DIVERSION OF MENTALLY DISORDERED OFFENDERS: INDICATIONS FROM
A SPECIAL HOSPITAL




PHIL WOODS
&
TOM MASON
1996



Copyright © Phil Woods & Tom Mason 1997

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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