Schizophrenia in a high-security hospital: long-term forensic, clinical, administrative & social outcomes

Abstract

Objective: To determine forensic, clinical, social and administrative outcomes of high-security patients. Method: Prospective year follow-up study of 169 patients with schizophrenia, 1992–1993. Results: By the end of the study, 46 (27.2%) patients were in high security, 43 (25.5%) in medium- or low-secure units, 35 (20.7%) in an open ward, 3 (1.8%) in prison and 40 (23.7%) in the community. Violence occurred in 75% of patients over the 10-year follow-up period, and this was serious in 25%. Continuous positive symptoms of psychosis were present in over one-third. One-third had self-harmed during this period but there was only one known suicide and 11 (6.5%) deaths in total. At the end of the study, there was only one person in voluntary employment, 18 (12.7%) living independently and 10 (7.1%) in a relationship. Models were developed to determine factors relevant to these major outcomes. Conclusions: This is the first study providing comprehensive outcome data over a 10-year period. Forensic services appear good at managing the risk to the community but poor at promoting better social outcomes. The levels of violence within inpatient units are high.

Keywords:

• Schizophrenia
• outcomes
• high security
• mentally disordered offenders

Acknowledgements

We are grateful to the following people who played a role in the research reported in this thesis and/or provided advice and support: Jon Steele, Michelle Davidson, Caroline Brett, John Bogue, Martin Butwell, Martin Humphreys, Pamela Taylor, Eve Johnstone, David Cunningham Owens, John Crichton, Morven Leese, Peter Leese, Gayle Christie, Joyce MacKay, Patrick Miller and Andrew McIntosh. We thank the patients and staff of the State Hospital, and many other hospitals and services for their participation in this study, and particularly the medical records officers for their assistance. In addition, we thank the Scottish Prison Service and the Scottish Criminal Records Office for their help.