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Mental disorder and violence

A special (high security) hospital study

Published online by Cambridge University Press:  02 January 2018

Pamela J. Taylor*
Affiliation:
Institute of Psychiatry, London
Morven Leese
Affiliation:
Institute of Psychiatry, London
Martin Butwell
Affiliation:
Broadmoor Hospital
Rachel Daly
Affiliation:
United Dental and Medical School of Guy's and St Thomas' Hospital, London
Emmet Larkin
Affiliation:
The Towers Hospital, Leicester
*
P. J. Taylor, Professor of Special Hospital Psychiatry, Institute of Psychiatry, London SE5 8AF

Abstract

Background

From a first clinical description of a complete resident sample of special (high security) hospital patients, we examined the association between mental disorder and violence.

Method

A record survey of all 1740 patients resident at any time between 1 January and 30 June 1993. inclusive, and, for most, the official criminal record.

Results

1015 patients (58%) had functional psychosis, one-quarter of whom also had an independent personality disorder: 461 (26%)had personality disorders uncomplicated by psychosis, and 264 (16%) had learning disabilities. Pre-admission substance misuse, which was probably under-recorded, had been most common among those with psychosis and an independent personality disorder. Less than 10% had never been convicted of a criminal offence, although 25% had been admitted directly from other hospitals. Direct personal violence was more common among men, and fire-setting among women. Schizophrenia was most strongly associated with personal violence. More than 75% of those with a psychosis were recorded as being driven to offend by their delusions. In the absence of delusions, hallucinations had no such effect.

Conclusions

For people with personality disorder better clinical descriptions seem essential. For people with a pure psychosis, as symptoms were usually a factor driving the index offence, treatment appears as important for public safety as for personal health.

Type
Papers
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Dell, S. & Robertson, G. (1988) Sentenced to Hospital. Maudsley Monograph Number 32. Oxford: Oxford University Press.Google Scholar
Gunn, J., Maden, A. & Swinton, M. (1991) Treatment needs of prisoners with psychiatric disorders. British Medical Journal, 303, 338340.CrossRefGoogle ScholarPubMed
Heads, T. C., Taylor, P. J. & Leese, M. (1997) Childhood experiences of patients with schizophrenia and a history of violence: a special hospital sample. Criminal Behaviour and Mental Health, 7, 117130.Google Scholar
Hellerstein, D., Frosch, W. & Koeningsberg, H. W. (1987) The clinical significance of command hallucinations. American Journal of Psychiatry, 144, 219221.Google Scholar
Hodgins, S. (1992) Mental disorder, intellectual deficiency and crime. Archives of General Psychiatry, 49, 476483.CrossRefGoogle Scholar
Lidz, G. W., Mulvey, E. R. & Gardener, W. (1993) The accuracy of predictions of violence to others. Journal of the American Medical Association, 269, 10071011.CrossRefGoogle ScholarPubMed
Link, B. G. & Stueve, A. (1994) Psychotic symptoms and the violent/illegal behavior of mental patients compared to community controls. In Violence and Mental disorder. Developments in Risk Assessment (eds Monahan, J. & Steadman, H.), pp. 137159. Chicago, IL: University of Chicago Press.Google Scholar
Maden, A., Curie, C., Meux, C, et al (1993) The treatment and security needs of patients in special hospitals. Criminal Behaviour and Mental Health, 3, 290306.CrossRefGoogle Scholar
McNeil, D. E. (1994) Hallucinations and violence. In Violence and Mental Disorder. Developments in Risk Assessment (eds Monahan, J. & Steadman, H. J.), pp. 183202. Chicago, IL: University of Chicago Press.Google Scholar
McNeil, D. E. & Binder, R. L. (1995) Correlates of accuracy in the assessment of psychiatric inpatients: risk of violence. American Journal of Psychiatry, 152, 901906.Google Scholar
Peay, J. (ed) (1996) Inquiries after Homicide. London: Duckworth.Google Scholar
Swanson, J. W., Holzer, C. F., Ganju, V. K., et al (1990) Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area Surveys. Hospital and Community Psychiatry, 41, 761770.Google Scholar
Swanson, J. W., Borum, R., Swartz, M., et al (1996) Psychotic symptoms and disorders and the risk of violent behaviour in the community. Criminal Behaviour and Mental Health, 6, 309329.Google Scholar
Taylor, P. J. (1985) Motives for offending among violent and psychotic men. British Journal of Psychiatry, 147, 491498.Google Scholar
Taylor, P. J. (1993) Schizophrenia and crime: distinctive patterns in association. In Mental Disorder and Crime (ed. Hodgins, S.). pp. 3964. Newbury Park. CA: Sage.Google Scholar
Taylor, P. J. & Gunn, J. (1984a) Violence and psychosis. British Medical Journal, 288, 19451949.Google Scholar
Taylor, P. J. & Gunn, J. (1984b) Violence and psychosis. British Medical Journal, 289, 912.Google Scholar
Taylor, P. J., Grounds, A. & Snowden, P. (1993) Forensic Psychiatry in the National Health Service of England and Wales. In forensic Psychiatry: Clinical, Legal and Ethical Issues (eds Gunn, J. & Taylor, P. J.), pp. 691731. Oxford: Butterworth – Heinemann.Google Scholar
Taylor, P. J., & Hodgins, S. (1994) Violence and psychosis: critical timings. Criminal Behaviour and Mental Health, 4, 266289.Google Scholar
Taylor, P. J., & Monahan, J. (1996) Dangerous patients or dangerous diseases? British Medical Journal, 312, 967969.CrossRefGoogle ScholarPubMed
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. WHO: Geneva.Google Scholar
World Health Organization (1994) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO: Geneva.Google Scholar
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