Restricted hospital orders: A survey of forensic psychiatrists' practice and attitudes to their use

Humphreys, Martin; Kenney‐Herbert, Jeremy; Gray, Colin M.

doi:10.1080/09585189808402187

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Currently, there is not much written about the management of restricted patients that is research‐based. There is some work published around the views of older adult patients (O’Sullivan & Chesterman 2007) and what at the time were called Responsible Medical Officers (RMOs) on statutory community aftercare (Humphreys et al. 1998) and also the implications for practice of forensic community mental health nurses’ views on statutory aftercare (Riordan et al.…”

Section: Design and Methodsmentioning

confidence: 99%

Deconstructing imposed recovery - clinical perceptions of the legal and administrative framework for managing restricted mental health patients - the experience of one hospital in the independent sector

Young

2011

Journal of Nursing and Healthcare of Chronic Illness

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young a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 397–406 Deconstructing imposed recovery – clinical perceptions of the legal and administrative framework for managing restricted mental health patients – the experience of one hospital in the independent sector Aims and objectives. This paper sets out to address the potentially important issue or issues relating to mental health professionals’ views on the arrangements for the management of patients subject to a restricted hospital order. Background. Less‐than‐optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management in the context of forensic mental health. Design. Report of a survey. A grounded theory approach was used for both ‘collecting’ and ‘analysing’ the data. Method. A total of 14 mental health practitioners were interviewed regarding the legal and administrative framework for managing restricted patients and their use of a patient‐centred care model to assist restricted patients with serious mental illness to identify their self‐management needs. The research interviews were conducted between 2008 and 2009. Conclusions. ‘Imposed’ recovery and the systemic issues and the value assumptions that health professionals often bring to their interactions with clients need to be explored further. Not until we have serious debate about such issues as will health services fully translate the current rhetoric of collaborative partnership into reality for clinicians and the clients they serve. Relevance to clinical practice. Forensic practitioners must practice within a legal framework and carefully balance the needs and rights of patients against the need to protect the public from harm. Imposed recovery involves a high degree of skill and expertise in terms of risk assessment, risk decision‐making and working interprofessionally and cooperatively with government agencies.

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Section: Design and Methodsmentioning

confidence: 99%

Deconstructing imposed recovery - clinical perceptions of the legal and administrative framework for managing restricted mental health patients - the experience of one hospital in the independent sector

Young

2011

Journal of Nursing and Healthcare of Chronic Illness

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“…If a restriction order was not being recommended in such cases then there should be evidence of a reasoned analysis for this. This appears at odds with the practice of some psychiatrists who only provide an opinion if specifically asked by the court (Humphreys et al, 1998). The view of the judiciary was that this practice serves only to cause delays in the resolution of court proceedings.…”

Section: Experience and Practicementioning

confidence: 99%

“…Where restriction orders have been imposed contrary to medical evidence, clinicians have perceived this as interfering with clinical management (Travers, 1995) and resulting in unnecessary excessive detention (Verdun-Jones, 1989). Such cases may not be uncommon and in a survey of forensic psychiatrists, conducted during 1998, 23% of respondents had been involved in cases where a restriction order had been made contrary to medical recommendations (Humphreys et al,1998).…”

Section: Introductionmentioning

confidence: 99%

Sections 37/41 Mental Health Act 1983: a study of judges' practice and assessment of risk to the public

Qurashi

Shaw

2008

Med Sci Law

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Previous studies have reported that a significant proportion of forensic psychiatrists have had experience of restriction orders being made contrary to medical recommendations. Judges were interviewed to ascertain their experiences, sentencing practice and the factors taken into consideration when determining whether or not to attach a restriction order. In particular, the reasons why a restriction order might be made contrary to medical opinion were explored. Twelve judges sitting in crown courts in England were interviewed. The interviewees were unanimous in their view that where a hospital order was being considered involving a serious offence a psychiatrist should take a firm view on whether a restriction order was also required. Furthermore, the interviewees stated that they would anticipate a positive recommendation from psychiatrists in cases involving homicide, arson and serious sexual and violent offences. Demographic factors, including ethnicity, were irrelevant in their deliberations. The experience of this sample is that restriction orders are rarely made contrary to medical recommendations and in the rare circumstances they are made, insufficient emphasis has been placed on previous offending behaviours or the issue of public protection. In addition to the primary intention to protect the public nearly half the sample stated that an additional intention was to ensure compliance with both after-care services and medication.

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“…The RHO combines aspects of civil detention with 'safeguards' to protect the public from serious harm. Although it is clear that psychiatrists view the RHO as a useful rehabilitative measure (Humphreys et al, 1998), sentencers see it as a means of incapacitation and, on occasions, retribution (Romilly et al, 1997;Street, 1998). Prior to the introduction of an appeal against a restriction order to a Mental Health Review Tribunal (in England and Wales) or a Sheriff Court (in Scotland) under the Mental Health Act 1983 and the Mental Health (Scotland) Act 1984 respectively, politicians could incapacitate restricted mentally disordered offenders for as long as they liked.…”

Section: Restricted Hospital Ordersmentioning

confidence: 99%

Crime and Punishment (Scotland) Act 1997: A Survey of Sentencers’ Views concerning the Scottish ‘Hybrid Order’

2002

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The Crime and Punishment (Scotland) Act 1997 introduced the hospital direction (HD), often termed the 'hybrid order' because it allows courts to simultaneously send a mentally disordered offender to hospital and impose a prison sentence, to be completed after hospital discharge. It is the first measure that explicitly allows the imposition of a prison sentence for an offender meeting criteria for detention under the Mental Health (Scotland) Act 1984. A previous survey showed that psychiatrists in Scotland favoured the principle of a hybrid order (Darjee et al., 2000). In this study all Scottish Sheriffs (n = 110) and High Court Judges (n = 26) were surveyed for their views on the HD. Of the 56 respondents 19 felt unable to participate largely due to lack of experience in sentencing mentally disordered offenders. Respondents felt the HD was a useful measure, but, in contrast to Scottish Office guidance, indicated that psychiatrists should recommend it directly if they considered that it was an appropriate disposal. Respondents viewed the HD as primarily an incapacitating measure and most respondents hoped that it would encourage psychiatrists to admit 'psychopaths'; although Scottish psychiatrists do not favour the hospitalisation of offenders with primary personality disorders. It is concluded that in its current form and with current guidance the HD is difficult to use, as there are no criteria to differentiate it from a hospital order (HO) and psychiatrists cannot recommend it. Further, recent legislation that makes public safety the primary concern when deciding on the discharge of restricted patients in Scotland, erodes the utility of the HD as an incapacitating measure. However following the Reports of the Millan and MacLean Committees in Scotland, the role of the HD may be strengthened and clarified.

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Restricted hospital orders: A survey of forensic psychiatrists' practice and attitudes to their use

Cited by 8 publications

References 11 publications

Deconstructing imposed recovery - clinical perceptions of the legal and administrative framework for managing restricted mental health patients - the experience of one hospital in the independent sector

Deconstructing imposed recovery - clinical perceptions of the legal and administrative framework for managing restricted mental health patients - the experience of one hospital in the independent sector

Sections 37/41 Mental Health Act 1983: a study of judges' practice and assessment of risk to the public

Crime and Punishment (Scotland) Act 1997: A Survey of Sentencers’ Views concerning the Scottish ‘Hybrid Order’

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