Criminal conviction after discharge from special (high security) hospital: the circumstances of early conviction on a serious charge

Forty patients who left the three high security (“special”) hospitals for England and Wales between 1987 and 1991 went on to be convicted of a serious offence by 31 January 1993. The aims of the study were to describe their characteristics, their psychiatric care and the circumstances of the offences. A comparison group, matched for time at risk but unmatched on other variables, was generated by identifying, for each subject, the next patient to be discharged who had not re-offended by 31 January 1993. Eight of the 40 who went on to be convicted of a serious offence left special hospital with no psychiatric follow-up and for a further five only informal arrangements were made. Of the 27 who left special hospital under supervision, 11 dropped out of that supervision in the period (mean 1.7 years) between discharge and offence. [Compared with patients discharged at the same time and not convicted the 40 were significantly younger, less likely to have been educated in ordinary schools, more likely to have a history of alcohol withdrawal and had more criminal convictions. In special hospital the 40 were more likely to have been detained under the legal category of psychopathic disorder, had shorter admissions and their discharge had more often been disputed by their clinical team. At discharge, the 40 were less likely to be prescribed neuroleptic medication and they were more likely to have been discharged directly into the community.] Most instances of serious re-offending after discharge are not the result of patients stopping taking medication and are not the consequence of mental state changes being observed and ignored by treating teams