Chapter 14: The interface with forensic services

Epidemiological studies on offenders who develop major mental illness have shown that there are two distinct groups: early starters and late starters. Compared to late starters, early starters …

Offend in adolescence

Offend before symptoms of mental illness are manifest

Offend only after symptoms of mental illness are manifest

Are convicted of fewer non-violent crimes

Are convicted of more violent crimes

Have a lower level of social functioning

Which of the following are key characteristics of ‘parallel’ forensic community service teams alongside generic services?

Forensic specialists work within community mental health teams

Separate referral meetings

Encourage non-forensic clinicians to develop risk assessment skills

Capped caseloads

Specialist management line

The number of patients on restriction orders has had a significant impact on the ability to discharge patients and has led to a decrease in the average duration of admission …

True

False

It is realistic for the forensic psychiatric services to manage all violent patients …

True

False

Which of the following come under behaviour category 1 of secure care admission criteria (Eastman and Bellamy 1998)?

Administering poison

Attempted murder

False imprisonment

Fraud

Rape

The Ministry of Justice can dictate that a patient be admitted to medium secure care even if the clinicians involved feel that his/her risk to others does not warrant this …

True

False

Which of the following criteria must be established to meet the admission criteria for dangerous severe personality disorder?

Damage to certain areas of the brain

Assessment confirming that they are unlikely to reoffend

PCL-R of 30 or above

Functional link between personality disorder and risk

PCL-R of 25-29 and another personality disorder, not including antisocial personality disorder

If you feel a patient is inappropriately placed in psychiatric intensive care and warrants an admission to medium secure care, which of the following pieces of information should be provided in your referral?

Psychodynamic formulation

A multiaxial diagnostic formulation

An independent psychiatric report

Violence category of index offence

All of the above

What approximate percentage of patients were detained under the legal category psychopathic disorder in special hospitals in 1998?

15%

25%

35%

45%

55%

According to Gunn and Taylor (1993) the percentage of inpatients within medium secure units transferred from general psychiatric services was less than …

10%

15%

20%

25%

Put this list in a hierarchy of supervision and security within the English Hospital System, according to Gunn and Taylor (1993) with 1 being the highest level of supervision and security and 8 being the lowest:

A. PICU
B. Unsupervised community care
C. Challenging behaviour unit
D. Open ward
E. No care
F. Regional secure unit
G. Community care with supervision
H. Special hospital

H, F, A, C, D, G, B, E

H, F, C, A, D, G, B, E

H, F, C, A, D, B, G, E

F, H, C, A, D, G, B, E

H, F, C, A, D, G, E, B

There is a pronounced increase in hospital episodes in which of the following groups compared to 20 years ago?

Younger men

Older men

Younger women

Older women

Children

Which of the following come under behaviour category 3 of secure care admission criteria (Eastman and Bellamy 1998)?

Possession of offensive weapon

Grievous bodily harm

Actual bodily harm

Threats to kill

Robbery

A patient on a Psychiatric Intensive Care Unit with violent behaviour, who has committed actual bodily harm and possession of an offensive weapon, has not yet responded to medication, but there is no concern that violence will escalate. What is an appropriate course of action?

Refer to forensic psychiatric services for admission to Low Secure Unit

Consider referral to forensic psychiatric services for Medium Secure Unit admission

Consider referral to forensic psychiatric services for risk assessment

Continue care in a Psychiatric Intensive Care Unit

None of the above

A patient on a Psychiatric Intensive Care Unit with violent behaviour, who has committed grievous bodily harm, hasn’t responded to neuroleptic medication prescribed in an adequate dose and duration. What is an appropriate course of action?

Refer to forensic psychiatric services for admission to Low Secure Unit

Consider referral to forensic psychiatric services for Medium Secure Unit admission

Consider referral to forensic psychiatric services for risk assessment

Continue care in a Psychiatric Intensive Care Unit

None of the above

NAPICU

National Association of Psychiatric Intensive Care and low secure units

Chapter 14: The interface with forensic services