff that fosters threats. Effects of threats on other patients, the program, and therapists are considered. Management of the threatening patient, the group, and staff reactions are described. Safety of group members is a sine qua non for the groups to function effectively.

Adult↗
PubMed2003

Dangerous and severe personality disorders: a new personality concept from the United Kingdom.

In 1998, we in England were shocked by the apparently motiveless murders of a mother and two of her children when they were traveling home from school in a rural area. Subsequently a patient with personality disorder, being monitored by the forensic psychiatric services, was convicted of their murders. The government was determined to prevent this type of offense from recurring and in 1999 introduced a new concept, dangerous and severe personality disorder (DSPD). This subsequently became a treatment and assessment program for individuals who satisfy three requirements: (1) have a severe disorder of personality, (2) present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover, and (3) the risk of offending should be functionally linked to the personality disorder. The implications of this program are discussed with regard to international systems of classification and service provision. We also attempt to place DSPD in the wider context of psychiatric participation in the management of personality disordered offenders.

Crime↗
PubMed2006

Personality disorder as harmful dysfunction: DSM'S cultural deviance criterion reconsidered.

The DSM's general criteria for personality disorder (PD) attempt to define PD versus nondisordered personality conditions. If dimensionalization of PD occurs in the DSM-V (perhaps, it is suggested, with PD diagnosis moved to Axis I and overall personality assessment in Axis II, thus separating diagnosis from case formulation), general criteria likely will still be needed to prevent massive false positives. In this article, one of the general criteria, the cultural deviance requirement (CDR), is examined from the perspective of the evolution-based harmful-dysfunction analysis of disorder. The CDR is often assumed to express value relativity of harm in diagnosis, but cultural values are a designed feature of human social functioning that influence personality formation. The CDR is thus argued to be an indicator of whether an individual's personality organization is due to an evolutionary dysfunction. Value relativity and evolutionary analysis thus converge.

Comorbidity↗
PubMed1988

Treating the hearing-impaired in a standard chemical dependence unit.

Treatment of deaf chemical-dependent patients is considered difficult except in special facilities. We summarize the treatment of three such patients in a standard chemical dependence unit. The deaf patients were involved completely in the unit, with as few concessions as possible made to their deafness. One of the three deaf patients achieved complete sobriety through treatment. However, it was thought that all patients had gained in quality of life and productivity. We recommend techniques to modify standard facilities when specialized programs for deaf patients are unavailable.

Adult↗
PubMed1992

The relationship between license type and alcohol-related problems attributed to licensed premises in Perth, Western Australia.

Drink-driving offenses, alcohol-related traffic accidents and number of assault charges were used as indicators of the degree of alcohol-related problems associated with individual licensed premises in the Perth Traffic Police region of Western Australia. These indicators were used to rank five main categories of licensed premises according to the levels of harm experienced by their customers while controlling for the amounts of alcohol sold in each category. Nightclubs, taverns and hotels emerged as "high-risk" in comparison with clubs and restaurants. The role of such factors as different customer characteristics, opening hours, types of entertainment, restrictions on clientele and provision of meals are discussed as possible explanations underlying this finding.

Accidents, Traffic↗