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Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment

Published online by Cambridge University Press:  13 June 2014

Conor O'Neill ,
Patrick Heffernan ,
Ray Goggins ,
Ciaran Corcoran ,
Sally Linehan ,
Dearbhla Duffy ,
Helen O'Neill ,
Charles Smith  and
Harry G Kennedy
Conor O'Neill
Affiliation:
St Brendan's Hospital, Rathdown Rd, Dublin, Ireland
Patrick Heffernan
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Ray Goggins
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Ciaran Corcoran
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Sally Linehan
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Dearbhla Duffy
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Helen O'Neill
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Charles Smith
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Harry G Kennedy
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
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Abstract

Objectives: To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.

Method: All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.

Results: There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.

Conclusions: Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.

Keywords

Forensic psychiatryNeeds assessmentLength of stayPlacementRiskDiversion schemesCriminal Law (Insanity) Bill
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 20 , Issue 4 , December 2003 , pp. 119 - 125
Copyright
Copyright © Cambridge University Press 2003

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