Seattle University Collaborative Projects - International Academy of ...

Introduction: The courts have recently become increasingly involved in the administration ofcompulsory psychiatric services in Israel. Data reveals a gradual increase in the rate of courtordered hospitalizations according to Section 15 of the Law for the Treatment of the Mentally Ill.This trend bears significant implications, particularly relating to the issues of security and safetyin psychiatric hospitalization.Aim: The presentation will present highlights from extensive British experience, focusing on thepotential implications on forensic psychiatry in Israel.Methods: The development of the hierarchy of security in the British psychiatric services isreviewed, beginning in the early 1970s with the establishment of the Butler Committee thatdetermined a hierarchy of three levels of security for the treatment of patients, culminating withthe establishment of principles for the operation of medium security units (Read Committee,1991). These developments were the basis for the forensic psychiatric services in Britain.Subsequently current experience and dilemmas in the process of planning the first mediumsecurity ward in Israel will be discussed.Conclusions: A safe and suitable environment is a necessary condition for a treatment setting.The establishment of separate medium security units or forensic psychiatry departments within amental health facility will enable the concentration and classification of court-orderedadmissions and will enable systemic flexibility and capacity for better treatment, commensuratewith patient needs as well as optimizing the risks relating to this population.Long-Term Outcomes of Patients with Schizophrenia Detained in a ScottishHigh Security HospitalRajan Darjee, The Orchard Clinic, Edinburgh, UK (Rajan.Darjee@nhslothian.scot.nhs.uk)Introduction: People with schizophrenia who commit serious violence are detained in securehospitals. The research presented here investigated the long-term outcomes of patients withschizophrenia detained in a high security hospital.Method: The sample was 169 patients with schizophrenia resident at the State Hospital,Carstairs, between August 1992 and August 1993. In 1992-4 patients and their psychiatrists wereinterviewed and data were collected from case records. Patients were followed up until the end of2001. Records covering the intervening period were examined, and patients and independentinformants were interviewed in 2000 and 2001. A number of structured instruments were used atinterviews and to interrogate case records.Results: Most patients were male, unmarried and from socially disadvantaged backgrounds.Most had been admitted from criminal courts after committing serious offences, half weresubject to restriction orders and a quarter had killed. Most had had psychiatric treatmentpreviously. Comorbid substance dependence and personality disorder were common. Threequarterscommitted at least one act of violence, but less than a quarter caused serious harm.There were almost 2000 violent incidents, mostly in high security. Violence in the communitywas rare. A third had episodic symptoms, a quarter continuous symptoms and a fifth recovery120