Offending in psychiatric patients after discharge from medium secure units
http://www.100md.com
《英国医生杂志》
EDITOR—Back seat drivers are the worst critics. Yes, we could have used additional measures of violent offending. The Macarthur study (cited in the paper) did that but cost $8m (￡4.4m; 6.5m) for a similar sample size and 50% less follow up. I have offered to do the same thing over here for half the price but have had no takers so far.
Reconviction is not the whole story, but it is an important part of it. Medium secure units usually admit patients after they have been convicted of an offence, and we should know how many are reconvicted. It is a good measure of serious violence, which is the public's main concern in relation to psychiatric services.
The authors debated whether to report results only for patients discharged to the community but decided this would be more misleading. We may not like to trumpet this fact, but one of our main tools in violence risk management is the further detention of patients who are considered too dangerous for an immediate return to the community. The patients who stayed in were not chosen at random, and to omit them would ignore this function of the service.
The reporting was not misleading, as our measure of offending was clearly defined. Outside the scientific arena, a propaganda war is taking place about violence by psychiatric patients, and we make no apology for pointing out that one part of mental health services is working well, according to one crucial measure. We are not complacent, and we end with suggestions for better identification of high risk patients. We could have discussed our limitations at greater length but correspondents should remember that their letters amounted to more than 750 words,1 whereas our description of a three year study took 500.
A Maden, professor of forensic psychiatry
Academic Centre, West London Mental Health NHS Trust Headquarters, Southall, Middlesex UB1 3EU a.maden@ic.ac.uk
Competing interests: None declared.
References
Electronic responses. Offending in psychiatric patients after discharge from medium secure units. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7455/1534 (accessed 9 Sep 2004.)
Reconviction is not the whole story, but it is an important part of it. Medium secure units usually admit patients after they have been convicted of an offence, and we should know how many are reconvicted. It is a good measure of serious violence, which is the public's main concern in relation to psychiatric services.
The authors debated whether to report results only for patients discharged to the community but decided this would be more misleading. We may not like to trumpet this fact, but one of our main tools in violence risk management is the further detention of patients who are considered too dangerous for an immediate return to the community. The patients who stayed in were not chosen at random, and to omit them would ignore this function of the service.
The reporting was not misleading, as our measure of offending was clearly defined. Outside the scientific arena, a propaganda war is taking place about violence by psychiatric patients, and we make no apology for pointing out that one part of mental health services is working well, according to one crucial measure. We are not complacent, and we end with suggestions for better identification of high risk patients. We could have discussed our limitations at greater length but correspondents should remember that their letters amounted to more than 750 words,1 whereas our description of a three year study took 500.
A Maden, professor of forensic psychiatry
Academic Centre, West London Mental Health NHS Trust Headquarters, Southall, Middlesex UB1 3EU a.maden@ic.ac.uk
Competing interests: None declared.
References
Electronic responses. Offending in psychiatric patients after discharge from medium secure units. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7455/1534 (accessed 9 Sep 2004.)