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Patients who set fires are a perennial cause of concern with psychiatric services although perhaps rather neglected in the clinical research literature. The current study considered the characteristics on admission of 129 patients, 93 men and 36 women, with a known history of arson who had been admitted to a medium secure psychiatric hospital. The distinguishing characteristics of the sample were high numbers of patients with extensive criminal histories, most probably due to high levels of prison transfer and a higher occurrence of mental illness than psychopathic disorder. Aside from return to prison, most patients were discharged either to another psychiatric hospital or directly to the community. There was a high rate of re-conviction after discharge, mainly for minor offences, with about one in 10 of discharged patients committing arson. It was established, however, that not all incidents of arson led to a prosecution. It is concluded that there are weaknesses in the areas of both risk assessment and evidence-based treatment for arsonists.

Objective Outcomes for any mental health service will vary with the characteristics of those admitted as well as with the clinical provision of the service itself. This study aims to explore, for a medium secure forensic service in England, temporal changes in (1) characteristics of those admitted and (2) outcome after discharge and (3) to examine whether such changes are related. Method Baseline characteristics and reconviction outcomes were derived from multiple data sources for 550 first admissions to a medium secure forensic unit for a 20-year period. Time to reconviction was examined using Kaplan–Meier analysis and Cox regression. Results Over time, severity of admissions increased, as did discharges to prison; discharges to non-secure hospitals reduced. Risk of reconviction increased by 3.9%–4.2% for each year of admission from 1983, which was explained by the increased admission of higher-risk patients. Conclusion This medium secure service admitted patients with increasing levels of risk; reoffending rates reflect admission characteristics. Service funding decisions should take account of the characteristics of those admitted. Significant outcomes This study indicates that the profile of patients admitted over a 20-year period increased in severity. Over time, reconviction after discharge occurred earlier after release. This increase in reconviction was explained by the type of patient admitted. Limitations Examination of a cohort from a single medium secure unit limits the generalizability of the findings. The study focuses on a criminological outcome measure (i.e. reconviction); other domains may be equally relevant (e.g. the relief of psychological distress). Examining an entire series of admissions introduces heterogeneity by, for example, considering the outcome of men and women together. Copyright © 2012 John Wiley & Sons, Ltd.

Background: Whilst women admitted to secure care are believed to require gender-specific services, there is limited research to inform their provision. Method: Clinical and forensic characteristics and outcomes on 93 women were obtained from multiple data sources and compared with 502 men admitted to the same medium secure unit over a 20-year period. Results: Compared to the men, the women were more likely to have more mental health needs and less criminality. At discharge, women were more likely to be transferred to secure care and less likely to be transferred to prison. Following discharge, the women had a higher rate of mortality. While reconviction rates were similar for the two groups for serious offenses, violent or arson incidents not leading to conviction were more likely for women. The women were more likely to be readmitted, and to be readmitted to high secure care. Conclusion: Despite more favorable criminological characteristics at baseline, our data suggest a poorer outcome for women overall...

Aims and methodThe aim of the study was to investigate changes in service utilisation following therapeutic community treatment for patients with severe personality disorder. The study examined service usage, in the form of acute psychiatric admissions, of a series of 52 admissions to a residential therapeutic community in the three years before and year after admission.ResultsThere was a reduction in the mean duration of acute psychiatric admissions after treatment, this was greater for extra-contractual referral patients than local district patients.Clinical ImplicationsThis study replicates results from previous studies. It also suggests that more accessible local services may be able to intervene earlier in patients' psychiatric careers preventing heavy use of acute services. We argue for greater provision of therapeutic community treatment for severe personality disorder.

Doeblin's texts, which range widely across contemporary discourses, are paradigms of the encounter between literary and scientific modernity. With their use of 'Tatsachenphantasie', they explode conventional language, seeking a new connection with the world of objects and things. This volume reassesses and reevaluates the uniquely interdisciplinary quality of Doeblin's interdiscursive, factually-inspired poetics by offering challenging new perspectives on key works. The volume analyses not only some of Doeblin's best-known novels and stories, but also neglected works including his early medical essays, political journalism and autobiographical texts. Other topics addressed are Doeblin's engagement with German history; his relation to medical discourse; his topography of Berlin; his aestheticisation of his own biography and his relation to other major writers such as Heine, Benn, Brecht and Sebald. With contributions in English and in German by scholars from Germany and the United Kingdom, the volume presents insights into Doeblin that are of value to advanced researchers and to students alike.