Contact with mental health services in the 12-month period before offending in a cohort of forensic order patients.

There has been limited research examining the details of mental health service contact in the pre-offending period. A retrospective case-note study of the complete cohort of people found not criminally responsible or permanently unfit for trial in Queensland, Australia, was conducted. An electronic clinical database search for seven treatment event types in the 12-months pre-offence was conducted. Of the 123 eligible patients, half were recorded as having experienced at least one treatment event. There was a statistically significant increase in the number of patients experiencing a treatment-related event per month over this 12-month pre-offence period (increase of ∼1.4 patients per month, p < .001). The findings highlight the need for appropriate weight to be placed on both longitudinal and recent factors when undertaking routine clinical review or mental health assessment, or considering changes to a patient's diagnosis and treatment plan. Screening in custody and early intervention are also indicated to ensure appropriate treatment.

Treating the untreatable? The biopsychosocial treatment of delusional disorder: a case study.

OBJECTIVE: Delusional disorder (DD) is well recognised, but its treatment is controversial. This article presents a case study that highlights the therapeutic benefits associated with assertive biopsychosocial treatment of DD. METHOD: The literature on pharmacological and psychological treatments for DD is briefly reviewed, and a case example from the Queensland Fixated Threat Assessment Centre is given to illustrate a comprehensive biopsychosocial treatment framework. RESULTS: Combined pharmacological and psychosocial intervention resulted in stabilisation and improvement in mental state for the case described. CONCLUSIONS: There is an emergent evidence base for an assertive biopsychosocial approach to treating DD. The case study demonstrates that a range of therapeutic goals is achievable.

Unauthorised absences from leave from an Australian security hospital.

OBJECTIVE: To consider incidents relating to absences without permission from authorised leave from a security hospital. METHOD: A retrospective audit over a 10-year period of all critical incidents relating to leave from the High Security Inpatient Services, Brisbane, Australia. RESULTS: There has been a low incidence of patients absenting themselves without permission from leave. Of the 12 patients who went absent without permission over the 10-year study period, only one patient was reported to have committed an offence and no patient seriously self-harmed. CONCLUSIONS: Attention to patient selection and risk management strategies have been effective in minimising the risk to patients and to the community as a direct result of absences without permission from authorised leave.

Characteristics of mentally disordered offenders referred for low secure forensic rehabilitation.

In the light of recognition of an increased need for secure mental health provision both at a local and national level, a 12-bed low secure forensic rehabilitation unit, Hillis Lodge, was opened in Birmingham in 2001. The aim of this study was to investigate characteristics of patients referred to this service. A retrospective case note survey was undertaken of all referrals to Hillis Lodge between August 2000 and April 2004. A comparison was then made between the accepted group and those not accepted for admission to identify characteristics that may be associated with admission to a low secure forensic unit. For the referred sample, mean age was 38 years (range 23-65 years, SD = 9.17) and in 86.4% of cases the primary diagnosis was schizophrenia. Those accepted were more likely to be detained under Part III sections of the Mental Health Act 1983 and have a greater number of previous convictions. By identifying need in this particular patient sample, this study has helped to inform the assessment process and treatment programmes in a low secure forensic rehabilitation service.