Jeanette Smith

Female admissions to a regional secure unit

Abstract The role of regional secure units in the care of mentally disordered women has received little attention. This article addresses the subject by examining admission characteristics of women admitted to such a facility. A number of important differences between the male and female admissions to the unit emerged. Possible reasons for these differences are explored. The typical female admission to the regional secure unit was a young personality disordered woman with a long history of deliberate self-harm and alcohol abuse. In contrast to the males, psychosis was not the predominant diagnosis. Compared to males in the unit, females were less violent, but more prone to arson and often had previous convictions for minor criminal damage. Females had fewer admissions to penal and NHS institutions than males. A history of childhood sexual abuse was not uncommon. The suitability of a regional secure unit for such patients is discussed

Amendments to the criminal code of canada: Impact on inpatient psychiatric remands

Abstract Following the changes in the Criminal Code of Canada provisions for the assessment of mentally disordered defendants, a substantial drop was observed in the numbers of patients being referred by the courts for inpatient psychiatric evaluation. No major change in the demographic, legal, or clinical characteristics of the remand patients was found. The expected increase in the finding of unfitness to stand trial was not observed. However, there was a marked trend for the new 5-day remand provision to be used for the assessment of the most severely mentally ill. Most of these individuals subsequently slipped through the gaps in the legislation, returning to jail after only 5 days in hospital and receiving no further psychiatric care. In contrast, of those remanded for 30 days, 41% were not suffering from a major psychotic illness. The implications of these findings for the care of the mentally ill offenders and the provision of forensic psychiatric services are discussed.

Maximum and medium security: the interface.

This paper examines transfer delays for patients moving between medium and maximum security hospitals. Delays appear to be getting shorter and Special Hospitals in particular respond very quickly to requests for admission. Recommendations are made for further improvements in transfer procedures. The authors argue that with closer working relationships between clinicians in Special Hospitals and Regional Secure Units, and the new proactive approach to transfers, the system will become increasingly flexible and responsive. Consequent improvements in the quality of care in Special Hospitals are anticipated, making the arguments for closing them, in turn, less convincing.

Schizophrenics Remanded to the Forensic Psychiatric Institute of British Columbia, 1975–1990

Clinical and legal data were collected on 1265 schizophrenic patients remanded to a maximum security hospital, for psychiatric evaluation of fitness to stand trial. Schizophrenics accounted for over half of the remand population. When compared to the non-schizophrenic group, they had more previous admissions to the Forensic Psychiatric Institute and the Provincial Mental Hospital. They were also more likely to be found unfit to stand trial or to have their charges stayed by the Crown. However, approximately half of the schizophrenics in this study returned to Court, fit to stand trial and with no further psychiatric treatment provided. This study raises major questions about the purpose and value of remanding schizophrenics to a maximum security hospital for in-patient fitness evaluations.

The Spectre of Criminalization: Remand Admissions to the Forensic Psychiatric Institute, British Columbia, 1975–1990

The history of the Forensic Psychiatric Institute (FPI) of British Columbia is reviewed through a description of the 3,500 remand admissions to the Institute between 1975 and 1990. Individuals charged with only minor offences and those who were certified under the Mental Health Act 1983 and subsequently had their charges stayed are examined in more detail. Results appear to suggest that these two groups are particularly vulnerable to the process of criminalization. The possible link between criminalization of the mentally ill and deinstitutionalization is explored.

Ethical dilemmas in old age psychiatry

Patients and their relatives sometimes make what to others appear to be unfortunate decisions. In this paper the ethical dilemmas raised by such decisions in the context of old age psychiatry are examined. The case also raises questions about financial responsibility for the care of the elderly and suggests that the health needs of patients can no longer be separated from their financial interests.