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This article summarises arguments for abolishing the mental impairment defence, using the example of the defence in Victoria, taking a historical and comparative approach. It considers the defence in practice, its origins and stagnation in medieval and Victorian England, a better approach based on modern developments in the UK and Europe, its resistance to meaningful reform, and its failure to achieve its laudable, humane and principled aim of sparing vulnerable people with severe mental health problems from punishment. We conclude that the only way to actually achieve this aim is to abolish the mental impairment defence and replace it with an approach that allows for flexible mental health disposals for mentally disordered offenders based on clinical needs and, where necessary, the need for containment, incorporated in and aligned with mental health legislation, regardless of culpability, and with modern systems and services that bring Victoria out of the nineteenth century. [ABSTRACT FROM AUTHOR]

White-collar crime (WCC) causes considerable societal harm, the economic and psychosocial costs of which exceed those of conventional crime. Despite the impact, it has received scant attention from the academic literature in forensic psychiatry. This narrative literature review covers important topics in our understanding of white-collar crime, including offender characteristics such as demographics, criminal history, mental illness, personality and psychopathy, the link with violent offending and the trajectory of the white-collar offender (WCO) through the criminal justice system. White-collar crime is under-researched, particularly with regards to psychopathology, and the field of forensic psychiatry may have important contributions to make to our understanding of this important and harmful type of crime. [ABSTRACT FROM AUTHOR]

Dr Proeve's paper draws upon empirical research and conceptual reasoning to provide the basis for a pragmatic consideration of remorse by both mental health experts and by the courts. The needs of the law pose certain questions that mental health experts may seek to answer; conversely, mental health professionals provide answers that may shape and at times constrain jurisprudence. Since its inception in 1978, ANZAPPL has sought to foster dialogue between legal professionals and mental health professionals. [Extracted from the article]

The field of sexual homicide research is relatively recent, with many existing studies limited by small sample sizes and sampling bias. In Australia and New Zealand specifically, only one study to date addresses this phenomenon but there is a lack of comprehensive descriptive data. This study aims to fill this research gap using a representative sample gathered from public legal databases. A total of 118 cases of sexual homicide offenders are described to create a portrait of this type of offender, their victims and their offence behaviour. Findings are similar to those found in other large samples from the UK, Canada and Germany. Because this crime is rare and practitioners tend to have limited experience of them, the findings of this research have the potential to inform investigative, criminal justice and clinical practice. [ABSTRACT FROM AUTHOR]

Sexual homicides (SHs) demand nuanced research for effective prevention, treatment, risk assessment and theoretical insights. Intimate‐partner sexual homicides (IPSHs), comprising approximately 20% of SHs, have received limited attention. This study compares IPSHs (n = 56) and non‐intimate partner sexual homicides (NIPSHs) (n = 236) in Australia and New Zealand by investigating offender, victim, and crime‐scene characteristics. While IPSH perpetrators were typically older, separated, and had prior domestic violence convictions, victims were more often non‐white with histories of domestic violence and substance use. Although crime‐scene locations and post‐offence behaviours differed, similar crime scene behaviours were displayed across offender groups, which seemed to be routed in different underlying motives. Whereas drivers of IPSH commonly were grievance and anger, associated with offences occurring after arguments, drivers for NIPSH were more often sexual deviance and sadism. Overall, IPSH encompasses aspects of domestic violence, homicide, and sexual violence, distinguishing it from SH. [ABSTRACT FROM AUTHOR]

Sexual sadism and psychopathy are often considered synonymous with sexual homicide, but there is limited research on their associates in sexual homicide offenders. Associates of dimensional measures of sexual sadism (Sexual Sadism Scale; SeSaS) and psychopathy (Psychopathy Check List-Revised [PCL-R] total, Factor 1, and Factor 2) were examined in 51 male Scottish cases. Over a third were DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) sexual sadists, just under a third screened in with the SeSaS, and a quarter were "Hare psychopaths." Sexual sadism and PCL-R measures were moderately associated. Sexual sadism predicted control, sexual deviance, and unusual behaviour at crime scenes; attempted homicide and having a co-accused; and multiple sexual homicides and previous sexual offending. PCL-R Factor 1 predicted violent, exploitative, and evading detection behaviours at crime scenes; completed homicide; and previous violent offending. PCL-R Factor 2 predicted impulsive behaviours at crime scenes, substance misuse, and previous general offending. Psychopathy and sexual sadism play key roles in sexual homicide, interact with each other, and determine different aspects of offences and offenders. [ABSTRACT FROM AUTHOR]

The present study examined distinctions between child (n = 30) and adult (n = 212) sexual homicide offenders (SHOs) in Australia and New Zealand, contributing to the limited international research on the subject. Data, primarily sourced from judges' sentencing comments on AustLII and New Zealand Legal Information Institute, revealed significant differences. Child SHOs displayed elevated rates of pedophilia, sexual deviance, and adverse childhood experiences, including sexual abuse. They were more likely to be married, cohabitate, and target familial victims. Their crimes were more often committed during daylight and outdoors, involving tactics such as victim conning, restraints, strangulation, and hiding victim's bodies. No significant group differences emerged regarding offenders' psychopathy or sexual sadism scores. Results were interpreted in line with child SHOs' deviant sexual preferences and the routine activity theory. The study, as the first investigating child sexual homicides in Australia and New Zealand, sets the foundation for an evidence‐based approach to policy and practice. [ABSTRACT FROM AUTHOR]

Objective:To determine forensic, clinical, social and administrative outcomes of high-security patients.Method:Prospective year follow-up study of 169 patients with schizophrenia, 1992–1993.Results:By the end of the study, 46 (27.2%) patients were in high security, 43 (25.5%) in medium- or low-secure units, 35 (20.7%) in an open ward, 3 (1.8%) in prison and 40 (23.7%) in the community. Violence occurred in 75% of patients over the 10-year follow-up period, and this was serious in 25%. Continuous positive symptoms of psychosis were present in over one-third. One-third had self-harmed during this period but there was only one known suicide and 11 (6.5%) deaths in total. At the end of the study, there was only one person in voluntary employment, 18 (12.7%) living independently and 10 (7.1%) in a relationship. Models were developed to determine factors relevant to these major outcomes.Conclusions:This is the first study providing comprehensive outcome data over a 10-year period. Forensic services appear good at managing the risk to the community but poor at promoting better social outcomes. The levels of violence within inpatient units are high. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) has focused on victims, with minimal attention given to perpetrators of violent crimes who might subsequently develop offense-specific PTSD from their own offenses. Its prevalence and associations are not well-established. In accordance with PRISMA guidelines, 10 databases were searched to identify studies examining offense-specific PTSD in perpetrators of violent crimes. Fourteen unique studies were identified across prison, forensic hospital, and community settings. Sample sizes ranged from 19 to 339, with 8 studies assessed to be of at least adequate quality. Prevalence rates of offense-specific PTSD ranged from 1.5% to 76.6%, with 8 studies identifying a prevalence of 33.3% or greater. Associations with offense-specific PTSD were examined by 8 studies, with PTSD from prior trauma and post-offense guilt and shame the most-studied. Post-offense guilt and shame was consistently associated with offense-specific PTSD. Other associates included alexithymia, co-morbid anxiety and depression, certain personality subtypes, and intentional perpetration. Offense-specific PTSD is present in a significant proportion of perpetrators of violent crimes. More research of higher quality is required on this condition and its associations. Increased recognition of offense-specific PTSD and viewing perpetrators of violent crimes as potentially-affected persons could guide clinicians in forensic settings toward a more trauma-informed approach. [ABSTRACT FROM AUTHOR]

This paper describes the recent decision of the Scottish Court of Criminal Appeal in the case of a restricted patient convicted of homicide by reason of diminished responsibility in 1967. Mr Reid had initially been detained under a hospital order with restrictions under the legal category of mental deficiency. The appellant was contesting this initial mental health disposal as it had since become clear he did not have a learning disability and was subsequently detained by virtue of a personality disorder diagnosis. It was put to the Court of Appeal that the original disposal was not informed by proper expert opinion, as evidenced by the court reports, and that a criminal justice disposal should be substituted. Reid believed he was more likely to be eventually released into the community from an indeterminate prison sentence than from a restricted hospital order. The court rejected the appeal, finding that the court reports presented at the time of disposal may not have reflected the full assessment of the experts who may also have given further explanation of their views in oral evidence. [ABSTRACT FROM AUTHOR]

This article describes the recent decision of the European Court of Human Rights in the case of a patient with personality disorder detained under a restriction order in Scotland's high security hospital. This is set in the context of recent case law in Scotland in similar cases and in England where forensic patients have made challenges, in domestic courts under the European Convention on Human Rights (ECHR), to their detention and treatment. We conclude that the ECHR has offered little in the way of tangible benefit to such patients. [ABSTRACT FROM AUTHOR]

Describes a case law about diminished responsibility in Scotland. Mental abnormality; Court decision; Establishment of exclusions from the abnormalities of mind category; Role of the expert witness.

Studies show that schizophrenia is associated with increased substance misuse/dependence. An association exists between co-morbidity and violence/offending. Our aim was to compare substance-dependent and non-substance-dependent patients with schizophrenia, by using patient interviews and retrospective case-note data. A sample of 169 patients with schizophrenia in high-security psychiatric care was divided into two groups by using the absence/presence of substance dependence. Diagnoses were made using St Louis criteria. Of the patients, 88.8% were male. Lifetime rates of substance misuse showed that 53.8% had a history of alcohol misuse and that 53.3% had a history of drug misuse. Co-morbid substance dependence was present in 41.4% and schizophrenia alone in 58.6%. Co-morbid patients were more likely to be from the west of Scotland, to have a history of convictions and to be intoxicated prior to admission. They were more likely to be treated with anti-cholinergics or anti-depressants, to suffer affective symptoms or to have anti-social personality disorder. They were less likely to have negative symptoms, thought disorder, or learning disability and less likely to be civilly detained. This study finds high rates of substance misuse/dependence occurring co-morbidly with schizophrenia in Scottish high-security settings. Co-morbidity is associated with increased offending. Differences in symptom profiles and demographics may have potential implications for recognition and risk management. [ABSTRACT FROM AUTHOR]

'Psychopathic disorder' has retained its place in English and Welsh mental health legislation since 1959, but is innominate in equivalent Scottish legislation. This paper describes the evolution of the law relating to personality disorder in Scotland, including consideration of the development of diminished responsibility, the introduction of the moral imbecile and the 'absence' of psychopathic disorder from the Mental Health (Scotland) Act 1960 and the Mental Health (Scotland) Act 1984. It emerges that statute law in Scotland has been very similar to that in England and Wales. However, legal practice in relation to diminished responsibility prior to the abolition of the death penalty excluded psychopathic offenders, and psychiatric practice since the 1970s has tended to reject hospital disposals for offenders with primary personality disorders. A historical understanding of personality disorder and the law in Scotland clarifies current difference between Scotland and England and Wales, and helps in the understanding of proposed future development in this area in Scotland, which, subsequent to devolution, is likely to diverge from England and Wales. [ABSTRACT FROM AUTHOR]

In Scotland the MacLean and Millan Committees have produced reports making proposals for serious violent and sexual offenders and for reform of mental health legislation respectively. The MacLean Committee proposals set out a framework for the assessment and sentencing of offenders who may pose a high risk of further serious offending. Such offenders would undergo a formal, accredited, structured clinical risk assessment prior to sentencing, and those determined to be high risk would be sentenced to an 'Order for Lifelong Restriction' (OLR). This OLR would be an indeterminate prison sentence, with release following a punishment tariff being dependent on risk assessment and a risk management plan. Risk management in the community would involve supervision, programmes, monitoring and potential recall to prison. The MacLean Committee proposals are clearly set out as criminal justice measures with the determination of 'dangerousness' not being linked to any form of mental disorder. The Committee did not feel that special provisions were required for personality disordered offenders. The Millan Committee's proposals for reform of the Mental Health (Scotland) Act 1984 highlight the protection of the rights of mentally disordered patients and shift the emphasis from detention in hospital to treatment for mental disorder, whether in hospital or the community. The Millan Committees proposals include explicit guiding principles, modernized categories of mental disorder, criteria for detention which include a modified incapacity criterion and a 'treatablity' criterion for all types of mental disorder, compulsory orders in hospital and the community, mental health tribunals to replace the sheriff court as the legal forum for granting orders and for appeals, and the end of the Executive's role in determining the discharge of restricted patients. The Scottish Executive responded positively to both reports, and a Criminal Justice (Scotland) Bill and Mental Health (Scotland)... [ABSTRACT FROM AUTHOR]

Examines several proposals for mental health legislation and for high-risk violent and sexual offenders in Scotland. Assessment and sentencing of offenders; Clinical risk assessment prior to sentencing; Determination of dangerousness; Protection of the rights of mentally disordered patients; Detention in hospital and treatment of the disorder.

Focuses on the legislation on the detention of untreatable patients with psychopathic disorder. Categories of mental disorders; Recommendations on managing people with dangerous personality disorders; Provision of the Mental Health Public Safety and Appeals) (Scotland) Act 1999.

The Crime and Punishment (Scotland) Act 1997 introduced the hospital direction, Scotland's 'hybrid order'; so called because it allows the courts simultaneously to send a mentally disordered offender to hospital and to impose a prison sentence, to be completed after hospital discharge. Similar legislation has been introduced in England and Wales for offenders with psychopathic disorder, but the Scottish legislation applies to all legal categories of mental disorder. There was opposition to the introduction of the hospital direction from psychiatrists in Scotland. In this survey psychiatrists engaged in forensic work in Scotland were identified (N = 51). Respondents (n = 41) completed a decision-making exercise based on fictional case-vignettes, designed to elicit their attitudes towards hospital directions. The majority of respondents favoured the introduction of a hospital direction (n = 29). It was felt to be useful in cases where personality disorder coexisted with mental illness which was brief, drug-induced or not related to offending. It was not felt to be useful in cases of antisocial personality disorder alone. However, there were concerns about the working of the new legislation: whether it would be used appropriately by courts and whether psychiatrists should recommend a disposal that includes imprisonment. [ABSTRACT FROM AUTHOR]

Reports on a court ruling on a case involving the detention of patients with psychopathic disorder in Scotland. Details of the case; Provisions of the Mental Health Act of 1984; Implications for medical laws and legislation.

Foreign object insertion (FOI) is considered as an unusual behavior and has been defined as the involuntary insertion of any object, by another individual, into any orifice of the victim. Although there is some research on the prevalence and nature of FOI in sexual homicides, there is very little on the characteristics of cases where FOI occurs, and no previous research has compared cases with and without FOI. Given the lack of research on FOI in general and the dissemination of untested ideas regarding the correlates of this behavior specifically, the current study aims to shine new light on sexual homicide cases involving FOI by examining the offender, victim, and crime characteristics associated with FOI. Using a sample of 662 cases of sexual homicide, chi-square and logistic regression analyses were used to compare cases with and without FOI. Results showed that offenders who experienced sexual dysfunction and victims who used alcohol/drugs prior to the crime were more likely to be involved in cases with FOI. Cases where victims were beaten, vaginal/anal fisting acts were perpetrated, and mutilation of genitals were observed, were more likely to show evidence of FOI. Finally, postmortem sexual activities and the use of strategies by offenders to avoid police detection were also more likely to occur in sexual homicide cases characterized by FOI. These findings are discussed in light of the literature on sexual homicide, the vulnerability of victims, and the manifestation of sadism. Practical implications are also discussed. [ABSTRACT FROM AUTHOR]

Research comparing sexual homicide (SH) and non-sexual homicide (NSH) has been rare outside North America and Europe and has contributed to addressing whether SH is primarily a sexual or homicide offence or a hybrid. This case–control study compared 142 SH and 142 NSH cases from Australia and New Zealand. Bivariate analyses indicated SH offenders more often had sexual problems, lacked intimacy, and appeared more prosocial, had less serious mental health problems, with lifestyles giving opportunities to access victims. Planning rather than reacting, sexual fantasies and arousal, time, and isolation to interact with victims privately, control of victims and crime scenes, lack of remorse, reliving the experience later, preventing detection, and more intrusive, intimate, and sadistic interactions characterised SH offences. Victims were more likely to be strangers, unrelated, single, and living alone. We developed multivariate models to predict SH, with the final model including: offender single, with a sexual disorder, but not a substance use disorder or major mental illness; offence long in duration, with expressive physical violence and unusual or ritualistic features, against a stranger, in an isolated location. These results are consistent with previous studies and indicate SH is different from NSH, supporting differential practice with SH. However, the findings could primarily reflect the over representation of sexual sadism in SH and the over representation of intimate partner victims in NSH. Future research needs to consider the heterogeneity of SH. [ABSTRACT FROM AUTHOR]

While a number of previous studies have compared sexual homicides to nonlethal sexual offenses, there have been few studies comparing sexual and nonsexual homicides. This study examines whether sexual homicide offenders differ from nonsexual homicide offenders in Scotland regarding characteristics of the offender, the victim, and the homicide incident. Unlike previous studies, only homicides committed by males against females were examined. Data from a national police database were used to compare 89 male sexual homicide offenders who killed adult females with 306 male nonsexual homicide offenders who had also killed adult females using bivariate and multivariate (logistic regression) analyses. The findings revealed not only some similarities between the two groups, particularly regarding some victim variables, but also significant bivariate and multivariate differences. Sexual homicides appeared to be associated with indicators of instrumentality and sexual deviance. We conclude that sexual homicide offenders might be considered a distinct group of homicide offenders, more similar to sexual offenders than to other homicide offenders. [ABSTRACT FROM AUTHOR]

The authors suggest that a basic flaw in proposed mental health legislation in Great Britain is the assumption on the part of the government that mental health law is a way in which to improve public protection. They believe that such legislation was successfully implemented in Scotland because its focus was on care and treatment.

Editorial. Presents an editorial regarding mental health legislation in Scotland as of October 2004. Concerns raised by the reform of mental health legislation in England and Wales; Statement that the Mental Health (Scotland) Act is more concerned with the care of people with mental health problems than with locking up dangerous offenders; Report that to compel treatment, patients must be treatable, some risk to self or others must exist, and their ability to make decisions about treatment should be significantly impaired because of their mental disorder; Introduction of the Mental Health Tribunal for Scotland; Procedures for offender patients.

Research on female sexual homicide has been very scarce. In Europe, it has rarely been examined, and in Scotland, it has never previously been studied. This exploratory study aims to examine the characteristics of sexual homicides involving female offenders between 1990 and 2015 in Scotland. Using data from the Scottish Homicide Database between 1990 and 2015, female sexual homicides (n = 7) were compared to nonsexual homicides committed by females (n = 106) and to sexual homicides committed by men (n = 89) using Fisher's exact tests. The findings show that although female sexual homicide offenders are similar to both female nonsexual homicide offenders and male sexual homicide offenders in certain aspects, there are important differences that distinguish sexual homicides involving female offenders from both groups. Female sexual homicide offenders can arguably be seen as a distinct group of offenders, with specific characteristics and specific needs. [ABSTRACT FROM AUTHOR]

Forensic services in Scotland are evolving, based on similar developments previously in England and Wales. The Orchard Clinic in Edinburgh is the first medium secure unit to open in Scotland. This paper aims to describe the patients admitted to the unit in the first five years of its operation, to consider antecedents to their admission, patient characteristics and progress through the system. With the development of a new service it is important to benchmark against established services and, therefore, a comparison is made with earlier studies of forensic populations in Scotland and elsewhere in the UK. [ABSTRACT FROM AUTHOR]

Risk assessment tools are increasingly used in the management of mentally disordered offenders in Scotland, but there has been limited research into their validity among this population. The aim of this study was to examine the validity of risk assessment tools in predicting violence following discharge from a Scottish medium secure unit. The PCL-SV, the VRAG, and the historical subset of the HCR-20 were completed on 96 patients. Follow-up information regarding post-discharge violence and clinical factors was collected for two years. Four (4.2%) patients from the sample committed five serious violent offences, while 38 (40.6%) patients committed more than 100 minor violent offences. The risk assessment tools were found to have moderate predictive accuracy for violent outcomes. Thus this study provides useful evidence supporting the validity of risk assessment tools in Scotland. Individual clinical factors such as substance abuse, personality disorder, treatment non-compliance, and symptom relapse are also relevant in risk assessment and management. [ABSTRACT FROM AUTHOR]

Experience of psychological trauma is correlated with violent offending, with exposure reported for most offenders entering the criminal justice system. The practice of trauma-informed sentencing recognises this complex and consistent relationship, and endeavours to respond in a way that avoids re-traumatisation and reduces harm to offenders and victims. Trauma-informed approaches to offenders improve safety in custodial settings, enhance prospects of correctional rehabilitation and recovery from mental illness and promote the health and welfare of staff working with offenders. This quantitative pilot study examines the identification and impact of trauma – as recorded in sentencing decisions – for homicide perpetrators in Victoria, with particular attention to trauma-informed sentencing and whether or not gender makes a difference. Traumatic experiences were described in a high proportion of cases but only explicitly recognised in a minority. Trauma-informed sentencing recommendations were rare. Collaboration between clinical and legal professionals to inform and enhance trauma-informed procedures is recommended. [ABSTRACT FROM AUTHOR]

There is a dearth of research on multiple perpetrator sexual homicide. This is an exploratory and descriptive study of the phenomenon in Australia and New Zealand over the last five decades. Cases where sexual homicides were committed by two or more offenders were identified from a legal database. Legal reports and media sources were used to generate case vignettes describing groups, victims, offenders and offences. Summary descriptive data is presented, and the roles of leadership, group composition and sexual sadism are examined. There were 23 groups of 62 offenders, who killed 50 victims. Fifteen groups were pairs and eight were three or more. There were some similarities to single perpetrator cases in the literature, but female perpetrators, male victims, multiple victims, ability to form relationships and sadistic behaviour were over-represented. Most groups had a dominant leader. Leadership and group effects are key factors in most multiple perpetrator sexual homicides. Current models and typologies of sexual homicide need to be adapted to apply to this phenomenon. Sadistic behaviour in such cases is partly due to sexually sadistic leaders but partly due to the amplifying effect of group dynamics. • There has been very little research on multiple perpetrator sexual homicide. • These crimes in Australia and New Zealand over 50 years were complex and diverse. • Most involved a dominant leader, and few were equal partnerships. • Sadistic behaviour was common, due to both sexually sadistic leaders and group amplifying effects. • Current theoretical models require adaptation to apply to sexual homicides committed by groups. [ABSTRACT FROM AUTHOR]

Assessment of risk of violence is essential in the management of patients with schizophrenia admitted to secure hospitals. The present study was conducted to test the validity of actuarial measures and psychotic symptoms in the prediction of further violence and offending in this group. The H-10 scale of the HCR-20, Violence Risk Appraisal Guide and Psychopathy Checklist-Revised were scored retrospectively. Symptom severity was rated at interview and persistence from notes. Outcome was measured using criminal records and recorded incidents of aggression over an 8-10 year period. Seventy-six percent of patients were involved in more than 1800 incidents defined as physical contact with a victim or damage to property, and 28% in a serious incident defined as injury to a victim requiring hospital treatment, a contact sexual incident or fire setting. Fifteen percent of patients were convicted of any offense and 5% of a violent offense. The risk scales had moderate to high predictive accuracy for offenses and violent offenses but failed to predict incidents or serious incidents. Symptom severity and persistence predicted incidents but not offenses. Violence within this population is common. Actuarial measures of risk assessment are valid predictors of offending and violent offending but psychotic symptoms are more relevant to the prediction of violent incidents. Assessments of likely inpatient aggression must emphasize symptoms. [ABSTRACT FROM AUTHOR]

Background International literature is consistent on there being a significant relationship between psychosis and violence, less so on its extent and nature, but two main presentational types are increasingly recognized. In one, people are unremarkable before onset of illness and psychotic symptoms commonly drive violence; in the other, psychosis is preceded by childhood conduct problems, associated with personality disorder, and psychotic symptoms seem less relevant. Aims To explore the extent to which variations in aspects of social and service context in different jurisdictions affect presentational type among people admitted to high security hospitals. Hypotheses There will be differences between jurisdictions in proportions of patients with pure psychosis or with psychosis and antecedent personality disorder, but symptom drive to violence will be more common in the pure psychosis group regardless of social, legal and service context. Method Independently conducted record studies were used to compare high security hospital patients with psychosis in Scotland and England, all resident between 25 August 1992 and 13 August 1993. Results The cohorts were similar in offence histories, predominance of schizophrenia, age at first hospitalization for psychosis and first high security hospitalization. More Scottish patients had co-morbid substance misuse diagnoses and/or personality disorder than patients in England. Psychotic symptom drive to the index offence was, however, four times more likely in the pure psychosis groups, regardless of sex, ethnic group or country. Scottish patients spent less time in high security after the index act. Conclusions Our hypotheses were sustained. Knowledge about lifestyle before onset of psychosis is important for interpreting literature on how psychotic symptoms relate to violence. This may also influence longer term outcome, although the shorter length of secure hospital stay in Scotland was perhaps affected more by greater availability of open ‘step-down’ beds. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

With the increasing evidence for the significant contribution to violence made by alcohol and drug misuse in people with mental disorder, there is emerging evidence of the importance and increasing prevalence of substance misuse problems in patients admitted to high security hospitals in the UK. Recorded routine voluntary urine drug screening of patients at the State Hospital, the high security hospital for Scotland and Northern Ireland, started in 1998. Results of urinalysis over the 3 years from 1 January 1999 to 31 December 2001 were examined. Out of 7,069 samples sent from 421 patients there were 712 (10.1%) positive results. The majority were false positives (672; 9.5%) due to prescribed medication, with only 40 (0.6%) true positives. All the true positive results in the admission unit were related to substance misuse prior to admission, the remaining true positive results were all within the continuing care wards, with no true positives in the rehabilitation wards. Even though the testing was not truly random, it is likely that the findings reflect extremely low levels of substance misuse within the hospital in contrast with findings from UK prisons. Whether urine testing contributes to the prevention of drug misuse within the hospital is unclear, and there are potential ethical and legal concerns about the urine testing process. It is important that high security hospitals are virtually drug free, to enable the uncontaminated assessment and treatment of mentally disordered offenders. [ABSTRACT FROM AUTHOR]