Restricted hospital orders: A survey of forensic psychiatrists' practice and attitudes to their use

Abstract

Forensic psychiatrists throughout mainland UK and Northern Ireland were sent a postal questionnaire to determine their practice in cases where a restriction order was deemed appropriate and also their attitudes to the use of restricted hospital orders. Data were obtained about the estimated number of reports completed by each respondent and recommendations for restriction orders. In particular, the reasons why a restricted hospital order might be recommended or considered appropriate were sought. Out of the original sample of 97 psychiatrists, 74 (76%) returned completed questionnaires. They had written in excess of 3,000 legal reports in the previous 12 months and 60 (81%) had been involved in cases where a restriction order was considered appropriate in the same period. Of the 74 who responded, 33 (45%) said that they would specify the need for a restriction order when necessary, 27 (36%) stated that they would make no mention of it, and the remainder said that their practice would vary. Time-limited orders were not favoured. Some respondents said they would always recommend a restricted hospital order for certain types of offence; 18 (24%) said so for homicide. The majority agreed that the most important consideration when making a recommendation for a restriction order was the fact that it ensured long-term follow-up in cases where there was evidence of previous breakdown in arrangements. The findings strongly suggest that forensic psychiatrists consider restriction orders a clinically useful tool in some cases rather than primarily a punitive or purely legal instrument.