Suicide in high security hospital patients.

PURPOSE: People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide. METHODS: We extracted data from the Special Hospitals' Case Register on each person resident at any time between 1 January 1972 and 31 December 2000. Suicide rates were calculated for the whole period. We compared rates to the general population using standardised mortality ratios (SMRs). We used poisson regression to estimate the effects of gender, legal category of detention, offending history and length of admission on the suicide rate. RESULTS: Of the 5,955 individuals, 218 completed suicide. The suicide rate was nearly 7 times higher among resident men (SMR 662, 95% CI 478-845) and over 40 times higher in resident women (SMR 4,012, 95% CI 2,526-5,498) than in the general population; it was 23 times higher (SMR 2,325, 95% CI 1,901-2,751) and 45 times higher (SMR 4,486, 95% CI 2,727-6,245) among post-discharge men and women, respectively. The suicide rate was significantly higher among women than men inside high security but not after discharge. CONCLUSIONS: The suicide rate among high security hospital patients was significantly higher than in the general population. Women were especially at risk while resident, whereas for men, the risk was higher after discharge.

Children admitted to high security (special) hospital.

INTRODUCTION: The Special Hospitals in England provide psychiatric treatment in high security. The aim of this study was to examine the demographics and background characteristics of children admitted to high security hospitals in England, using the special hospital case register. METHOD: Forty-six children (the subject group) were admitted to a high security hospital under the MHA (1983) classification of disorder of mental illness and/or psychopathic disorder between 1983 and 1999, 33 (72%) of whom were male. A comparison group of adults was matched on sex, legal classification of detention and MHA 1983 classification of disorder. RESULTS: The children were admitted for a similar range of offences to those of the comparison group. However, the children had received convictions for criminal damage and violence at a significantly earlier age, they were more likely to have experienced a change in caregiver during their childhood, been placed in a children's home and were less likely to be living with a family member on their 16th birthday. Children admitted to special hospital experience a lot of disruption in their childhood and are extremely high users of multi-agency services as they grow up. DISCUSSION: Issues are raised regarding how to provide a developmentally sensitive service for children who require high security care.

Changes in patterns of excessive alcohol consumption in 25 years of high security hospital admissions from England and Wales.

BACKGROUND: It is now generally acknowledged that alcohol abuse increases the risk of violence among people with major mental disorder. Studies in the 1980s and earlier, however, tended to report an inverse relationship between their alcohol use and violence. AIMS: A study was undertaken to test a hypothesis that among people with major mental disorder considered to pose a serious risk to others the likelihood of excessive alcohol consumption in a period leading up to a violent or dangerous act has increased over time. METHODS: Analysis was made of annual high security hospital admission cohort case register data of 1 January 1975 to 31 December 1999; alcohol use data were taken from interview and records, and problem drinking defined as consumption of alcohol in excess of 21 units per week during the 12 months prior to the index offence or act. RESULTS: There was a linear increase in the proportion of patients in five-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offence or act. The increase was steeper among women than men, but cut across all diagnosis and offending groups. It was strongly associated with increasing tendency to abuse illicit drugs. CONCLUSIONS: The greater proportion of patients affected by excessive alcohol consumption occurred in spite of a reduction over the same period in admission of people in the diagnostic groups most likely to be implicated in substance misuse (personality disorder). This increased trend may simply reflect similar trends in the general population, but may also be associated with a lack of services or current consensus on appropriate treatment for patients whose mental illness is complicated by excessive alcohol use. Regardless, the trend suggests a growing need for 'dual diagnosis' services within and outside high security hospital.