The influence of admission characteristics on outcome: evidence from a medium secure forensic cohort.

Objective: Outcomes for any mental health service will vary with the characteristics of those admitted as well as with the clinical provision of the service itself. This study aims to explore, for a medium secure forensic service in England, temporal changes in (1) characteristics of those admitted and (2) outcome after discharge and (3) to examine whether such changes are related.

Method: Baseline characteristics and reconviction outcomes were derived from multiple data sources for 550 first admissions to a medium secure forensic unit for a 20-year period.

Patients with a history of arson admitted to medium security: characteristics on admission and follow-up postdischarge.

Patients who set fires are a perennial cause of concern with psychiatric services although perhaps rather neglected in the clinical research literature. The current study considered the characteristics on admission of 129 patients, 93 men and 36 women, with a known history of arson who had been admitted to a medium secure psychiatric hospital. The distinguishing characteristics of the sample were high numbers of patients with extensive criminal histories, most probably due to high levels of prison transfer and a higher occurrence of mental illness than psychopathic disorder.

Life-threatening hyponatraemia and intramuscular olanzapine: the world's longest therapeutic trial.

This case report provides a different perspective on the management of a patient with a psychotic illness. The detained patient, a man aged 50, had specific delusional beliefs about toxins affecting his kidneys, such that he needed to drink water to 'detoxify' himself. This resulted in him developing life-threatening hyponatraemia.

The EssenCES measure of social climate: a preliminary validation and normative data in UK high secure hospital settings.

Background: The social climate of forensic units is important but little investigated, in part because of the unavailability of a clinically practical and statistically sound measure.

Aims: To provide preliminary psychometric and normative data for the English version of the Essen Climate Evaluation Schema (EssenCES) in UK high-security hospital settings.

Method: A total of 324 staff and patients from three high-security hospital services completed the EssenCES, and a subgroup completed a range of other questionnaires related to therapeutic milieu and working environment (GMI, WAAM, WES-10).

Long-term outcomes after discharge from medium secure care: a cause for concern.

Background: There are few long-term follow-up studies of patients discharged from medium secure units in the UK, even though these units were introduced over 20 years ago.

Aims: To describe mortality, rates of reconviction at different time periods; violent behaviour (not leading to conviction), readmission and employment, after discharge from a medium secure unit.

Method: Of 595 first admissions over a 20-year period, 550 discharged cases were followed-up.

Meeting patients' needs in secure forensic psychiatric units.

The authors have developed a security needs assessment profile designed to match the service provided in secure, forensic psychiatric units more accurately with the needs of individual patients. They are carrying out an 18-month survey of all secure units in England and are seeking participants to help refine the profile, gain more understanding of what is provided throughout the country, and assess the views of other clinicians and managers.

Therapeutic community treatment of personality disorder: service use and mortality over 3 years' follow-up.

Background: A number of studies have demonstrated reductions in the utilisation of psychiatric services, especially acute in-patient admissions, following therapeutic community treatment of personality disorder. These studies have, however, been of limited duration (1 year) and follow-up has not always been complete.

Aims: To identify hospital admissions before and after therapeutic community treatment of personality disorder.