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In this study, the failure of a slope adjacent to a motorway was back-analyzed based on InSAR data. The location of the slided area and the exact date of the event were not known in advance. A post-processing strategy was applied on the displacement time series in order to aid the detection of instability signs and to enable the identification of the location and the narrowing down of the time interval of the slide. InSAR displacement time series were obtained following the small baseline subset approach implemented on an automatic processing platform. Distributed scatterers were clustered based on the similarity of their displacement time series, in order to form clusters of scatterers with similar behavior. This procedure allowed the computation of displacement time series representative of each cluster, aiding the detection of instability signs on the slope. One of the clusters showed a sudden movement away from the SAR sensor. It was later confirmed that the slide had occurred at the location of the scatterers belonging to that cluster and during the time interval between the two observation epochs corresponding to the break in the time series. In conclusion, the proposed method was effective in the back-analysis of the slope failure, hopefully contributing to the uptake of InSAR technology by structural safety experts.

This essay uses memory to cut through conventional,binary distinctions that seem to offer analytical approaches to Egmont, but ultimately disappoint. It contrasts memory and history as markers of different attitudes to the past, and ways of knowing, among the drama’s characters. After showing that Egmont’s appeal is based on the affective immediacy that distinguishes memory from history, the essay argues that he is as much a ‘new politician’ as Alba and Oranien, well aware of the political power of the imagination, fully conscious of what the Spanish occupation means in Brussels, and as capable as his antagonists of a calculated response. This approach also allows a reading of the fifth act, and of Egmont’s final vision, that is consistent with the rest of the play.

The aim of this article was to compare the characteristics and outcome of homicide and non-homicide mentally disordered patients all of whom had been hospitalised. Seventy-four patients with a homicide conviction were compared with 521 convicted of a non-homicide offense. The former group were older, were more likely to be diagnosed with schizophrenia but less likely to have suffered from childhood adversity, and had less criminality. They also had fewer convictions during the follow-up. Little distinguished these two groups with both suffering from multiple disadvantages suggesting the need for ongoing care and support.

Aims and methodWe examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.ResultsReadmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.Clinical implicationsThe long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.

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.

Aims and methodThe Security Needs Assessment Profile (SNAP) was developed to provide a detailed description of individual patient's security requirements in the then Trent Region of England. A national survey of secure units was undertaken to examine the content validity of the item structure of SNAP and revise the item definitions to reflect more broadly based clinical practice. A follow-up survey sought views on the usefulness of SNAP in clinical practice.ResultsThirty-five secure units from National Health Service and independent sector providers participated. No new security items were generated. All the item definitions were reviewed, many amended, and a small number revised extensively. Units' security profiles were rated on the original and revised instruments.Clinical implicationsThe revised SNAP has been shown to be generalisable across secure services in England; 92% of respondents agreed or strongly agreed that SNAP would be useful in providing a structured security needs assessment.

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...

Background The social climate of forensic units is important but little investigated, in part because of the unavailability of a clinically practical and statistically sound measure. Aims To provide preliminary psychometric and normative data for the English version of the Essen Climate Evaluation Schema (EssenCES) in UK high-security hospital settings. Method A total of 324 staff and patients from three high-security hospital services completed the EssenCES, and a subgroup completed a range of other questionnaires related to therapeutic milieu and working environment (GMI, WAAM, WES-10). Results The original three-factor structure and satisfactory internal consistency were retained. The pattern of correlations between the EssenCES scales and other climate-related variables support the construct validity of the EssenCES measure, with the exception of the Patient Cohesion subscale. Conclusions Although preliminary, these data suggest that the English version of EssenCES may be a valid tool for assessing the social climate of high secure hospital settings in the UK, but a larger research study is required, covering a wider range of psychiatric disorders, types of service and levels of security. Copyright © 2009 John Wiley & Sons, Ltd.

Although the care of forensic patients in the community has been partly taken over by specialist community forensic services (CFS), there are few data assessing their efficacy. The aim of this study was to compare the reconviction rates of patients discharged from a medium secure unit (MSU) either to a specialised community forensic service (CFS) or to a generic service (GS). We compared all patients discharged from Arnold Lodge MSU between 1983 and 2003 to mental health services in Nottinghamshire and Leicestershire, UK, on their rates of reconviction. The clinical and forensic characteristics of the two groups (70 discharged to CFS and 93 to GS) were broadly similar. Median time to reconviction was significantly lower for CFS than for GS (5 and 14+ years respectively, p = .014). Thus, contrary to expectations, patients discharged to the more specialised service had a shorter time to reconviction and this difference could not be explained by the clinical variables measured in the study, other than that t...

Im Juli 1916 wurde der Militararzt Doblin von der Westfront beurlaubt, um im frankischen Bad Kissingen ein chronisches Magenleiden auszukurieren. Er hatte zum Jahreswechsel 1914/15 im lothringischen Saargemund (dem heutigen Sarreguemines) den Dienst angetreten und dort den Wadzek-Roman sowie den Novellenband Die Lobensteiner reisen nach Bohmen abgeschlossen.

The high-security hospitals are undergoing a retraction process. In conjunction with this, regional services are being developed for those patients who require longer-term treatment at medium-security units. The retraction of the high-security hospitals has widespread implications for mental health

Although levels of security in UK forensic psychiatric services are generally accepted as being divided into high, medium and low security there are few detailed descriptors beyond those of high security. The lack of clear definitions of security poses problems for researchers, clinicians and patients. Developments in forensic care increasingly demand that patients should receive care under conditions of security that are no greater than necessary to manage the risks they present. This is not a simple proposition; a number of complex areas have to be addressed by clinicians when defining a patient's individual needs for security. In an attempt to provide a more comprehensive description of patients' security needs the authors developed the Security Needs Assessment Profile (S.N.A.P). This instrument builds on the three traditional dimensions of security: physical, procedural and relational. Each dimension is sub-divided into a number of items, 22 overall. Each item was described on a four-point scale, eac...

Reform of mental health legislation has been under consideration for several years in England and Wales (Department of Health, 2000a), where the Mental Health Act 1983 is in force, and in Scotland (Millan Committee Secretariat, 2001), which is governed by the Mental Health (Scotland) Act 1984. The Mental Health (Northern Ireland) Order 1986 is also under review, although the findings have yet to be published.

Arnold Lodge Regional Secure Unit has provided medium secure psychiatric care for the Trent Regional Health Authority since July 1983. We examined a series of 504 first admissions to Arnold Lodge in order to explore trends in demographic and service utilization characteristics over 16 years. We found an increase in the admission of more serious offenders; a reduction in the length of stay; a decline in the proportion of psychopathically disordered patients; and a sixfold increase in the ratio of men to women.

Supervised discharge was introduced, against much professional opposition, in the Mental Health (Patients in the Community) Act 1995. All patients subject to supervised discharge (SD) in a large health district were identified by medical records departments, and the outcome of their SD on 1 October 1997, eighteen months after the legislation came into effect, was assessed. In that first eighteen months, half of the general, rehabilitation and forensic psychiatrists in the trust used SD for 22 patients. Of the 12 orders in effect for over six months, six were renewed at six months and three at one year. In spite of professional hostility and scepticism about the clinical practicalities of SD, the use of the new power has gradually increased with experience. Outcomes to date seem generally positive, but further definitive research is needed.

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.

BackgroundLittle is known about the long-term mortality and causes of death after first psychiatric admission.MethodA consecutive series of 87 patients admitted for the first time from a strictly defined catchment area to Saxondale Hospital, Nottinghamshire, who were discharged in 1974 and 1975, were traced in 1992 to either their general practitioner or death. The causes of their deaths were ascertained and the observed mortality was compared with expected mortality.ResultsTwelve subjects had died. None had committed suicide, and there were no open verdicts or accidental deaths. Although the observed mortality was higher than expected, there was no significant excess.ConclusionsThere may be little scope for reducing suicide rates by targeting patients for careful follow-up after discharge from their first psychiatric admission. More research is required before large investments are made in potentially fruitless interventions to achieve the objectives ofThe Health of the Nation.

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.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.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.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.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.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.

This case report provides a different perspective on the management of a patient with a psychotic illness. The detained patient, a man aged 50, had specific delusional beliefs about toxins affecting his kidneys, such that he needed to drink water to ‘detoxify’ himself. This resulted in him developing life-threatening hyponatraemia. It became clear that he was very resistant to taking oral medication and was reluctant to engage with any psychological treatment. A novel approach was considered, involving the ‘off licence’ use of short acting intramuscular olanzapine for the successful treatment of the psychotic illness. The case demonstrates the safe use of intramuscular olanzapine for 155 days, which is the longest reported case for the use of intramuscular olanzapine for the treatment of a psychotic illness. The individual was later discharged on oral olanzapine.

The objectives of this study was to describe the rate of suicide and other causes of death in first admissions to a (medium) secure forensic psychiatric facility. All 595 patients were followed up for a maximum of 20 years. Death certificates were obtained and Standardized Mortality Ratios (SMRs) were calculated. At the June 2003 census, 57 patients (9.6%) had died of whom 18 (3.0%) had committed suicide; if deaths categorized as open verdicts are included the number rises to 26 (4.4%). The SMR for death by suicide was higher for a Mental Health Act classification of Mental Illness (SMR = 3,553) compared to Psychopathic Disorder (SMR = 1,892). The risks of mortality in this population are high from any cause, particularly from suicide.