David Reiss

The Stalking of Psychiatrists

Healthcare professionals are known from previous studies to be at risk from stalkers, and mental healthcare professionals, particularly psychiatrists, are thought to be at higher risk. However, no previous large-scale study has investigated this among psychiatrists. This questionnaire-based survey of 10,429 UK psychiatrists aimed to investigate the prevalence, nature and impact of stalking of UK psychiatrists. Of the 2,585 psychiatrists who submitted valid responses, 21% thought they had been stalked; the experiences of 33% met current legal criteria and 10% met strict research criteria. Three percent of respondents were currently being stalked; 2% reported that their stalking had begun in the past year. Of those who had been stalked, 64% were stalked by patients. The most commonly reported motives were intimacy seeking and resentment. Stalking persisted for over a year for 52% of victims. The stalking was intrusive, disruptive, and had significant impact. Organizational and individual responses varied in scope and effectiveness. Stalking of psychiatrists is therefore an important professional hazard with a serious impact. Improvements in organizational responses to stalking are needed.

Who stalks? A description of patients at a high security hospital with a history of stalking behaviour

BACKGROUND Knowledge about stalking, and in particular the people who do it, is limited in the UK. AIM This study aims to describe a sample of stalkers drawn from the resident population of Broadmoor high security hospital in the UK. METHODS Case notes and research database information for 362 consecutive admissions were used to identify stalkers retrospectively. Data were extracted using a stalking behaviour screening checklist. RESULTS A total of 33 patients (9.1%) were classified as stalkers. They were mostly male (28), young (median age 29), unmarried (30), minimally educated and unemployed. Most had psychosis and personality disorder. They had inflicted a wide range of unwanted intrusions and communications on their victims, and both threats (55%) and assaults (45%) were common. The types of stalkers were more or less equally split between intimacy seeking, rejected suitors, resentful and predatory, with only a tiny group being incompetent suitors. CONCLUSIONS Although this small group of stalkers had been intrusive and attacking, few had been referred for treatment because of the stalking. The screening questionnaire is easy to use and can be done from records. It may be that such screening should become routine in specialist secure hospitals.

Counterfactuals and inquiries after homicide

In England, mandatory inquiries following homicides by psychiatric patients consume a significant amount of resources but their efficacy is uncertain. Social psychologists have produced a theory of cognitive functioning called counterfactual thinking that may help us to understand better how inquiries work. Counterfactual thoughts express a past that is possible but untrue. Counterfactual theory describes a number of mutability rules that determine which events are more likely to be changed when events are examined retrospectively.Events that are more available, such as actions and exceptions (as opposed to inactions and norms), are more likely to be mutated. Inquiries also have explicit and implicit purposes that influence the counterfactuals generated. The mutability of an event is not based on an assessment of the actual influence of that event in causing an outcome. The changing of events that were not actually instrumental in determining the final event in a sequence can be dysfunctional, as inquiries may sometimes alter good decision rules to bad ones on this basis. Counterfactual theory helps to explain how inquiries may be subject to biases and errors of judgement that can manifest themselves in incorrect perceptions and the misallocation of blame.

Does ‘like predict like’ when patients discharged from high secure hospitals re-offend? An instrument to describe serious offences

BACKGROUND The statement that past behaviour is the best predictor of future behaviour has empirical support in respect of whether an individual will, or will not, commit a criminal offence. People who have offended in the past are more likely to offend in the future. The aims of this study were to develop an instrument and to examine whether the same statement applies in respect of the nature and circumstances of successive offences committed by the same person. METHOD A rating instrument to describe seven variables relating to the nature and circumstances of a serious offence, the SODI, was developed by the authors. Inter-rater reliability was measured when the instrument was applied to 80 offences committed by 40 patients leaving high secure hospitals. The data were examined for evidence of similarity in the nature and circumstances of successive offences. RESULTS For five of the seven items of the instrument the kappa coefficients for inter-rater reliability were > 0.65. No significant associations, in terms of SODI ratings, were found between the offence that led to hospital admission and that which was committed after discharge. CONCLUSIONS The SODI is a reliable instrument for the description of serious offences committed by this group. Risk assessments in psychiatry should be informed by an awareness that in only a proportion of cases will the nature and circumstances of any serious re-offence resemble the nature and circumstances of the offence which contributed to a patients admission to hospital.