DIVERSION OF MENTALLY DISORDERED OFFENDERS: INDICATIONS FROM
A SPECIAL HOSPITAL
PHIL WOODS
&
TOM MASON
1996
Click
here to obtain a copy (or right mouse click and save target as)
1 ACKNOWLEDGEMENTS
2 ABSTRACT
3 INTRODUCTION
3.1 DIVERSION IN SCOTLAND
3.2 DIVERSION IN CANADA
3.3 COURT BASED DIVERSION SCHEMES
3.4 THE MENTALLY DISORDERED IN PRISON
3.5 DIVERSION FROM REMAND OR A CUSTODIAL SENTENCE
3.6 THE SPECIAL HOSPITALS
4 AIMS
5 METHOD
6 RESULTS
6.1 DEMOGRAPHIC INFORMATION
6.2 REASON FOR ADMISSION
6.3 DIAGNOSIS ON ADMISSION
6.4 PRESENT OFFENCE
6.5 FIRST VICTIM DETAILS
6.6 ALCOHOL AND SUBSTANCE USAGE
6.7 PREVIOUS INSTITUTIONAL EXPERIENCES
6.8 CRIMINAL HISTORY
6.9 PREVIOUS CARE OR SUPERVISION ORDERS
7 SUMMARY
8 REFERENCES
9 BIBLIOGRAPHY
TABLES
1. Admission source over the last twenty years
2. Source of admission by gender
3. Mental Health Act Classification on admission
4. Legal category on admission
5. First reason for admission
6. Second reason for admission
7. Clinical diagnosis on admission
8. Current delusions or hallucinations
9. Murder offences
10. Manslaughter offences
11. Assault and robbery offences
12. Sexual offences
13. Arson, burglary, criminal damage and other indictable offences
14. Non-indictable offences
15. Motive for offence
16. Number of offences convicted of
17. Total number of aggressors involved in the present offence
18. Number of victims resulting from present offence
19. Sex of victim one
20. Age of first victim
21. Relationship of victim to offender
22. Location of offence
23. Main method of assault (violent offences only)
24. Secondary method of assault (violent offences only)
25. Consumption of alcohol prior to the offence
26. Consumption of drugs prior to the offence
27. Circumstances of the offence
28. Precipitating events
29. Provocation (violent offences only)
30. Sexual features of the offence (violent offences only)
31. Drink problem
32. Cannabis - frequency of use during year prior to admission
33. Amphetamines - frequency of use during year prior to admission
34. Barbiturates - frequency of use during year prior to admission
35. Heroin or morphine - frequency of use during year prior to admission
36. LSD - frequency of use during year prior to admission
37. Number of admissions to a Special Hospital
38. Institutional experiences prior to sixteenth birthday
39. Criminal history
40. Juvenile record
41. Adult criminal record
42. Past offences convicted of
43. History of youth custody, borstal training, detention centre or approved school
order
44. History of care, supervision, probation or hospital orders
45. Probation order with condition of treatment
46. Hospital order with restrictions
FIGURES
Figure 1. Number of admissions a year over the last twenty years
Figure 2. Number of previous psychiatric admissions
Figure 3. Number of custodial sentences
Figure 4. Total number of prior court appearances
Figure 5. Age at first court appearance as a juvenile
Figure 6. Number of court appearances as a juvenile
Figure 7. Age at first adult court appearance
Figure 8. Number of court appearances as an adult
Figure 9. Age at first violence offence
Figure 10. Age at first sex offence
Figure 11. Age at first offence of arson, criminal/wilful/malicious damage
Figure 12. Number of previous supervisory sentences
1 ACKNOWLEDGEMENTS
During the course of the project we would like to express our thanks to the following:
Professor Ron Blackburn the then Director of Research at Ashworth Hospital
Mr Colin Dale the then Director of Professional Development at Ashworth Hospital
Ms Diane Fawcett the then Case Register Manager at Ashworth Hospital
High Sheriff of Merseyside for funding support of the project
2 ABSTRACT
This report disseminates the findings of a study undertaken within Ashworth Hospital
Authority, which caters for those patients directed for treatment under conditions of high
security due to their dangerous, violent and/or criminal propensities. The study aimed to
determine if any core features exist between patients admitted from court and patients
admitted from prison. Data on all admissions over a twenty year period were collected and
a number of variables collated from the Special Hospital's Case Register. It would seem
from the limited data analysis (due to restrictions on time) that there is little evidence
of a pattern emerging from this study regarding differences between prison or remand
centre and court in relation to admissions to a special hospital. However, what did emerge
were differences between the existence and non-existence of certain factors regarding
special hospital admission.
3 INTRODUCTION
The diverting of mentally disordered offenders from the criminal justice system, either
prior to or following sentencing, is not a new concept. A recent government circular (Home
Office, 1990) and a review of services for mentally disordered offenders by Dr Reed (Department
of Health and Home Office, 1993) advocated that wherever possible a mentally
disordered offender (or alleged offender) should receive care and treatment from services
other than those provided by the criminal justice system. In practice the process should
involve the identification of mentally disordered offenders at the point of arrest and if
possible diverting the individual from a custodial remand to a place where further
assessment and/or treatment can be obtained. Therefore, when appearing at court for
sentencing, with all the information available on that individual the court is able to
make an order concerning treatment which is more formal and binding.
To date the diversion of mentally disordered offenders from the criminal justice system to
the mental health system has been considered somewhat arbitrary (Davis, 1994);
dependent on the enthusiasm of individuals concerned with the defendant. i.e. defence,
prosecution or judge (Cooke, 1991b); and the personal motivation of individuals in
relation to the resources made available (Exworthy & Parrott, 1993). Graeme
Sandell from NACRO argues that mental health services receive a low priority from social
services departments, with mentally disordered offenders receiving the lowest priority of
all (Sandell, 1991). Furthermore, Haynes and Henfrey report that mentally
disordered offenders experience the most complex of social and personal problems; are
deprived of the simple practical services which may help them; and frequently fall between
the different services available to care for them (Haynes & Henfrey, 1995).
Indeed, there is an overall lack of investment in this most unattractive group of
individuals (Prins, 1992), described as the 'hard to like' or 'not nice' patients (Scott,
1975), or the just "too bad" for the psychiatric units (Richer, 1990).
Therefore, `diversion needs to be seen against the background of the management of mental
disorder in general' (Prins, 1992); there needs to be a co-ordination between all
services involved, with a development of policies to ensure that this takes place (Jones,
1990); and schemes need to be flexible, both in their development and their
operational approach (Cooke, 1991a). Indeed, many doctors argue that provisions
should exist that ensures that no mentally disordered offender requiring treatment is sent
to prison (Richer, 1990).
Staite and Martin highlight a number of factors relevant to the concept of diversion;
firstly, sometimes magistrates have no choice but to remand in custody; secondly, the
pressure of public opinion against persons perceived as dangerous has to be considered;
thirdly, reliance on multi-agency co-operation, as no one agency can provide the answer
alone; and fourthly, the changes in the shift in the emphasis from the criminality to the
mental health of mentally disordered offenders is coming from many different sources,
places and the schemes which are in place to identify them vary enormously (Staite
& Martin, 1993; Staite, 1994).
Diversion is not without its critics, with arguments that diversion schemes fail to
preserve public interest; and violate the rights of the accused, with undue pressure
placed on them to participate in treatment (McKittrick and Eysenck, 1984).
Furthermore, it should be asked - to what extent should mentally disordered offenders be
held responsible for their actions; and how much consideration should be given to the
views of the victim (Prins, 1992)? Indeed, the formal legal process can be a
valuable way of testing a mentally disordered offenders' concept of reality (Smith
& Donovan, 1990). Defenders of such statements argue that: diversion should be
justified from humanitarian factors and not economic factors (Cooke, 1991a); if an
offence is more likely to be linked to mental disorder than greed, badness or wickedness,
then diversion might possibly be the more humane action to take (Moody, 1993); and
schemes need to aim towards obtaining a delicate balance between public interest, the
rights of the accused, and clinical effectiveness (Cooke, 1991b).
Diversion can occur in a number of ways, either from magistrates court, following remand
into custody, at sentencing, or following a custodial sentence. The time at which
diversion can occur is largely dependant on the Crown Prosecution Service, and whether or
not they are prepared to discontinue the criminal proceedings. Their decision is dependant
on a number of factors; severity of the offence; circumstances surrounding the offence;
penalty; age (youth or old age and infirmity); complainants attitude; and mental illness
or stress (Prins, 1992).
3.1 DIVERSION IN SCOTLAND
In Scotland a method of primary diversion is
utilised, with the procurators fiscal, equivalent to the English Crown Prosecution
Service, making a decision whether to divert a mentally disordered offender or not, and
offer treatment as opposed to prosecution. Only individuals charged with minor offences
are eligible for the scheme; and for individuals felt to be less motivated to comply with
treatment offered a decision can be deferred for three months. The individuals mental
state at the time of the offence is considered as well as any external stresses or events
which may have played a part. Initial research results indicate that most diverted were
first offenders, with offences unplanned and impulsive, easy to commit and the risk of
detection low (Cooke, 1991a, 1991b).
3.2 DIVERSION IN CANADA
In Canada a court has the power to order an
accused, who is apparently mentally disordered to undergo pre-trial psychiatric
assessment. Following research into this assessment process three factors have been found
to influence their decision of whether to divert or not; firstly, offence seriousness;
secondly, court jurisdiction; and thirdly, the psychiatrist (Davis,1994). These
three factors were identified following analysis of case material, over a three year
period of all those assessed, and comparison of those that were diverted to the mental
health system and those that could have been but were not.
3.3 COURT BASED DIVERSION SCHEMES
There are currently over 60 court diversion
schemes (Backer-Holst, 1994), however there is little cohesion or systematic
approach in their administration. Indeed, whilst some schemes are operational others
remain `paper exercises' (Joseph, 1990).
Gina Hillis describes one operational scheme, the Birmingham court diversion scheme, which
caters for the largest number of magistrates courts in Europe. The scheme aims to identify
the mentally disordered as soon as possible after arrest, offer advice, liaise with other
agencies and arrange assessment, treatment and admission if necessary. Assessment is
carried out for all offenders who are charged with violent offences, lesser offences whose
behaviour is observed to be odd, and those with a known history of mental disorder.
Assessment is in the form of unstructured interview, and looks for the presence of serious
disorders, psychosis and depression, potential self-harm and suicide. A high number of the
offenders assessed have related problems with substance and alcohol abuse (Hillis,
1993).
Similar operational schemes are described in the literature in Manchester (Holloway
& Shaw, 1992; 1993), South East London (Banerjee. et al, 1992; Exworthy &
Parrott, 1993), and inner London (Joseph & Potter, 1990; 1993a; 1993b; James
& Hamilton, 1991). Furthermore, all the schemes have access to all the information
that the police have, including the previous criminal record of the accused. Some also
report that they obtain previous psychiatric and social reports; and discharge summaries
from general practitioners and hospitals.
Results that are reported from the schemes in relation to those mentally disordered
offenders who are or are not diverted from the prison system, appear to move in the
direction of certain trends. Those that are diverted are frequently charged with only
minor offences and are first time offenders. Those that are not diverted tend to be
charged with more violent, serious offences and have a history of offending behaviour.
However, also included in this group are the minor mentally disordered offender, who is
homeless and are often charged with non-custodial offences.
3.4 THE MENTALLY DISORDERED IN PRISON
Recent research indicates that a high number of mentally disordered individuals are
finding their way into the criminal justice system; with as many as 37% of the total
sentenced prison population suffering from some form of mental heath problem at any one
time; of whom, 2% were diagnosed psychotic and 3% thought to require immediate transfer to
hospital for treatment (Gunn. et al, 1991). A similar prevalence level was found in
the remand population at Bristol prison with 26% having a mental disorder.
In the case of the more serious, violent mentally disordered offender, it is almost
inevitable that they will spend a period in custody either awaiting a psychiatric report,
or transfer for further assessment or treatment (Joseph, 1990; Robertson. et al, 1994).
Furthermore, due to legislation within the Bail Act 1976 the mentally disordered offender
is more likely than the non-mentally disordered offender to be remanded into custody,
indeed, even when charged with a non-custodial offence; the main reason for this is the
'protection of the defendant' (Joseph, 1990); and there is a general tendency to
regard the mentally disordered as dangerous (Robertson, 1988). One diversion scheme
tries to reduce the time spent on remand in prison by having a psychiatric report
completed within one week and therefore a quicker decision of disposal can be arrived at;
whether to hospital, the community or the penal system (Bangerjee. et al, 1992).
In a recent study undertaken into the prevalence of mental disorder within the remand
population it was found that 2.3% had a clinical diagnosis of major psychiatric disorder
and 53.4% had previous psychiatric contact. Results were based on data collected in seven
remand prisons on socio-demographic details; historical data; current charge; personal and
family background; and past medical, psychiatric and forensic history (Davidson. et al,
1995).
3.5 DIVERSION FROM REMAND OR A CUSTODIAL
SENTENCE
The Wessex project although not diversion in its
truest sense focuses on the sentenced male prison population at Winchester prison and aims
to provide a comprehensive assessment for persistent minor offenders. Following mental
health screening cases are identified as worthy of follow-up and support is arranged once
released through the Care Programme Approach and Social Services Care Management
initiatives, and hopefully this support and follow-up will alleviate the possibility of
re-offending (Barker & Swyer, 1994).
3.6 THE SPECIAL HOSPITALS
The Special Hospitals like Prisons, constantly
cater for the outer limits of human behaviour, however, it is unusual for an admission to
take place during the remand period (Kinsley, 1990). As the Special Hospitals form
part of the mental health system and deal, mainly with those patients directed for
admission from courts; or, later via prison it would be important to know if information
concerning both groups were noted or available at the original court appearance.
Furthermore, as currently a high number of admissions to Ashworth are from the prison
population (approximately 47%), it would be useful for forensic practice to study this
population to identify if any similarities can be established between them; and if there
are any core identifying features that availed them from being diverted at the point of
arrest.
4 AIMS
| 1 | To identify those patients at Ashworth hospital who have been transferred from the prison population; and those who have been admitted on other sections |
| 2 | To extract selected case register variables related to the information courts may have available. For example demographic details, victim details, present offence and criminal history |
| 3 | To determine if any core features exist between the groups to distinguish them |
| 4 | To determine the feasibility of further research to devise a checklist for future court diversion schemes |
5 METHOD
Data for the study were collected from the special hospitals case register. This
database holds information on all past and current hospital admissions as well as
discharges and transfers. From this case register data were extracted on all the patients
admitted to the hospital over the past twenty years in relation to:
| 1 | Demographic details; |
| 2 | Clinical diagnosis on admission; |
| 3 | Present offence and criminal history; |
| 4 | Victim details. |
Data were further examined by the route of admission, to identify patients who had either;
(a) been admitted directly from the court or; (b) had been admitted from prison or whilst
on remand. Data were subsequently analysed using descriptive statistics.
Previous work with case register data have indicated that there are elements of missing
data and incorrect entries but these have not, to the authors knowledge, been published.
In this current research with case register data a number of obviously incorrect entries
and a number of missing data have been identified. No reliability test of the remaining
case register data was undertaken and this should be seen as a limitation of the study.
Permission to undertake the study was requested from Ashworth Hospital's Research and
Ethics Committees. All normal safeguards were employed to ensure the confidentiality of
information collected regarding patients.
6 RESULTS
Due to the extensive nature of the results, and for the sake of understanding we intend to
incorporate the discussion within each section as we proceed through the results.
Over the past twenty years 1464 patients have been admitted to the hospital, with the
source of admission shown by Table 1. In summary this table shows that approximately 20%
of the admissions have been admitted from other special hospitals, 20% have been admitted
from other health care institutions, 23% have been admitted from prison or remand centre,
and 31% have been admitted from court. As the study intended to examine aspects of
diversion from custody of mentally disordered offenders it is the latter two groups which
are of interest to the researchers; firstly, admissions from prison or remand centre
N=330; and secondly, admissions from court N=459.
Table 1. Admission source over the last twenty years
| Source of admission | n | (%) |
|---|---|---|
| Broadmoor | 223 | (15.2) |
| Rampton | 48 | (3.3) |
| Carstairs | 15 | (1) |
| Regional Secure Unit, Interim Secure Unit | 124 | (8.5) |
| Psychiatric hospital or bed | 90 | (6.1) |
| Subnormality hospital or bed | 49 | (3.4) |
| Prison or remand centre | 330 | (22.5) |
| Youth custody centre, Detention centre or Borstal | 31 | (2.1) |
| L.A. residential accommodation. | 13 | (0.9) |
| Court | 459 | (31.4) |
| Home | 21 | (1.4) |
| Police station (usually only recalled patients) | 12 | (0.8) |
| Other | 42 | (2.9) |
| Not known | 7 | (0.5) |
| Total | 1464 | (100) |
The total number of admissions each year over the twenty year period for the two groups is
shown by Figure 1. This shows that there was a significantly higher number of admissions
from court up to 1988 (c2 = 26.496, df = 12, p<0.01), when a difference of only 1 is apparent (prison
n=17; court n=16). Following on in 1989, the amount swings to a significantly higher
number of patients being admitted from prison (c2 =15.907, df = 5,
p<0.01); the only exception being in 1990, when more patients were admitted from court.
Figure 1. Number of admissions a year over the last twenty years (N=789).
6.1 DEMOGRAPHIC INFORMATION
Table 2 identifies the gender of the patients
admitted in the two groups. This shows there has been a comparable amount of male
admissions from both groups, with admissions from prison or remand centre totalling 301;
and admissions from court totalling 369. When examining female admissions a significant
difference exists between the two groups, with admission from prison or remand centre
totalling 29; and admissions from court totalling 90 ( c2= 16.714, df = 1,
p<0.001). When total admissions from both groups are examined; 91.2% of admissions from
prison are male, and 8.8% are female; and 80.4% of admissions from court are male, and
19.6% are female.
Table 2. Source of admission by gender
| Male admissions | Female admissions | Total admissions | ||||
|---|---|---|---|---|---|---|
| Source of admission | n | (%) | n | (%) | N | (%) |
| Prison or remand centre | 301 | (91.2) | 29 | (8.8) | 330 | (100) |
| Court | 369 | (80.4) | 90 | (19.6) | 459 | (100) |
The Mental Health Act Classification of the admissions from the two groups is identified
in Table 3. This reveals that for patients classified as suffering from mental illness, a
significantly higher number 54.9%, were admitted from prison or remand centre (c2 = 52.896, df = 1, p<0.001). Opposite, for those patients classified as
suffering from personality disorder a significantly higher number 69.2% are admitted from
court (c2 = 20.774, df = 1, p<0.001). Furthermore, a significantly higher number of
patients classified as suffering from mental impairment 85%, are admitted from court (c2 = 18.030, df = 1, p<0.001).Table 3. Mental Health Act Classification on
admission
| Prison or remand centre | Court | Total | ||||
|---|---|---|---|---|---|---|
| Classification | n | (%) | n | (%) | n | (%) |
| MI | 214 | (54.9) | 176 | (45.1) | 390 | (100) |
| PD | 86 | (30.8) | 193 | (69.2) | 279 | (100) |
| Mimp | 9 | (15) | 51 | (85) | 60 | (100) |
| SMImp | 3 | (27.3) | 8 | (72.7) | 11 | (100) |
| MI+PD | 12 | (48) | 13 | (52) | 25 | (100) |
| MI+Mimp | 0 | (0) | 2 | (100) | 2 | (100) |
| MI+SMImp | 0 | (0) | 1 | (100) | 1 | (100) |
| PD+Mimp | 6 | (33.3) | 12 | (66.7) | 18 | (100) |
| PD+SMImp | 0 | (0) | 1 | (100) | 1 | (100) |
| Not known | 0 | (0) | 2 | (100) | 2 | (100) |
| Total | 330 | (100) | 459 | (100) | 789 | (100) |
Table 4. Legal category on admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Section | n | (%) | n | (%) |
| 3 | 3 | (0.9) | 3 | (0.7) |
| 35 | 4 | (1.2) | 32 | (7) |
| 36 | 0 | (0) | 2 | (0.4) |
| 37 | 2 | (0.6) | 79 | (17.2) |
| 38 | 3 | (0.9) | 39 | (8.5) |
| 37/41 | 4 | (1.2) | 284 | (61.9) |
| 47 | 3 | (0.9) | 0 | (0) |
| 48 | 4 | (1.2) | 0 | (0) |
| 47/49 | 245 | (74.2) | 0 | (0) |
| 48/49 | 56 | (17) | 0 | (0) |
| CPIA | 1 | (0.3) | 19 | (4.1) |
| Not known | 5 | (1.5) | 1 | (0.2) |
| Total | 330 | (100) | 459 | (100) |
From the court admissions the highest number of patients 284 (61.9%) are admitted under
section 37/41 of the Mental Health Act 1993, a hospital order with restrictions; with a
further 79 patients (17.2%) admitted under section 37, the same hospital order but without
any restrictions applied. From the prison or remand centre admissions the highest number
of patients 245 (74.2%) are admitted under a similar section of the Act, section 47/49 the
transfer of a sentenced prisoner with restrictions. Only a small number of admissions from
both of the groups are under remand or transfer of un-sentenced prisoner sections of the
act; 34 patients (7.4%) from the court admissions under sections 35 or 36; and 60 patients
(18.2%) from the prison or remand centre admissions under sections 48 or 48/49 (see table
4).
6.2 REASON FOR ADMISSION
When examining the reason for admission for the
two groups, a possible first and second reason are given. Table 5 identifies the first
reason for both groups. The most frequent first reason for admission in both groups is
because of physical attacks; 27.6% from prison or remand centre and 53.6% from court ( c2 = 52.057, df = 1, p<0.001). For admissions from prison or remand centre this
is closely followed by being hallucinated or deluded (21.5%), and the next main first
reason is because of suicidal threats or self injury (14.8%). For admissions from court,
damage to property is the second most frequent first reason for admission (29%).
Table 5. First reason for admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Admission reason | n | (%) | n | (%) |
| Physical attacks on patients or public, including robbery | 54 | (16.4) | 238 | (51.9) |
| Physical attacks on hospital or prison staff, including robbery | 37 | (11.2) | 8 | (1.7) |
| Sexual behaviour | 12 | (3.6) | 37 | (8.1) |
| Suicidal threats or self injury | 49 | (14.8) | 0 | (0) |
| Threats of violence | 32 | (9.7) | 10 | (2.2) |
| Damage to property | 13 | (3.9) | 133 | (29) |
| Theft, larceny | 0 | (0) | 8 | (1.7) |
| Hallucinated, deluded | 71 | (21.5) | 2 | (0.4) |
| Other, including burglary (trespass) | 62 | (18.8) | 23 | (5) |
| Total | 330 | (100) | 459 | (100) |
The second reason for admission for both groups is identified in Table 6. In both groups,
admissions from prison or remand centre (50.9%), and admissions from court (73.4%) a
significantly higher percentage have no second reason for admission (c2 = 41.256, df =1,
p<0.001). From the remaining fifty percent of the admissions from prison or remand
centre being hallucinated or deluded (15.2%) is the most frequent second reason for
admission, followed by threats of violence (6.7%).
Table 6. Second reason for admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Admission reason | n | (%) | n | (%) |
| No second reason | 168 | (50.9) | 337 | (73.4) |
| Physical attacks on hospital or prison staff, including robbery | 12 | (3.6) | 2 | (0.4) |
| Sexual behaviour | 3 | (0.9) | 15 | (3.3) |
| Suicidal threats or self injury | 16 | (4.8) | 2 | (0.4) |
| Threats of violence | 22 | (6.7) | 12 | (2.6) |
| Absconder | 1 | (0.3) | 1 | (0.2) |
| Damage to property | 8 | (2.4) | 20 | (4.4) |
| Theft, larceny | 1 | (0.3) | 16 | (3.5) |
| Hallucinated, deluded | 50 | (15.2) | 12 | (2.6) |
| Other, including burglary (trespass) | 49 | (14.8) | 42 | (9.2) |
| Total | 330 | (100) | 459 | (100) |
6.3 DIAGNOSIS ON ADMISSION
The clinical diagnosis on admission, as determined
by the patients Responsible Medical Officer (RMO) is shown in table 7. It is interesting
to note that a significantly higher number, 278 patients (60.6%) of the total court
admission group, are diagnosed as personality disordered, whereas 166 patients (50.3%)
from the prison or remand centre admission group are (c2 = 7.807, df = 1,
p<0.01); 84 patients (25.5%) from the prison or remand centre group are diagnosed as
paranoid, as opposed to 52 patients (11.3%) from the court admission group (c2 = 25.870, df = 1, p<0.001); and not surprising 89 patients (19.4%) from the
total court admission group are diagnosed as mental subnormality, as opposed to 23 (7%)
from the prison or remand centre group (c2 = 9.246, df = 1,
p<0.01).
Identified by Table 8 is whether the patients RMO found evidence that delusions or
hallucinations were present on admission. Interestingly this identifies that although a
relatively equal number, 153 patients (46.4%) are admitted from prison suffering from
delusions or hallucinations than are not, 164 patients (49.7%); a significantly smaller
number (c2 = 19.916, df = 1, p<0.001) 146 (31.8%) are admitted from court suffering from
them than are not, 302 patients (65.8%).
Table 7. Clinical diagnosis on admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Diagnosis | n | (% of total group) | n | (% of total group) |
| Affective disorder - Depression | 19 | (5.8) | 10 | (2.2) |
| Affective disorder - Mania | 25 | (7.6) | 13 | (2.8) |
| Schizophrenia | 112 | (33.9) | 143 | (31.2) |
| Epilepsy | 10 | (3) | 30 | (6.5) |
| Organic disorder other than epilepsy | 18 | (5.5) | 18 | (3.9) |
| Personality disorder | 166 | (50.3) | 278 | (60.6) |
| Neurosis | 12 | (3.6) | 10 | (2.2) |
| Paranoid state | 84 | (25.5) | 52 | (11.3) |
| Mental illness - Unspecified | 31 | (9.4) | 26 | (5.7) |
| Mental subnormality | 23 | (7) | 89 | (19.4) |
| Transient situational reaction | 13 | (3.9) | 27 | (5.9) |
| Alcoholic | 27 | (8.2) | 19 | (4.1) |
| Drug addict | 25 | (7.6) | 16 | (3.5) |
| Brain damage - Unspecified | 1 | (0.3) | 1 | (0.2) |
Table 8. Current delusions or hallucinations
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Present | 153 | (46.4) | 146 | (31.8) |
| Absent | 164 | (49.7) | 302 | (65.8) |
| Not known | 13 | (3.9) | 11 | (2.4) |
| Total | 330 | (100) | 459 | (100) |
6.4 PRESENT OFFENCE
From the patients admitted from remand centre or
prison 92 (27.9% ) are convicted of committing murder, a further 29 (8.8%) are convicted
of attempting, threatening or conspiring to murder. Only 47 patients (10.2%) admitted from
court are convicted of either committing, attempting, threatening or conspiring to murder
(see Table 9). Whenexamining patients admitted for manslaughter offences the situation
reverses with 74 patients (16.2%) admitted from court admission group for the offence and
33 patients (10%) from the prison or remand centre group (see table 10).
Table 9. Murder offences
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Indictable offences | n | (% of total group) | n | (% of total group) |
| Murder | 92 | (27.9) | 20 | (4.4) |
| Attempted murder | 21 | (6.4) | 19 | (4.1) |
| Threat or conspiracy to murder | 8 | (2.4) | 8 | (1.7) |
Table 10. Manslaughter offences
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Indictable offences | n | (% of total group) | n | (% of total group) |
| Manslaughter, section 2 Homicide Act 1957 (diminished responsibility) | 19 | (5.8) | 71 | (15.5) |
| Other manslaughter, child destruction, causing death by dangerous driving | 13 | (3.9) | 3 | (0.7) |
| Infanticide | 1 | (0.3) | 0 | (0) |
For a high proportion of the admissions from both groups assault is the present offence,
however no significant differences exist between the groups. Convictions for grievous or
actual bodily harm from the prison or remand centre admission group are 90 patients
(27.3%), whereas there are 148 patients (32.3%) from the court admission group (see table
11). Furthermore, only a small percentage of patients from both of the admission groups
are for sexually related offences, but with a significant difference between them (c2 = 4.767, df = 1, p<0.05); 67 patients (20.3%) from the prison or remand centre
group and 65 patients (14.1%) from the court admission group (see table 12).
Table 11. Assault and robbery offences.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Indictable offences | n | (% of total group) | n | (% of total group) |
| Wounding GBH - other act endangering life | 55 | (16.7) | 94 | (20.5) |
| Assault ABH | 35 | (10.6) | 54 | (11.8) |
| Robbery or assault with intent to rob | 47 | (4.2) | 17 | (3.7) |
A highly significant difference exists between the groups for the offence of arson (c2 = 30.500, df = 1, p<0.001); with 125 patients (27.2%) of the patients from the
court admission group and only 36 (10%) of the patients from the prison or remand centre
group admitted for it. Only a small significant difference exists between the groups for
criminal damage (c2
= 5.553, df = 1, p<0.5); 46 patients (10%) from the court
admissions and 17 patients (5.2%) from the prison or remand centre admissions (see table
13).
Table 12. Sexual offences.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Indictable offences | n | (% of total group) | n | (% of total group) |
| Buggery or attempt, indecent assault on a male | 8 | (2.4) | 10 | (2.2) |
| Indecency between males | 2 | (0.6) | 2 | (0.4) |
| Rape or attempted rape | 32 | (9.7) | 23 | (5) |
| Indecent assault on a female | 22 | (6.7) | 26 | (5.7) |
| Unlawful sexual intercourse | 1 | (0.3) | 2 | (0.4) |
| Gross indecency with a child | 2 | (0.6) | 2 | (0.4) |
Table 13. Arson, burglary, criminal damage and other indictable offences.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Indictable offences | n | (% of total group) | n | (% of total group) |
| Arson | 36 | (10.9) | 125 | (27.2) |
| Criminal damage indictable malicious damage | 17 | (5.2) | 46 | (10) |
| Burglary or attempt, breaking or attempt, sacrilege | 35 | (10.6) | 49 | (10.7) |
| Theft, larceny | 25 | (7.6) | 38 | (8.3) |
| Other indictable offences | 47 | (14.2) | 40 | (8.7) |
Not surprising is that very few patients, 23 (7%) from the prison or remand centre
admissions and 30 (6.6%) from the court admissions are for non-indictable offences such as
aggravated or common assault, possession of offensive weapon and drunkenness (see table
14).
Table 14. Non-indictable offences.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Non-indictable offences | n | (% of total group) | n | (% of total group) |
| Aggravated assault, assault on a constable, common assault | 3 | (0.9) | 5 | (1.1) |
| Possession of an offensive weapon | 17 | (5.2) | 20 | (4.4) |
| Drunkenness | 1 | (0.3) | 0 | (0) |
| Other non-indictable offences | 2 | (0.6) | 5 | (1.1) |
Identified in Table 15 is the motive for the offence as determined by the patients RMO.
The most noticeable point for both groups, prison or remand centre admissions 90 patients
(27.3%) and court admissions 145 patients (31.6%), the offence was apparently motiveless.
Furthermore, for both groups prison or remand centre admissions 74 patients (22.4%) and
court admissions 84 patients (18.3%), the motive was sexual. Also interesting to note is a
significantly higher number of prison or remand centre admissions 52 patients (15.8%) the
motive was furtherance of theft, this number is opposed to 39 patients (8.5%) of court
admissions (c2 = 9.220, df = 1, p<0.01).
Table 15. Motive for offence
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Motive | n | (% of total group) | n | (% of total group) |
| Defence of self | 26 | (7.9) | 49 | (10.7) |
| Defence of other(s) | 6 | (1.8) | 11 | (2.4) |
| Defence of property | 4 | (1.2) | 2 | (0.4) |
| Furtherance of theft | 52 | (15.8) | 39 | (8.5) |
| Sex | 74 | (22.4) | 84 | (18.3) |
| Jealousy/Revenge | 53 | (16.1) | 85 | (18.5) |
| Apparently motiveless | 90 | (27.3) | 145 | (31.6) |
| Other | 101 | (30.6) | 152 | (33.1) |
For both of the admission groups a high and similar percentage of the patients have been
convicted of one offence on this admission, prison or remand centre admissions 166
patients (50.3%) and court admissions 256 patients (55.8%). Furthermore, as the number of
offences convicted of increases, the percentage of patient admissions from both of the
groups continues to remain similar (see table 16).
Table 16. Number of offences convicted of
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Number | n | (%) | n | (%) |
| No present offence | 3 | (0.9) | 3 | (0.6) |
| One | 166 | (50.3) | 256 | (55.8) |
| Two | 63 | (19.1) | 103 | (22.4) |
| Three | 49 | (14.9) | 50 | (10.9) |
| Four | 13 | (3.9) | 20 | (4.3) |
| Five | 10 | (3) | 9 | (2) |
| Six | 4 | (1.2) | 6 | (1.3) |
| Seven | 6 | (1.8) | 5 | (1.1) |
| Eight or more | 9 | (2.7) | 3 | (0.7) |
| Not known | 7 | (2.1) | 4 | (0.9) |
| Total | 330 | (100) | 459 | (100) |
Table 17. Total number of aggressors involved in the present offence
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Number | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Patient only | 221 | (67) | 261 | (56.9) |
| Patient and one other | 18 | (5.5) | 10 | (2.2) |
| Patient and two others | 4 | (1.2) | 2 | (0.4) |
| Patient and three others | 5 | (1.5) | 3 | (0.7) |
| Patient and four others | 1 | (0.3) | 0 | (0) |
| Not known | 1 | (0.3) | 3 | (0.7) |
| Total | 330 | (100) | 459 | (100) |
Tables 17 and 18 indicate the total number of aggressors involved in, and the number of
victims resulting from the present offence. For 80 (24.2%) of the prison or remand centre
admissions and 180 (39.2%) of the court admissions there were no aggressors involved or
there was no victim resulting from the present offence or the offence was not of a violent
nature, for example murder or attempted murder, manslaughter, indictable assault, wounding
or serious sexual offence. This result in itself is interesting, as a statistically
significant result (c2
= 18.809, df = 1, p<0.001) indicates that from both the
groups there is high chance of them committing an aggressive offence resulting in a victim
from the offence. In summary table 17 indicates that for the higher percentage of both the
admission groups the patient was the only aggressor involved in the offence, prison or
remand centre admissions 221 patients (67%) and court admissions 261 patients (56.9%).
Furthermore, table 17 shows that for both of the admission groups there is one victim as a
result of the offence, prison or remand centre admissions 207 patients (62.7%) and court
admissions 231 patients (50.3%).
Table 18. Number of victims resulting from present offence
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Number | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| One | 207 | (62.7) | 231 | (50.3) |
| Two | 32 | (9.7) | 32 | (7) |
| Three | 6 | (1.8) | 10 | (2.2) |
| Four | 2 | (0.6) | 2 | (0.4) |
| Five | 0 | (0) | 2 | (0.4) |
| Eight | 1 | (0.3) | 1 | (0.2) |
| Fourteen | 1 | (0.3) | 0 | (0) |
| Not known | 1 | (0.3) | 1 | (0.2) |
| Total | 330 | (100) | 459 | (100) |
6.5 FIRST VICTIM DETAILS
The demographic details of the first victim are shown by tables 19, 20 and 21. For 115
(34.9%) of the prison or remand centre admissions the first victim was male and for 133
(40.3%) the victim was female (see table 19). Similarly, for the court admission group no
significant difference exists, male victim 137 (29.9%) and female victim 139 (30.3%).
Table 19. Sex of victim one
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Sex | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Male | 115 | (34.9) | 137 | (29.9) |
| Female | 133 | (40.3) | 139 | (30.3) |
| Not known | 2 | (0.6) | 3 | (0.7) |
| Total | 330 | (100) | 459 | 100) |
For both of the admission groups it appears uncommon for the victim to be under 16 years
of age, prison or remand centre admissions 36 patients (10.3%) and court admissions 41
patients (8.9%). There appears from the data to be no obvious difference in the age group
of the victim between the admissions groups, except for the 17-32 age group where the
victim is twice as likely to be from this age group for the prison or remand centre
admissions (see table 20).
Table 20. Age of first victim
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Age | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| 1 - 16 | 27 | (8.2) | 41 | (8.9) |
| 17 - 32 | 53 | (16.1) | 40 | (8.7) |
| 33 - 48 | 23 | (7) | 24 | (5.2) |
| 49 - 60 | 16 | (4.9) | 22 | (4.8) |
| 61 - 72 | 18 | (5.5) | 26 | (5.7) |
| Over 72 | 12 | (3.6) | 12 | (2.6) |
| Not known but under 16 | 7 | (2.1) | 0 | (0) |
| Not known but over 16 | 91 | (27.6) | 111 | (24.2) |
| Not known | 3 | (0.9) | 3 | (0.7) |
| Total | 330 | (100) | 459 | (100) |
For the prison or remand centre admissions a stranger is twice as likely to be the victim
of the offence, 28.2% of the prison or remand centre admissions as opposed to 15.5% of the
court admissions (c2
= 7.973, df = 1, p<0.01). Furthermore, a friend, a well
known acquaintance, a neighbour or fellow lodger are the next most likely victims for both
of the admission groups, 17.9% of the prison or remand centre admissions and 13.1% of the
court admissions. Table 21 gives a fuller breakdown of the relationship of the victim to
the offender and this indicates that there are no significant differences between the
other victim/offender relationships for the two admission groups.
Table 21. Relationship of victim to offender.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Relationship | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Spouse or cohabitee | 18 | (5.5) | 10 | (2.2) |
| Ex-spouse or ex-cohabitee | 4 | (1.2) | 4 | (0.9) |
| Progeny | 5 | (1.5) | 3 | (0.6) |
| Parent | 9 | (2.7) | 31 | (6.8) |
| Grandparent | 1 | (0.3) | 3 | (0.7) |
| Sibling | 2 | (0.6) | 5 | (1.1) |
| Fiancee or lover | 8 | (2.4) | 7 | (1.5) |
| Other relative, including in-laws and step-parents | 11 | (3.3) | 9 | (2) |
| Fellow patient | 7 | (2.1) | 19 | (4.1) |
| Fellow prisoner | 5 | (1.5) | 3 | (0.7) |
| Policeman or woman | 5 | (1.5) | 10 | (2.2) |
| Prison officer, staff of penal institution | 2 | (0.6) | 1 | (0.2) |
| Doctor or nurse | 2 | (0.6) | 13 | (2.8) |
| Other person acting in an official capacity | 9 | (2.7) | 19 | (4.1) |
| Workmate or past workmate | 4 | (1.2) | 5 | (1.1) |
| Friend, well known acquaintance, neighbour, fellow lodger | 59 | (17.9) | 60 | (13.1) |
| Other | 1 | (0.3) | 2 | (0.4) |
| Stranger | 93 | (28.2) | 71 | (15.5) |
| Not known | 5 | (1.5) | 4 | (0.8) |
| Total | 330 | (100) | 459 | (100) |
For the prison or remand centre admission group there is a 19.4% chance that the location
of the offence will be the home of the victim; this is followed by a 13% chance of it
being a lonely spot, 10.9% chance of it being the home of both the victim and the patient
and a 8.8% chance of it being a public place thoroughfare. Similarly for the court
admissions the home of the victim is the most likely location of the offence (12.2%), but
then this is followed by the home of both the victim and the patient (11.1%); public place
thoroughfares account for a similar percentage as in the prison or remand centre
admissions (9.6%), however there is half the chance of the location for court admissions
being a lonely spot (6.3%) as for the previous group. Furthermore, there is a 6.3% chance
of the location being a mental institution (see table 22).
Table 22. Location of offence
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Location | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Home of both offender and victim | 36 | (10.9) | 51 | (11.1) |
| Home of offender but not victim | 14 | (4.2) | 19 | (4.1) |
| Home of victim but not offender | 64 | (19.4) | 56 | (12.2) |
| Workplace of both victim and offender | 3 | (0.9) | 2 | (0.4) |
| Workplace of offender but not victim | 1 | (0.3) | 0 | (0) |
| Workplace of victim but not offender | 9 | (2.7) | 15 | (3.3) |
| Mental institution | 7 | (2.1) | 29 | (6.3) |
| Penal institution | 7 | (2.1) | 8 | (1.7) |
| Public place i.e. cafe, hotel | 9 | (2.7) | 12 | (2.6) |
| Thoroughfares of public places | 29 | (8.8) | 44 | (9.6) |
| Lonely spot | 43 | (13) | 29 | (6.3) |
| Other | 18 | (5.5) | 10 | (2.2) |
| Not known | 10 | (3) | 4 | (0.9) |
| Total | 330 | (100) | 459 | (100) |
Tables 23 and 24 show the main and secondary methods of assault for violent offences
including murder, attempted murder, manslaughter, infanticide, wounding, indictable
assault, buggery, indecent assault, rape or attempted rape, unlawful sexual intercourse
and gross indecency with a child. For the main method of assault (table 23), 113 patients
(34.2%) from the prison or remand centre admissions and 217 patients (47.3%) from the
court admissions, the offence was not an offence of a violent nature resulting in a
victim. For both of the admission groups the most frequent main method of assault was the
use of a sharp instrument, 84 patients (25.5%) from the prison or remand centre admissions
and 112 patients (24.4%) from the court admissions. For the prison or remand centre
admissions the use of a blunt instrument is the next most frequent method (46 patients;
13.9%), and is closely followed by punching, kicking or pushing (35 patients; 10.6%). For
the court admissions the situation is reversed, punching, kicking or pushing is the next
most frequent main method of assault (46 patients; 10%), followed by the use of a blunt
instrument (34 patients; 7.4%).
Table 23. Main method of assault (violent offences only).
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Method | n | (%) | n | (%) |
| Not applicable | 113 | (34.2) | 217 | (47.3) |
| Strangulation or asphyxia (not drowning) | 22 | (6.7) | 27 | (5.9) |
| Sharp instrument | 84 | (25.5) | 112 | (24.4) |
| Blunt instrument | 46 | (13.9) | 34 | (7.4) |
| Punched, kicked or pushed | 35 | (10.6) | 46 | (10) |
| Firearms | 18 | (5.5) | 5 | (1.1) |
| Poison | 1 | (0.3) | 2 | (0.4) |
| Other (including threats or drowning) | 5 | (1.5) | 12 | (2.6) |
| Not known | 6 | (1.8) | 4 | (0.9) |
| Total | 330 | (100) | 459 | (100) |
For 278 patients (84.2%) from the prison or remand centre admissions and 408 patients
(88.9%) from the court admissions there was no secondary method of assault on the first
victim; or the offence was not of a violent nature and resulted in a victim. For both of
the admission groups the most frequent second method of assault for only a small number of
the admissions (see table 24) was by punching, kicking or pushing; for prison or remand
centre admissions 19 patients (5.8%) and for court admissions 23 patients (5%).
Table 24. Secondary method of assault (violent offences only).
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Method | n | (%) | n | (%) |
| Not applicable or no second method | 278 | (84.2) | 408 | (88.9) |
| Strangulation or asphyxia (not drowning) | 5 | (1.5) | 2 | (0.4) |
| Sharp instrument | 5 | (1.5) | 7 | (1.5) |
| Blunt instrument | 7 | (2.1) | 8 | (1.7) |
| Punched, kicked or pushed | 19 | (5.8) | 23 | (5) |
| Firearms | 0 | (0) | 1 | (0.2) |
| Other (including drowning) | 7 | (2.1) | 6 | (1.3) |
| Not known | 9 | (2.7) | 4 | (0.9) |
| Total | 330 | (100) | 459 | (100) |
From the prison or remand centre admissions 76 patients (23%) had consumed alcohol prior
to the offence; and of these 30 patients (9.1%) had been consuming alcohol along with
their victim. However, from the court admissions a relatively smaller number had consumed
alcohol, 58 patients (12.6%); and of these 19 patients (4.1%) had consumed it along with
their victim (see table 25). More interesting however, is that a significantly higher
number of patients from both of the admission groups had not consumed alcohol prior to the
offence (c2 = 9.198, df = 1, p<0.01), prison or remand centre admissions 143 patients
(43.3%) and court admissions 196 patients (42.7%).
Table 25. Consumption of alcohol prior to the offence.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Consumption | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Offender only drinking | 46 | (13.9) | 39 | (8.5) |
| Victim only drinking | 7 | (2.1) | 6 | (1.3) |
| Offender and victim drinking | 30 | (9.1) | 19 | (4.1) |
| Neither offender or victim drinking | 143 | (43.3) | 196 | (42.7) |
| Not known | 24 | (7.3) | 19 | (4.1) |
| Total | 330 | (100) | 459 | (100) |
Table 26. Consumption of drugs prior to the offence.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Consumption | n | (%) | n | (%) |
| Not applicable | 80 | (24.2) | 180 | (39.2) |
| Offender only taken drugs | 23 | (7) | 12 | (2.6) |
| Victim only taken drugs | 0 | (0) | 0 | (0) |
| Offender and victim taken drugs | 2 | (0.6) | 4 | (0.9) |
| Neither offender or victim taken drugs | 201 | (60.9) | 244 | (53.2) |
| Not known | 24 | (7.3) | 19 | (4.1) |
| Total | 330 | (100) | 459 | (100) |
A significantly higher number of patients from both of the admission groups had not
consumed drugs prior to the offence (c2 = 4.399, df = 1,
p<0.05), prison or remand centre admissions 201 patients (60.9%) and court admissions
244 patients (53.2%). Furthermore, it is interesting that only a small number of patients
from both of the admission groups had actually consumed drugs prior to the offence, 25
patients (7.6%) from the prison or remand centre admissions and 16 patients (3.5%) from
the court admissions (see table 26).
For a high percentage of both the admission groups the circumstances surrounding the
offence was entirely unexpected (see table 27); 180 patients (54.6%) form the prison or
remand centre admissions and 210 patients (45.8%) from the court admissions. Only a
relatively small percentage had a history of previous threats, attacks or discord between
the victim and the patient, with their being no significant difference between the two
admission groups; 55 patients (16.6%) from the prison or remand centre admissions and 58
patients (12.6%) form the court admissions. Furthermore, from both the admission groups
for a high percentage of the patients there were no precipitating events to the offence
(see table 28); 149 patients (45.2%) from the prison or remand centre admissions and 180
patients (39.2%) from the court admissions.
Table 27. Circumstances of the offence.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Circumstance | n | (%) | n | (%) |
| Not applicable | 82 | (24.9) | 182 | (39.6) |
| Entirely unexpected | 180 | (54.6) | 210 | (45.8) |
| History of previous attacks, threats or discord between the offender and victim | 55 | (16.6) | 58 | (12.6) |
| Not known | 13 | (3.9) | 9 | (2) |
| Total | 330 | (100) | 459 | (100) |
Table 28. Precipitating events.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Event | n | (%) | n | (%) |
| Not applicable | 82 | (24.8) | 185 | (40.3) |
| Presence of precipitating event | 87 | (26.4) | 88 | (19.2) |
| No precipitating event | 149 | (45.2) | 180 | (39.2) |
| Not known | 12 | (3.6) | 6 | (1.3) |
| Total | 330 | (100) | 459 | (100) |
For a high number from both of the admission groups the patient struck the first blow,
which would indicate that the victim did not physically provoke their attacker (see table
29); prison or remand centre 183 patients (55.5%) and court 219 patients (47.7%).
Furthermore, for only a very small percentage from both of the admission groups did the
victim actually strike the first blow; prison or remand centre admissions (1.8%) and court
admissions (1.5%).
Table 29. Provocation (violent offences only).
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Not applicable | 114 | (34.5) | 216 | (47.1) |
| Offender struck first blow | 183 | (55.5) | 219 | (47.7) |
| Victim struck first blow | 6 | (1.8) | 7 | (1.5) |
| No physical contact (e.g. threats, poisoning, firearms) | 18 | (5.5) | 11 | (2.4) |
| Not known | 9 | (2.7) | 6 | (1.3) |
| Total | 330 | (100) | 459 | (100) |
Table 30 indicates if any sexual features were present in the offence. In each of the
admission groups sexual features were only present in a relatively small number and no
significant differences exist between the admission groups. For the prison or remand
centre admissions 48 patients (14.6%) had sexual features present and 164 patients (49.7%)
did not; and for the court admissions 38 patients (8.3%) they were present and for 204
patients (44.4%) they were not.
Table 30. Sexual features of the offence (violent offences only).
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Not applicable | 112 | (33.9) | 210 | (45.8) |
| Sexual features present | 48 | (14.6) | 38 | (8.3) |
| Sexual features absent | 164 | (49.7) | 204 | (44.4) |
| Not known | 6 | (1.8) | 7 | (1.5) |
| Total | 330 | (100) | 459 | (100) |
6.6 ALCOHOL AND SUBSTANCE USAGE
It appears from the literature that the abuse of alcohol or drugs may be an
influential factor in the decision making process for diverting a mentally disordered
offender from the criminal justice system or not. The case register holds information
collected from patient interview on admission on aspects of their alcohol and drug usage.
Indicated by table 31 is how many of the patients in each of the admission groups drink
alcohol and whether they have a drink problem or not. A high number of the patients from
both of the admission groups reported that they had a drink problem; prison or remand
centre admissions 183 patients (55.5%) and court admissions 245 patients (53.4%). Only a
small percentage from both of the groups reported that they drank alcohol but did not have
a drink problem. No significant difference exist between the two admission groups.
Table 31. Drink problem
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never drinks | 48 | (14.5) | 97 | (21.1) |
| Yes | 183 | (55.5) | 245 | (53.4) |
| No | 50 | (15.2) | 59 | (12.9) |
| Not known | 49 | (14.8) | 58 | (12.6) |
| Total | 330 | (100) | 459 | (100) |
Table 32. Cannabis - frequency of use during year prior to admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never taken, not taken during last year | 163 | (49.4) | 319 | (69.5) |
| Once or very few occasions | 19 | (5.8) | 17 | (3.7) |
| Intermittently (weekends) | 28 | (8.5) | 15 | (3.3) |
| Regularly (daily) | 65 | (19.7) | 47 | (10.2) |
| Diagnosed as addict | 3 | (0.9) | 2 | (0.4) |
| Not known | 52 | (15.7) | 59 | (12.9) |
| Total | 330 | (100) | 459 | (100) |
Tables 32 - 36 identify the frequency of drug usage for the year prior to admission as
reported by the patients on admission. For all the five types of illegal substances
cannabis, amphetamines, barbiturates, heroin or morphine and LSD a significantly
percentage of the patients from both of the admission groups reported that they had never
taken or not taken the substances during the year prior to admission.
Table 33. Amphetamines - frequency of use during year prior to admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never taken, not taken during last year | 236 | (71.5) | 373 | (81.3) |
| Once or very few occasions | 9 | (2.7) | 5 | (1.1) |
| Intermittently (weekends) | 13 | (3.9) | 10 | (2.2) |
| Regularly (daily) | 18 | (5.5) | 12 | (2.6) |
| Diagnosed as addict | 1 | (0.3) | 0 | (0) |
| Not known | 53 | (16.1) | 59 | (12.8) |
| Total | 330 | (100) | 459 | (100) |
Table 34. Barbiturates - frequency of use during year prior to admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never taken, not taken during last year | 267 | (80.9) | 388 | (84.5) |
| Once or very few occasions | 2 | (0.6) | 2 | (0.4) |
| Intermittently (weekends) | 6 | (1.8) | 4 | (0.9) |
| Regularly (daily) | 5 | (1.5) | 7 | (1.5) |
| Diagnosed as addict | 0 | (0) | 0 | (0) |
| Not known | 50 | (15.2) | 58 | (12.6) |
| Total | 330 | (100) | 459 | (100) |
For those that reported non-usage of cannabis a significant difference exists between the
two admission groups (see table 32), twenty percent more reported non-usage from the court
admission group (c2
= 34.567, df = 1, p<0.001). Again from those reporting
non-usage of amphetamines a significant difference exists between the two groups (see
table 33), ten percent more reporting non-usage from the court admission group (c2 = 10.868, df = 1, p<0.001). For the remaining three types of illegal substance
barbiturates, heroin or morphine and LSD a small non-significant difference exists between
the two admission groups, this difference is approximately five percent and for all three
types of substance the higher difference is from the court admission group.
Table 35. Heroin or morphine - frequency of use during year prior to admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never taken, not taken during last year | 260 | (78.8) | 385 | (83.9) |
| Once or very few occasions | 9 | (2.7) | 4 | (0.9) |
| Intermittently (weekends) | 3 | (0.9) | 4 | (0.9) |
| Regularly (daily) | 9 | (2.7) | 7 | (1.5) |
| Diagnosed as addict | 0 | (0) | 1 | (0.2) |
| Not known | 49 | (14.9) | 58 | (12.6) |
| Total | 330 | (100) | 459 | (100) |
For those patients that reported that they had used the illegal substances during the year
prior to admission, and the frequency of usage is grouped together, approximately twice
the percentage of patients reported usage from the prison or remand centre admission group
for three of illegal substances; for cannabis usage 34.9% from the prison or remand centre
admissions and 17.2% from the court admissions (see table 32); for amphetamine usage 12.4%
from the prison or remand centre admissions and 5.9% from the court admissions (see table
33); and for heroin or morphine usage 6.3% from the prison or remand centre admissions and
3.5% from the court admissions (see table 35). For the remaining two illegal substances
barbiturates and LSD only a small differences, approximately one percent, exists between
the two admission groups, with the higher reported usage for both substances from the
prison or remand centre admission group.
Table 36. LSD - frequency of use during year prior to admission
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Never taken, not taken during last year | 246 | (74.6) | 364 | (79.3) |
| Once or very few occasions | 14 | (4.2) | 10 | (2.2) |
| Intermittently (weekends) | 7 | (2.1) | 16 | (3.5) |
| Regularly (daily) | 11 | (3.3) | 11 | (2.4) |
| Diagnosed as addict | 0 | (0) | 0 | (0) |
| Not known | 52 | (15.8) | 58 | (12.6) |
| Total | 330 | (100) | 459 | (100) |
6.7 PREVIOUS INSTITUTIONAL EXPERIENCES
From the prison or remand centre admissions 163 patients (49.4%) had no previous
psychiatric admissions and from the court admissions 161 ( 35.1%) patients had none. For
the remaining patients from the two admission groups, 162 (49.1%) patients from the prison
or remand centre admissions and 292 (63.6%) from the court admissions, have had previous
psychiatric admissions and this represents a significant difference beyond the one percent
level (c2 = 16.032, df = 1, p<0.001). For 5 patients from the prison or remand centre
admissions and 6 patients from the court admissions it is not known if they have had
previous psychiatric admission or not. The mean number of previous admissions, for
patients who it is known if they have had previous psychiatric admission or not, from the
prison or remand centre admissions is 1.769 admissions (SD = 3.474, Minimum = 0, Maximum =
29) and the mean number from the court admissions is 2.804 (SD = 3.934, Minimum = 0,
Maximum = 22). Although only a mean difference of 1.034 exists between the two groups this
is significant beyond the one percent level (t = 3.87, df = 743, p<0.001). Furthermore,
if we use the 95% confidence interval for the difference between the means, we can assume
that the mean difference for the number of previous psychiatric admissions is between
0.510 and 1.559 less for patients admitted from prison or remand centre than from court.
Figure 2 displays graphically the trend for the number of previous psychiatric admissions
for the two admission groups.
Figure 2. Number of previous psychiatric admissions (N=454)
For 280 (84.8%) patients from the prison or remand centre admissions and 406 (88.5%)
patients from the court admissions their present admission is their first to a Special
Hospital (see table 37).
Table 37. Number of admissions to a Special Hospital.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| n | (%) | n | (%) | |
| Present admission first | 280 | (84.8) | 406 | (88.5) |
| Present admission second | 39 | (11.8) | 41 | (8.9) |
| Present admission third | 8 | (2.4) | 8 | (1.7) |
| Present admission fourth | 1 | (0.3) | 2 | (0.4) |
| Present admission sixth | 0 | (0) | 1 | (0.2) |
| Unknown | 2 | (0.6) | 1 | (0.2) |
| Total | 330 | (100) | 459 | (100) |
Figure 3. Number of custodial sentences (N=372)
From the prison or remand centre admissions 111 (33.6%) patients had no previous criminal
history or custodial sentences and from the court admission 287 (62.5%) patients had none.
From the remainder of the patients from the two admission groups, 208 (63%) from the
prison or remand centre admissions and 164 (35.7%) from the court admissions, had served a
custodial sentence, and this represents a significant difference beyond the one percent
level (c2 = 61.084, df = 1, p<0.001). For 11 patients from the prison or remand centre
admissions and 8 patients from the court admissions it is unknown if they had served a
custodial sentence or not. The mean number of previous custodial sentences, for the
patients who it is known if they have served a previous custodial sentence or not, for the
prison or remand centre admissions is 4.288 custodial sentences (SD = 5.604, Minimum = 0,
Maximum = 36) and for the court admission 1.749 custodial sentences (SD = 3.725, Minimum =
0, Maximum = 29). The mean difference between the two groups is 2.539 and this is
significant beyond the one percent level (t = 7.06, df = 512, p<0.001). Furthermore, if
we use the 95% confidence interval for the difference between the two means, we can assume
that the mean difference for the number of previous custodial sentences is between 1.833
and 3.245 more custodial sentences for patients from prison or remand centre than from
court. Figure 3 is a graphical representation of the number of previous custodial
sentences served by patients from the two admission groups.
Table 38. Institutional experiences prior to sixteenth birthday
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Experience | n | (% of total group) | n | (% of total group) |
| Children's Home, Community Home, Approved School | 89 | (27) | 126 | (27.5) |
| E.S.N. School | 20 | (6.1) | 31 | (6.8) |
| School for maladjusted children | 14 | (4.2) | 25 | (5.4) |
| Psychiatric or Subnormality Hospital | 16 | (4.8) | 40 | (8.7) |
| Penal Institution | 45 | (13.6) | 21 | (4.6) |
A high percentage of patients from both of the admission groups had institutional
experiences prior to their sixteenth birthday, 132 (40%) patients from the prison or
remand centre admissions and 181 (39.4%) patients from the court admissions. These
experiences range from children's homes to psychiatric hospitals or penal institutions. A
break of the experiences for the patients from the two admission groups is shown by table
38.
6.8 CRIMINAL HISTORY
A high percentage of the patients from both of the admission groups have a previous
criminal history - 278 (84.2%) from the prison or remand centre admission and 362 (78.9%)
from the court admissions. This represents a significant difference beyond the five
percent level (c2
= 4.877, df = 1, p<0.05). Only 43 (13%) patients from the
prison or remand centre admissions and 89 (19.4%) patients from the court admissions had
no previous criminal history (see table 39).
Table 39. Criminal history.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| History | n | (%) | n | (%) |
| Yes | 278 | (84.2) | 362 | (78.9) |
| No | 43 | (13) | 89 | (19.4) |
| Not known | 9 | (2.7) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
Figure 4 depicts graphically the number of court appearances for the patients from the two
admission groups with a criminal history prior to the present offence. For the patients
who it is known whether or not they had a prior criminal history (prison or remand centre
n=321 and court n=451) the mean number of previous court appearances is 7.832 appearances
(SD = 6.614, Minimum = 0, Maximum = 33) for the prison or remand centre admissions and
5.100 appearances (SD = 5.843, Minimum = 0, Maximum = 37) for the court admissions. There
is a mean difference of 2.732 between the two groups and this is significant beyond the
one percent level (t = 5.93, df = 635, p<0.001). Furthermore, if we use the 95%
confidence interval for the difference between the two means, we can assume that for the
number of previous court appearances the mean difference is between 1.828 and 3.636 more
appearances for patients admitted from prison or remand centre than from court.
Figure 4. Total number of prior court appearances (N=670).
A significantly higher percentage of the prison or remand centre admissions have a
juvenile criminal record (prior to their seventeenth birthday) - 187 (56.7%) as opposed to
215 (46.9%) from the court admissions (see table 40). This represents a significant
difference beyond the one percent level (c2 = 7.475, df = 1,
p<0.01).
Table 40. Juvenile record.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Juvenile record | n | (%) | n | (%) |
| Yes | 187 | (56.7) | 215 | (46.9) |
| No | 136 | (41.2) | 236 | (51.4) |
| Not known | 7 | (2.1) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
Figure 5. Age at first court appearance as a juvenile (N=402).
Depicted by Figure 5 is a graphical representation of the age of first appearance in court
for the patients who have a juvenile criminal record. The mean age is 13.005 years (SD =
2.067, Minimum = 8, Maximum =16) for the prison or remand centre admission and 13.721
years (SD = 1.925, Minimum = 8, Maximum = 16) for the court admissions. Although there is
only a mean difference of only 0.716 between the two groups this is significant beyond the
one percent level. Furthermore, if we use the 95% confidence interval for the difference
between the two means, we can assume for the age at first appearance in court as a
juvenile the mean difference is between 0.324 and 1.107 years younger for patients
admitted from prison or remand centre than court. Figure 6 indicates the number of court
appearances as a juvenile these patients had. The mean number of appearances for the
prison or remand centre admissions is 3.957 appearances (SD = 2.609, Minimum = 1, Maximum
= 16) and for the court admissions 2.88 appearances (SD = 2.470, Minimum = 1, Maximum =
17). Again although the mean difference between the two groups is only 1.069 this is
significant beyond the one percent level (t = 4.22, df = 400, p<0.001). Furthermore, if
we use the 95% confidence interval for the difference between the two means, we can assume
for the number of court appearances as a juvenile the mean difference is between 0.570 and
1.567 more court appearances for patients admitted from prison or remand centre than
court.
Figure 6. Number of court appearances as a juvenile (N=402)
Table 41. Adult criminal record.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Adult record | n | (%) | n | (%) |
| Yes | 262 | (79.4) | 301 | (65.6) |
| No | 61 | (18.5) | 150 | (32.7) |
| Not known | 7 | (2.1) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
From both of the admission groups a high percentage of the admissions had a previous adult
criminal record (seventeen years of age onwards) with a significantly higher percentage
from the prison or remand centre group - prison or remand centre 79.4% and court 65.6%.
Furthermore, a significantly higher percentage of the court admissions had no previous
adult criminal record - prison or remand centre 18.5% and court 32.7% (see table 41). This
represents a difference beyond the one percent level (c2 = 18.892, df = 1,
p<0.001).
Figure 7. Age at first adult court appearance (N=563)
Figure 7 depicts graphically the age at first court appearance as an adult. The mean age
for the prison or remand centre admissions is 19.111 years of age (SD = 4.653, Minimum =
17, Maximum = 54) and for the court admissions is 20.096 years of age (SD = 5.213, Minimum
= 17, Maximum = 56). Although there is only a mean difference of 0.986 between the two
groups this is significant beyond the five percent level (t = 2.37, df = 561, p<0.05).
Furthermore, if we use the 95% confidence interval for the difference between the two
means, we can assume for the age at first court appearances as an adult the mean
difference is between 0.169 and 1.803 years younger for patients admitted from prison or
remand centre than court. Figure 8 indicates the number of previous court appearances for
the patients who had a previous adult criminal record. The mean number of previous adult
court appearances for those patients that it is known whether they have a previous adult
record or not (prison or remand centre n=321 and court n=451) is for the prison or remand
centre group 5.579 appearances (SD = 5.486, Minimum = 0, Maximum = 30) and for the court
group 3.698 appearances (SD = 5.094, Minimum = 0, Maximum = 35). There is a mean
difference of 1.881 appearances between the two groups and this is significant beyond the
one percent level (t = 4.84, df = 657, p<0.001). Furthermore, if we use the 95%
confidence interval for the difference between the two means, we can assume for the number
of court appearances as an adult the mean difference is between 1.117 and 2.645 more court
appearances for patients admitted from prison or remand centre than court.
Figure 8. Number of court appearances as an adult (N=563).
Outlined in table 42 is the past offences that the patients from the two admission groups
have been convicted of. From both of the admission groups the highest percentage of
patients had previously been convicted of the offence of theft or larceny and furthermore
a significant difference exists beyond the one percent between the two groups, prison or
remand centre admissions 70.3% and court 56.2% (c2 = 15.610, df = 1,
p<0.001). A high percentage of the admissions from both of the groups had also been
previously convicted of - burglary, prison or remand centre 55.2% and court 36.8%, with a
significant difference beyond the one percent level (c2 = 25.388, df = 1,
p<0.001); wounding or indictable assault, prison or remand centre 47.3% and court
32.5%, with a significant difference beyond the one percent level (c2 = 17.139, df = 1, p<0.001); criminal, malicious or wilful damage, prison or
remand centre 44.5% and court 41.4%; robbery, prison or remand centre 19.1% and court 7%,
with a significant difference beyond the one percent level (c2 = 25.492, df = 1,
p<0.001); arson, prison or remand centre 14.5% and court 18.1%; indecent assault on a
female, prison or remand centre 9.7% and court 7.6%; and rape or attempted rape, prison or
remand centre 6.4% and court 3.1%, with a significant difference beyond the five percent
level (c2 = 4.221, df = 1, p<0.05)
Table 42. Past offences convicted of
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Offence | n | (% of total group) | n | (% of total group) |
| Murder, attempted murder, threat or conspiracy to murder | 5 | (1.5) | 5 | (1.1) |
| Manslaughter, infanticide | 5 | (1.5) | 3 | (0.7) |
| Wounding or indictable assault | 156 | (47.3) | 149 | (32.5) |
| Buggery or attempt, indecent assault on a male | 13 | (3.9) | 12 | (2.6) |
| Rape or attempt | 21 | (6.4) | 14 | (3.1) |
| Indecent assault on a female | 32 | (9.7) | 35 | (7.6) |
| Indecent exposure | 10 | (3) | 13 | (2.8) |
| Robbery or attempt | 63 | (19.1) | 32 | (7) |
| Burglary or attempt, breaking or attempt, sacrilege | 182 | (55.2) | 169 | (36.8) |
| Theft, larceny, TDA | 232 | (70.3) | 258 | (56.2) |
| Arson | 48 | (14.5) | 83 | (18.1) |
| Criminal, malicious or wilful damage | 147 | (44.5) | 190 | (41.4) |
| Prevention of Crime Act 1953, possession of an offensive weapon | 64 | (19.4) | 56 | (12.2) |
| Drunkenness | 24 | (7.3) | 40 | (8.7) |
| Prostitution | 3 | (0.9) | 2 | (0.4) |
| Death by dangerous driving | 4 | (1.2) | 0 | (0) |
| Dangerous driving | 10 | (3) | 2 | (0.4) |
Figure 9 displays the age at the first violent offence for the patients from the two
groups. From the prison or remand centre admission group 138 (41.8%) patients have no
criminal history or no violent offences in their history, 183 (55.5%) patients have a
violent offence, and for 9 (2.7%) patients it is unknown; and from the court admission
group 284 (61.9%) patients have no criminal history or violent offences in their history,
167 (36.4%) patients have a violent offence, and for 8 (1.7%) patients it is unknown. This
difference is significant beyond the one percent level (c2 = 29.408, df = 1,
p<0.001).
For the patients from the two groups who have a violent offence in their history, the mean
age at first violent offence for the prison or remand centre admissions is 19.459 years of
age (SD = 5.466, Minimum = 10, Maximum = 54) and the mean age for the court admissions is
21.365 years of age (SD = 7.557, Minimum = 10, Maximum = 56). The mean difference between
the two groups is 1.906 years of age and this is significant beyond the one percent level
(t = 2.68, df = 300, p<0.01). Furthermore, if we use the 95% confidence interval for
the difference between the two means, we can assume for the age at first violent offence
the mean difference is between 0.507 and 3.305 years younger for patients admitted from
prison or remand centre than court.
Figure 9. Age at first violence offence (N=350).
A high percentage of the admissions from both of the admission groups have no criminal
history or sex offences in their history, prison or remand centre 262 (79.4%)patients and
court 395 (86.1%) patients. Therefore, only a small percentage of the admissions from the
groups have a history of sex offences, prison or remand centre 60 (18.2%) patients and
court 57 (12.4%) patients. For 8 (2.4%) patients from the prison or remand centre
admissions and 7 (1.5%) patients from the court admissions it is unknown if they have a
history of sex offences. The difference between the two admission groups is significant
beyond the five percent level (c2 = 4.857, df = 1,
p<0.05). Figure 10 depicts graphically the age at first sex offence for those patients
who have a history of previous sex offences from the two admission groups.
The mean age at first sex offence for those patients who have a history of sex offences is
- for prison or remand centre admissions 20.300 years of age (SD = 5.397, Minimum = 11,
Maximum = 33) and for the court admissions 20.526 years of age (SD = 5.632, Minimum = 10,
Maximum = 43). There is only a non-significant mean difference of 0.226 years between the
admission groups (t = 0.22, df = 115, p=0.825).
Figure 10. Age at first sex offence (N=117).
From the prison or remand centre admissions 163 (49.4%) patients have no criminal history
or history of arson, criminal/wilful/malicious damage; 159 (48.2%) patients have a history
and for 8 (2.4%) patients it is unknown. From the court admissions 238 (51.8%) patients
have no history, 213 (46.4%) patients have a history and for 8 (1.7%) patients it is
unknown. There is no significant difference between the two admission groups.
Figure 11. Age at first offence of arson, criminal/wilful/malicious damage (N=372).
Figure 11 displays the age at the first offence of arson, criminal/wilful/malicious damage
for the patients from the two admission groups. The mean age at the first offence for the
prison or remand centre admissions is 19.151 years of age (SD = 5.973, Minimum = 10,
Maximum = 42) and for the court admissions 19.911 years of age (SD = 6.857, Minimum = 10,
Maximum = 49). There is only a non-significant mean difference of 0.760 years between the
two admission groups (t = 1.12, df = 370, p = 0.265).
6.9 PREVIOUS CARE OR SUPERVISION ORDERS
Table 43. History of youth custody, borstal training, detention centre or approved school
order.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Order | n | (%) | n | (%) |
| No criminal history, custody, training or orders | 164 | (49.7) | 333 | (72.6) |
| Approved school order only | 9 | (2.7) | 10 | (2.2) |
| Detention centre order only | 15 | (4.6) | 23 | (5) |
| Youth custody and/or borstal training | 56 | (17) | 54 | (11.8) |
| Approved school and detention centre orders | 3 | (0.9) | 1 | (0.2) |
| Approved school order and youth custody or borstal training | 13 | (3.9) | 5 | (1.1) |
| Detention centre order and youth custody or borstal training | 49 | (14.9) | 24 | (5.2) |
| Approved school and detention centre orders, and youth custody or borstal training | 10 | (3) | 1 | (0.2) |
| Not known | 11 | (3.3) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
A significantly higher percentage of the patients from the court admissions have no
history of youth custody, detention centre or approved school orders - prison or remand
centre 164 (49.7%) patients and court 333 (72.6%) patients. This difference is significant
beyond the one percent level (c2 = 40.085, df = 1, p<0.001). From the
remaining admissions 56 (17%) patients from the prison or remand centre admission group
and slightly fewer 54 (11.8%) patients from the court admission group had youth custody
and/or borstal training, whereas, over twice the percentage of admissions from the prison
or remand centre group (14.9%) had a detention centre order and youth custody or borstal
training than the court group (5.2%). Table 43 gives a full breakdown of the youth
custody, borstal training, detention centre and approved school orders for the patients
from the two admission groups.
Table 44. History of care, supervision, probation or hospital orders.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Order | n | (%) | n | (%) |
| No criminal history or orders | 110 | (33.3) | 177 | (38.6) |
| Care or supervision orders only | 49 | (14.8) | 67 | (14.6) |
| Probation orders only | 83 | (25.2) | 91 | (19.8) |
| Hospital orders only | 14 | (4.2) | 28 | (6.1) |
| Care/Supervision orders and probation orders | 39 | (11.8) | 42 | (9.2) |
| Care/Supervision orders and hospital orders | 6 | (1.8) | 8 | (1.7) |
| Probation and hospital orders | 13 | (3.9) | 29 | (6.3) |
| Care/Supervision, probation and hospital orders | 5 | (1.5) | 9 | (2) |
| Not known | 11 | (3.3) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
Only a small percentage of the admission from the two groups have no history of care,
supervision, probation or hospital orders - prison or remand centre 110 (33.3%) patients
and court 177 (38.6%) patients. Table 44 gives a breakdown of the previous orders that the
patients from the two admission groups have had. A high percentage of patients from the
prison or remand centre admissions had previous probation orders (25.2%), care or
supervision orders (14.8%), and care/supervision and probation orders (11.8%); and a high
percentage of patients, but slightly lower than the previous group, from the court
admissions had previous probation orders (19.8%), care or supervision orders (14.6%), and
care/supervision and probation orders (9.2%). Only a small percentage of the two admission
groups had previous hospital orders.
From the prison or remand centre admissions 113 (34.2%) patients have no criminal history
or history of supervisory sentences whereas 219 (47.7%) patients from the court admissions
don't have; 206 (62.4%) patients from the prison or remand centre admissions and 232
(50.5%) patients from the court admissions have a history of supervisory sentences; and
for 11 (3.3%) patients from the prison or remand centre admissions and 8 (1.7%) patients
from the court admissions it is unknown. This difference is significant beyond the one
percent level (c2 = 12.614, df = 1, p<0.001). Figure 12 displays the total number of previous
supervisory sentences for the patients from the two groups.
Figure 12. Number of previous supervisory sentences (N=438).
For the patients that it is known whether they have a history of previous supervisory
sentences (prison or remand centre n=319 and court n=451) the mean total number of
sentences is - prison or remand centre 1.646 supervisory sentences (SD = 1.760, Minimum =
0, Maximum =10) and court 1.315 supervisory sentences (DF = 1.876, Minimum =0, Maximum =
13). Although there is only a small mean difference between the two admission groups
0.331, this is significant beyond the five percent level (t = 2.47, df = 768, p<0.05).
Furthermore, if we use the 95% confidence interval for the difference between the two
means, we can assume for the number of previous supervisory sentences the mean difference
is between 0.068 and 0.594 more supervisory sentence for patients admitted from prison or
remand centre than court.
Table 45. Probation order with condition of treatment.
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Order | n | (%) | n | (%) |
| Yes | 21 | (6.4) | 35 | (7.6) |
| No | 300 | (90.9) | 416 | (90.6) |
| Not known | 9 | (2.7) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
Table 45 shows the number of admissions from the two groups that had previous probation
orders with a condition of treatment included. This table indicates that only a very small
percentage of patients from both of the admission groups had an order of this type
previously - prison or remand centre 21 (6.4%) patients and court 35 (7.6%) patients.
There is no significant difference between the two admission groups. Table 46 indicates
the number of admissions from the two groups who had previous hospital orders with
restrictions included. Again only a very small percentage of the patients from the two
admission groups had a previous order of this type - prison or remand centre 7 (2.1%)
patients and court 15 (3.3%) patients.
Table 46. Hospital order with restrictions
| Prison or remand centre | Court | |||
|---|---|---|---|---|
| Order | n | (%) | n | (%) |
| Yes | 7 | (2.1) | 15 | (3.3) |
| No | 314 | (95.2) | 436 | (95) |
| Not known | 9 | (2.7) | 8 | (1.7) |
| Total | 330 | (100) | 459 | (100) |
7 SUMMARY
Initially it would appear that a large number of the admissions over the twenty year
period have been as a result of the transfer from one of the other special hospitals -
Rampton, Broadmoor, and Carstairs (Scotland's State Hospital); with this number accounting
for nearly one quarter of all the admissions. This figure, however, is larger than would
have been normally expected, with opening of the north campus of the hospital, formally
Park Lane Hospital in the early 1980's, when a large number of patients were transferred
for demographical or managerial reasons. Only a small number of the admissions, about one
fifth, have come from either mainstream psychiatric or subnormality beds, or Regional
Secure Units, but the largest group of admissions, over one half, have come from the
criminal justice system, either prison or remand centre or direct from the court.
As the study intended to differentiate between those patients admitted from either prison
or court it was this latter group of patients that were of particular interest to the
writers. For the purposes of the study those patients that were admitted directly from
court were defined as being diverted from the criminal justice system; and those patients
that were admitted from prison or remand centre were defined as not being diverted.
Admission to a Special Hospital is, without doubt, a major life event for those patients
concerned. This is, not least at all, because of the serious stigma that is attached to
special hospital patients and the fact that the average length of stay is so inordinately
long. It is not surprising therefore that it is, by and large, the more seriously
disturbed patients who are deemed high risk to the community that tend to be admitted.
However, since the Mental Health Act's (1983) requirement for those admitted to be
susceptible to treatment, or at least whose condition can be prevented from deteriorating,
there is a commonly held view that more persons are being admitted from prison having
being sentenced, rather than from the courts via hospital orders. The axiom being that if
patients admitted from prison are not susceptible to treatment they can be returned to
prison rather than be released or incarcerated ad infinitum in a special hospital.
Indeed, the results appear to substantiate this view as a clear switch over point is
evident, where the higher number of admissions each year reverts from court to prison or
remand centre in 1989. It is also interesting that a higher number of mentally ill
patients have been admitted from prison or remand centre, whereas a higher number of
personality disordered patients have been admitted from court. Furthermore, a high number
of the admissions from prison or remand centre were paranoid on admission. The findings
also substantiate the theory of Kinsley (1990) that it is unusual for a patient to be
admitted to a special hospital whilst on remand with only small numbers found to be
admitted on remand or transfer of un-sentenced prisoner sections of the Mental Health Act
(1983)
On examination for differences between the groups in relation to their gender, it is
apparent there is no significant difference between the groups for male admissions.
However, when examining the female admissions it appears that a female is three times more
likely to be diverted to high security care from the court than remanded or given a
custodial sentence. One possible explanation is the general perception that females are
suffering from disorder and need treatment as opposed to being viewed as `bad' and
requiring some form of punishment from the criminal justice system.
The highest discrepancies between prison or remand centre and court admissions reason for
admission are for physical attacks including robbery and for damage to property. It would
seem surprising that so many admissions from court are for such offences as a primary
reason for admission. One can only wonder, at this stage, what other factors the judge may
be considering in his or her deliberations. Another interesting finding in the first and
second reasons for admission is the high rate of hallucinated and deluded persons who are
admitted from prison rather than directly from court. This may well indicate that mentally
vulnerable persons are being sent to prison where they deteriorate and then require
transfer to hospital. The question is now raised as to the need for early detection of
such vulnerable people and their possible diversion from the criminal justice system. This
is, possibly, reinforced by the figures concerning threats of suicide and self injurious
behaviour where there is a much higher number of admissions from prison or remand centre
for these reported behaviours. Again, does this reflect a deterioration of mental states
once they have been sent to prison? The third, and final, point regarding the reason for
admission is in relation to the category of `sexual behaviour' as a reason for admission
to a special hospital. Three times as many sex offenders are admitted from court as from
prison for a first reason and five times as many for a second reason for admission. It
would appear that the courts perceive sexual offences as amenable to treatment more so
than the prisons. Although we do not have available to us the total number of sex
offenders dealt with by the courts and their mode of disposal it is interesting to note
that there appears easier access to hospitalisation direct from the courts. However,
another dimension may be that psychiatrists are reluctant to accept prison transfers of
sex offenders on the treatability issue and have less say in declining directions from
court. If this is the case then the psychopathalogising of sexual behaviour is being
undertaken moreso by the courts than by psychiatry itself.
A number of differences exist between the two admission groups with regard to their
present offence. Not surprising a mentally disordered offender who has murdered is seven
times more likely to be admitted from prison or remand centre whereas one that has
committed manslaughter is three times more likely to be admitted from court. From both of
the admission groups assaultive offences are high but not significantly different.
Sexually related offences are higher within the prison or remand centre admissions but
with only a small significant difference than the court admissions. The most interesting
result is that patients admitted from the court are three times more likely to have
committed arson.
The motive for the present offence shows similarities between the groups, for a high
number of admissions from the prison or remand centre group the motive was apparently
motiveless, sex or revenge and for the court admission group was apparently motiveless,
sex or revenge. Furthermore, from both of the admission groups there is a high chance of
there being a victim as a result of the present offence, with the patient being the only
aggressor involved.
It would seem from the limited data analysis (due to restrictions on time) that there is
little evidence of a pattern emerging from this study regarding differences between prison
or remand centre and court in relation to admissions to a special hospital. However, what
did emerge were differences between the existence and non-existence of certain factors
regarding special hospital admission. For example the use of alcohol was much higher than
non-use for admissions but little difference between prison or remand centre and court
referrals.
The following section highlights the main summary bullet points in relation to the
findings:
8 REFERENCES
BACKER-HOLST, T (1994): A New Window of Opportunity: The Implications of the Reed
Report for Psychiatric Care. Psychiatric Care, 1(1), pp 15-18.
BANERJEE, S., EXWORTHY, T., O'NEILL-BYRNE, K. AND PARROTT, J. (1992): An integrated
service for mentally disordered offenders. Psychiatric Bulletin, 16, pp 773-775.
BARKER, M. AND SWYER, B. (1994): Community care for mentally disordered offenders:
The experience of the Wessex Project. Prison Service Journal, 95, pp 45-48.
COOKE, D J. (1991a): Psychological Treatment as an Alternative to Prosecution: A
Form of Primary Diversion. The Howard Journal, 30(1), pp 53-65.
COOKE, D J. (1991b): Treatment as an Alternative to Prosecution: Offenders Diverted
for Treatment. British Journal of Psychiatry, 158, pp 785-791.
DAVIDSON, M., HUMPHREYS, M S., JOHNSTONE, E C. AND CUNNINGHAM OWENS, D G. (1995): Prevalence
of Psychiatric Morbidity Among Remand Prisoners in Scotland. British Journal of
Psychiatry, 167, pp 545-548.
DAVIS, S. (1994): Factors Associated with the Diversion of Mentally Disordered
Offenders. Bulletin of the American Academy of Psychiatry and Law, 22(3), pp 389-397.
DEPARTMENT OF HEALTH AND HOME OFFICE. (1993): Review of Health and Social Services
for Mentally Disordered Offenders and others requiring similar services. Volume 2 Service
Needs. HMSO, London.
EXWORTHY, T. AND PARROTT, J. (1993): Evaluation of a diversion from custody scheme at
magistrates' courts. Journal of Forensic Psychiatry, 4(3), pp 497-505.
GUNN, J., MADEN, A. AND SWINTON, M. (1991): Treatment needs of prisoners with
psychiatric disorders. British Medical Journal, 303, pp-338-341.
HAYNES, P. AND HENFREY, D. (1995): Making a Reality of Reed? Probation Journal,
June 1995, pp 83-87.
HILLIS, G. (1993): Diverting tactics. Nursing Times, 89(1), pp 24-27.
HOLLOWAY, J. AND SHAW, J. (1992): Providing a forensic psychiatry service to a
magistrates' court. Journal of Forensic Psychiatry, 3(1), pp-153-159.
HOLLOWAY, J. AND SHAW, J. (1993): Providing a forensic psychiatry service to a
magistrates' court: a follow-up study. Journal of Forensic Psychiatry, 4(3), pp 575-581.
HOME OFFICE. (1990): Provision for Mentally Disordered Offenders. Circular 66/90.
Home Office, London.
JAMES, D V. AND HAMILTON, L W. (1991): The Clerkenwell scheme: assessing efficacy and
cost of a psychiatric liaison service to a magistrates' court. British Medical Journal,
303, pp 282-285.
JONES, D. (1990): Mentally disordered offenders - diversion from the criminal
justice system. Health Trends, 22(2), pp 49-50.
JOSEPH, P. (1990): Mentally disordered offenders: diversion from the criminal
justice system. Journal of Forensic Psychiatry, 1(2), pp 133-138.
JOSEPH, P L A. AND POTTER, M. (1993a): Diversion from Custody.I: Psychiatric
Assessment at the Magistrates' Court. British Journal of Psychiatry, 162, pp 325-330.
JOSEPH, P L A. AND POTTER, M. (1993b): Diversion from Custody. II: Effect on
Hospital and Prison Resources. British Journal of Psychiatry, 162, pp 330-334.
JOSEPH, P L. AND POTTER, M. (1990): Mentally disordered homeless offenders -diversion
from custody. Health Trends, 22(2), pp 51-53.
KINSLEY, J. (1990): Prisons and Special Hospitals: Custodial Care. Prison Service
Journal, 81, pp 40-43.
McKITTRICK, N. AND EYSENCK, S. (1984): `Diversion: a big fix?'. Justice of the
Peace, June 16, pp 377-379; 393-394.
MOODY, S. (1983): Diversion from the Criminal-Justice Process. Scottish Office
Central Research Unit, Edinburgh.
PRINS, H. (1992): The diversion of the mentally disordered: some problems for
criminal justice, penology and health care. Journal of Forensic Psychiatry, 3(3), pp
431-443.
RICHER, A D. (1990): Should The Prison Medical Service Develop Its Role In The
Treatment Of Mentally Ill Offenders. Prison Service Journal, 81, pp 15-18.
ROBERTSON, G. (1988): `Arrest Patterns among Mentally Disordered Offenders'.
British Journal of Psychiatry, 153, pp 313-316.
ROBERTSON, G., DELL, S., JAMES, K. AND GROUNDS, A. (1994): Psychotic Men Remanded
in Custody to Brixton Prison. British Journal of Psychiatry, 164, pp55-61.
SANDELL, G. (1991): A case for diversion therapy. Community Care, 28 November, pp
ii-iii.
SCOTT, P.D. (1975): Has Psychiatry Failed in the Treatment of Offenders?
Institute for the Study and Treatment of Delinquency, London.
SMITH, J. AND DONOVAN, N. (1990): The Prosecution of Psychiatric Inpatients.
Journal of Forensic Psychiatry, 1, pp 379-383.
STAITE, C. (1994): Diversion from custody for mentally disordered offenders. Prison
Service Journal, 95, pp 42-45.
STAITE, C. AND MARTIN, N. (1993): What else can we do? New initiatives in diversion
from custody. Justice of the Peace, 157, pp 280-281.
WATT, F., TOMISON, A. AND TORPY, D. (1993): The prevalence of psychiatric disorder
in a male remand population: a pilot study. Journal of Forensic Psychiatry, 4(1), pp75-83.
9 BIBLIOGRAPHY
BANERJEE, S., O`NEILL-BYRNE, K., EXWORTHY, T. AND PARROTT, J. (1995): The Belmarsh
Scheme: A Prospective Study of the Transfer of Mentally Disordered Remand Prisoners form
Prison to Psychiatric Units. British Journal of Psychiatry, 166, pp 802-805.
BYNOE, I. (1990): The prison medical wing: a `place of safety'? Journal of Forensic
Psychiatry, 1(2), pp 251-257.
COHEN, P. (1993): Safe inside. Nursing Times, 89(36), pp 19.
COID, J W. (1988): Mentally abnormal prisoners on remand: I-Rejected or accepted by
the NHS? British Medical Journal, 296, pp 1779-1782.
COID, J W. (1988): Mentally abnormal prisoners on remand: II-Comparison of services
provided by Oxford and Wessex regions. British Medical Journal, 296, pp 1783-1784.
DEPARTMENT OF FORENSIC PSYCHIATRY, INSTITUTE OF PSYCHIATRY. (1992): Reprinted
document: Evidence submitted to Lord Justice Woolf`s enquiry into prison disturbances
(August 1990). Criminal Behaviour and Mental Health, 2, pp 43-57.
ETHERIDGE, P. (1994): Policing mentally ill people. Metropolitan Journal, October
1994, pp 34-36.
FAHY, T A. (1989): The Police as a Referral Agency for Psychiatric Emergencies -a
Review. Medicine Science and Law, 29(4), pp 315-322.
GROUNDS, G. (1990): The Mentally Disordered in Prison. Prison Service Journal, 81,
pp 29-40.
JOSEPH, P L A. AND POTTER, M. (1993): "Court Diversion": Reply. British
Journal of Psychiatry, 163, pp 413-414.
KENNEDY, N M J. AND WARD, M. (1992): Training aspects of the Birmingham court
diversion scheme. Psychiatric Bulletin, 16, pp 630-631.
KITCHINER, N. (1996): Forensic community mental health nurses and court diversion
schemes. Psychiatric Care, 3 (2), pp 65-69.
MARCHANT, C. (1992): Crime and Treatment. Community Care, 10 December, pp 8.
McMILLAN, I. (1992): Unlocking the cell. Nursing Times, 88(7), pp 20.
McMILLAN, I. (1993): Widening the safety net. Nursing Times, 89(1), pp 23.
MODESTIN, J. AND AMMANN, R. (1995): Mental Disorders and Criminal Behaviour.
British Journal of Psychiatry, 166, pp 667-675.
PALERMO, G B., SMITH, M B. AND LISKA, F J. (1991): Jails Versus Mental Hospitals: The
Milwaukee Approach to a Social Dilemma. International Journal of Offender Therapy and
Comparative Criminology, 35(3), pp-205-216.
PHIPPS, A J. (1994): The Reed Report: Mentally disordered offenders. Prison Service
Journal, 95, pp 50-52.
PITT, R. (1993): Who Cares? Nursing Times, 89(1), pp 27-29.
SADLER, C. (1992): Prison support. Nursing Times, 88(37), pp 21.
SELBY, M F G. (1990): Grendon - The Care Of Acute Psychiatric Patients -A Pragmatic
Solution. Prison Service Journal, 81, pp 19-22.
SIM, J. (1991): Medical power in prisons: The Prison Medical Service in England
1774-1989. Open University Press, Milton Keynes.
SWAANINGEN, R van. AND BEIJERSE, J uit. (1993): From Punishment to Diversion and Back
Again: The Debate on Non-Custodial Sanctions and Penal Reform in the Netherlands. The
Howard Journal, 32(2), pp 136-156.
TRAVERS, R F. AND BRABBINS, C J. (1993): Court Diversion. British Journal of
Psychiatry, 163, pp 412-413.
WOODS, P. AND MASON, T. (1997). Twenty Years of Admissions to a Special Hospital.
Psychiatric Care, Psychiatric Care, 4(1), 22-25.
ZITO, J. (1994): Diminished Responsibility. Nursing Times, 90(5), pp 42-43.
Link to Homepage
Copyright © Phil Woods & Tom Mason 1997