Martin Humphreys

The State Hospital survey: A description of psychiatric patients in conditions of special security in Scotland

Abstract The State Hospital, Carstairs, is the maximum security psychiatric facility for Scotland and Northern Ireland. This study describes the cohort of patients there (N = 241) between 1992 and 1994. Case-notes were examined to ascertain demographic details and information on psychiatric, medical, drug, forensic, family and personal histories. Diagnoses were made by application of the St Louis criteria (Feighner et al 1972). Standardized interviews were held with each patient and the responsible medical officer. Patients were on average 34 years old and had spent 9 years in psychiatric hospitals. There were 169 (70.1%) who had a principal diagnosis of schizophrenia. Approximately half were admitted following an offence and over 80% had a history of criminal activity. Physical health problems were present in more than 50% of patients. Adverse childhood events of diverse kinds were frequently reported. Psychotic symptoms continued to occur in many patients despite extensive treatment. More than half were...

Medical students’ attitudes to psychiatric illness in primary care

Context  Previous research has shown that general practitioners (GPs) hold negative attitudes towards patients with schizophrenia, which do not simply reflect the nature or chronic aspects of the illness. This study aimed to describe the attitudes and predicted behaviour of medical students towards patients with mental illness in a primary care setting and to investigate whether these were affected by the students’ level of training.

The future of psychiatry.

There is widespread concern among psychiatrists that the profession is in crisis and that it faces an array of external and internal challenges. Indeed, some observers have questioned whether the psychiatrist is an endangered species. This paper argues that medical specialties can become extinct as the case of the apothecaries exemplifies. The training template for psychiatry in the UK was put in place 40 years ago and there is a need to carefully examine whether it is still fit for purpose. Advances in theoretical knowledge and in basic understanding of psychiatric disorders have not significantly influenced the structure of clinical placements; rather it is service developments and administrative demands that have been the determinants of changes in training. Urgent action is required to address the need for reform of training that will ensure the future of psychiatry as a profession.

Possible Predictors of Outcome for Conditionally Discharged Patients – A Preliminary Study:

Conditional discharge for restricted hospital order patients is by and large a successful process. The present study aimed to identify variables among a cohort of conditionally discharged patients in the West Midlands that would predict whether an individual was more likely to be readmitted to hospital, involved in a serious incident, to be recalled to hospital or given an absolute discharge. A retrospective case note analysis was undertaken. Logistic regression analysis was used to identify variables that could predict outcome. Patients were six times more likely to be readmitted to hospital if they misused drugs and nine times more likely if they self-harmed. They were also six and four times more likely to be involved in a serious incident if they misused alcohol and drugs respectively. Patients were five times more likely to be recalled to hospital if they did not have close social support and were four and a half times more likely to get an absolute discharge if they lived in supported accommodation. Conditional discharge is an effective model of community care for restricted hospital order patients. Addressing the problems caused by drug and alcohol misuse, self-harming behaviour, recognising the importance of a close social support network and developing more appropriate housing for these individuals will help make the process more successful.

CONSULTANT PSYCHIATRISTS' KNOWLEDGE OF MENTAL HEALTH LEGISLATION IN SCOTLAND

There has been increasing concern recently over an apparent lack of knowledge of mental health law among psychiatrists and other medical practitioners involved in its use. This has been particularly highlighted by the introduction of new and complex legislation intended to facilitate care in the community. As a result of findings from previous studies of other groups of medical practitioners in Scotland, a national survey of consultant psychiatrists working there was undertaken to determine their level of understanding of the statutory provision for the care of the mentally disordered. A purpose-designed instrument was used at interview with 72 consultants chosen at random from all psychiatric specialties. Their knowledge of even the most basic definitions and fundamental areas was limited, with only just over half being able to give the correct title of one relevant piece of legislation and only one in 10 being able to define mental disorder in terms of the Act. Otherwise knowledge was generally patchy. Greater emphasis should be placed upon training in mental health law for consultant psychiatrists in general, as the findings are unlikely to reflect purely localized patterns. Attitudes to the use of compulsory measures also need to be addressed.

Restricted hospital orders: A survey of forensic psychiatrists' practice and attitudes to their use

Abstract Forensic psychiatrists throughout mainland UK and Northern Ireland were sent a postal questionnaire to determine their practice in cases where a restriction order was deemed appropriate and also their attitudes to the use of restricted hospital orders. Data were obtained about the estimated number of reports completed by each respondent and recommendations for restriction orders. In particular, the reasons why a restricted hospital order might be recommended or considered appropriate were sought. Out of the original sample of 97 psychiatrists, 74 (76%) returned completed questionnaires. They had written in excess of 3,000 legal reports in the previous 12 months and 60 (81%) had been involved in cases where a restriction order was considered appropriate in the same period. Of the 74 who responded, 33 (45%) said that they would specify the need for a restriction order when necessary, 27 (36%) stated that they would make no mention of it, and the remainder said that their practice would vary. Time-l...

Changes in laws are necessary to allow patients detained under Mental Health Act to vote

Editor—Before the Representation of the People Act 1983 came into force many people with mental illness were denied the right to vote. Even after the act was passed it remained more difficult for people with mental illness to register to vote than it did for other people.1 Until recently, patients detained under the Mental Health Act had been assumed to be disenfranchised because they lacked a permanent address. Recently, the Home Office issued guidelines on the eligibility of people with mental illness to vote.2 The day after the …

A Clinician’s Brief Guide to the Mental Health Act

Tony Zigmond. RCPsych Publications, 2011, £18.00, pb, 126 pp. ISBN: 9781908020024 Book titles, even in the case of non-fiction, can sometimes be ambiguous, unintentionally misleading or even deliberately obscure. This is definitely not so with Dr Zigmond’s new guide to the Mental Health Act. It

Conditionally discharged restricted patients and the need for long-term medium security

In the context of a larger investigation of follow-up of a specific group of mentally disordered individuals, the study described here examined the characteristics of all 55 people conditionally discharged for the first time from a medium secure unit in the West Midlands over a 13-year period. A retrospective case note analysis was undertaken. The findings illustrate that these patients are a distinct group. They were mainly single men who had committed a grave offence. The majority had an extensive criminological history with early onset of offending and chronic mental illness. Fifty per cent of those with a criminal record had received at least one custodial sentence prior to the index offence. Co-morbid substance misuse was common, as was a history of self-harm. There were high levels of previous contact with psychiatric services and compulsory in-patient treatment. Most were detained under the Mental Health Act category of mental illness. A quarter had been transferred from a special hospital prior to conditional discharge into the community. The characteristics of this sample demonstrate clearly the need for the provision of long-term medium secure facilities and allied services.

Monosymptomatic hypochondriacal psychosis and prolonged solitary confinement

A man previously imprisoned for 11 years developed unremitting and treatment-resistant monosymptomatic hypochondriacal psychosis following a period in excess of 12 months in solitary confinement. We are unaware of any other reported incidences of this disorder arising in such circumstances.