Attention to patient selection and risk management strategies have been effective in minimising the risk to patients and to the community as a direct result of absences without permission from authorised leave.

In the light of recognition of an increased need for secure mental health provision both at a local and national level, a 12-bed low secure forensic rehabilitation unit, Hillis Lodge, was opened in Birmingham in 2001. The aim of this study was to investigate characteristics of patients referred to this service. A retrospective case note survey was undertaken of all referrals to Hillis Lodge between August 2000 and April 2004. A comparison was then made between the accepted group and those not accepted for admission to identify characteristics that may be associated with admission to a low secure forensic unit. For the referred sample, mean age was 38 years (range 23-65 years, SD = 9.17) and in 86.4% of cases the primary diagnosis was schizophrenia. Those accepted were more likely to be detained under Part III sections of the Mental Health Act 1983 and have a greater number of previous convictions. By identifying need in this particular patient sample, this study has helped to inform the assessment process and treatment programmes in a low secure forensic rehabilitation service.

Objective: Delusional disorder (DD) is well recognised, but its treatment is controversial. This article presents a case study that highlights the therapeutic benefits associated with assertive biopsychosocial treatment of DD. Method: The literature on pharmacological and psychological treatments for DD is briefly reviewed, and a case example from the Queensland Fixated Threat Assessment Centre is given to illustrate a comprehensive biopsychosocial treatment framework. Results: Combined pharmacological and psychosocial intervention resulted in stabilisation and improvement in mental state for the case described. Conclusions: There is an emergent evidence base for an assertive biopsychosocial approach to treating DD. The case study demonstrates that a range of therapeutic goals is achievable.

No abstract