Vicious circles of Dr. Alan Weston, consultant in forensic psychiatry
care
at Stanley
Royd
hospital, Wakefield, and a consultant at two prisons in Yorkshire, l
discusses the complex problem posed by the mentally abnormal offender.
(
(
i
(
| l
j
So often the mentally abnormal offender shuffles from Prison to mental hospitals, which he may have only JUst left a few weeks before, to pass into the hands of *his mythical community care. As the number of hospital beds decreases, psychiatric patients, who have spent a greater part of their
1'ves
in the supportive, protective care of the mental leave to return into the world of keen competition in which only the strong can live. They find their tranquillisers no longer provide them with protection, there is no longer a ward to retreat to, a kindly sister to rectify all ills, they are out alone with only the protection of community care. It is almost inevitable that they will offend society and start the endless road back. They are arrested, remanded for psychiatric report, brought before the courts and often return to their old homes, under Section 60 or 65 of the Mental Health Act. A court appearance must be a very traumatic, stressful affair for these offenders and their bewilderment must cause further distress before they are back amongst their own familiar surroundings. Sometimes these offenders do not return to the mental hospital. They are examined on remand and it is felt that they cannot be dealt with under Section 60 and they may spend time in prison. Whilst in prison they sometimes find that the regime has the same institutional factor as the mental hospital and so survive their sentence, but on release, they may need further institutional care, and so return as informal patients. They have come from mental hospital to prison and on release, return to the mental hospital; this circular movement has become more prevalent since the 1959 Act.
hospital,
Steal
to
survive
At the British Medical Association's meeting in Londonderry in April, 1967, Dr. Henry Rollin reported that patients discharged from mental hospitals?often chronic psychotics so severely crippled by mental illness that they had to steal to survive?ended in
prison
and
eventually
returned to the mental
hospital.
Apart from the problem posed by the generally inadequate, there is also the separate issue of absconders and violent patients who discharge themselves from psychiatric tion in these two
hospital.
The highly emotive quesis Whether or not further restrictive measures should be advocated. Psychiatrists will know how often they are called to see their ex-patients in the remand and local prisons and how often they are asked for case notes of their old patients, who they only recently discharged into the community. How can we avoid this shuttle service and how can we recognise who is likely to return? It is easy to send patients home especially if a relative requests their discharge, without full and adequate enquiry into the social conditions to which the patient is cases
returning.
It is often difficult to give full and extensive afterbecause, as we all know, out-patient clinics have to cope with many more patients than they can handle
care
adequately. Often, out-patient psychiatry is like passing through a supermarket in a fast car, hoping you can pick up all your needs. The home care, which is given by over-worked mental welfare officers, can never be adequate because their case loads far exceed what is considered reasonable. Also the chronic psychotic is often unable to express his needs, whereas the neurotic tends to demand much more time in the interview session.
Anti-social behaviour The relatives to whom the patient returns have very little insight into psychiatric illness and may become impatient. This mounting frustration in the home may cause the ex-patient to show anti-social behaviour. It is relatively easy to be tolerant and understanding in a hospital, but when you live 24 hours a day with the problem it can become very difficult. Loss of patience and intolerance soon develop, and may cause the patient to start acting out his frustrations and inade-
Violence and crime
Photo:
quacies by resorting
to anti-social behaviour.
When these facts that our courts see
are so
looked at, is it any wonder many psychiatric ex-hospital
patients? What steps can we take to avoid this? Community has been a by-word for many years, but is it effective? It will take many more years before it can become a useful therapeutic tool. It would be as well for those who discharge these patients to make full and extensive enquiries into the home conditions long care
Daily Mirror
before discharge and to try to organise adequate afterbefore they consider allowing a patient into the
care
community. Herald breakdown Often, social needs may be fulfilled, but industrial not. Industrial therapy in some mental is slowly approaching the pace and efficiency of normal industry, but where patients in industrial therapy have adequate support, one or two patients
needs
are
hospitals
Violence
and crime
forking
on a
line may find that the pace
It may help our approach to the understanding of hospital discharge if this problem is seen and under-
Both mental hospital and prison have a population the support of institutionalisation. It may be relatively immaterial to them which type of institution it is. But the provision ?f hostels, with sheltered workshops attached, might he the answer.
stood in terms of human relations and also in economic terms because the economics of discharge? partial after-care?prison remand?court proceedings ?are heavy. Let us be aware of the question?community care, prison or mental hospital? Let us look at which is the best for the patient.
is
production
too great.
m which many members need
Violence and crime
i
Police carrying
a
child's
body from Saddleworth
Moor.
Photo:
Daily Mirror
care
at Stanley
Royd
hospital, Wakefield, and a consultant at two prisons in Yorkshire, l
discusses the complex problem posed by the mentally abnormal offender.
(
(
i
(
| l
j
So often the mentally abnormal offender shuffles from Prison to mental hospitals, which he may have only JUst left a few weeks before, to pass into the hands of *his mythical community care. As the number of hospital beds decreases, psychiatric patients, who have spent a greater part of their
1'ves
in the supportive, protective care of the mental leave to return into the world of keen competition in which only the strong can live. They find their tranquillisers no longer provide them with protection, there is no longer a ward to retreat to, a kindly sister to rectify all ills, they are out alone with only the protection of community care. It is almost inevitable that they will offend society and start the endless road back. They are arrested, remanded for psychiatric report, brought before the courts and often return to their old homes, under Section 60 or 65 of the Mental Health Act. A court appearance must be a very traumatic, stressful affair for these offenders and their bewilderment must cause further distress before they are back amongst their own familiar surroundings. Sometimes these offenders do not return to the mental hospital. They are examined on remand and it is felt that they cannot be dealt with under Section 60 and they may spend time in prison. Whilst in prison they sometimes find that the regime has the same institutional factor as the mental hospital and so survive their sentence, but on release, they may need further institutional care, and so return as informal patients. They have come from mental hospital to prison and on release, return to the mental hospital; this circular movement has become more prevalent since the 1959 Act.
hospital,
Steal
to
survive
At the British Medical Association's meeting in Londonderry in April, 1967, Dr. Henry Rollin reported that patients discharged from mental hospitals?often chronic psychotics so severely crippled by mental illness that they had to steal to survive?ended in
prison
and
eventually
returned to the mental
hospital.
Apart from the problem posed by the generally inadequate, there is also the separate issue of absconders and violent patients who discharge themselves from psychiatric tion in these two
hospital.
The highly emotive quesis Whether or not further restrictive measures should be advocated. Psychiatrists will know how often they are called to see their ex-patients in the remand and local prisons and how often they are asked for case notes of their old patients, who they only recently discharged into the community. How can we avoid this shuttle service and how can we recognise who is likely to return? It is easy to send patients home especially if a relative requests their discharge, without full and adequate enquiry into the social conditions to which the patient is cases
returning.
It is often difficult to give full and extensive afterbecause, as we all know, out-patient clinics have to cope with many more patients than they can handle
care
adequately. Often, out-patient psychiatry is like passing through a supermarket in a fast car, hoping you can pick up all your needs. The home care, which is given by over-worked mental welfare officers, can never be adequate because their case loads far exceed what is considered reasonable. Also the chronic psychotic is often unable to express his needs, whereas the neurotic tends to demand much more time in the interview session.
Anti-social behaviour The relatives to whom the patient returns have very little insight into psychiatric illness and may become impatient. This mounting frustration in the home may cause the ex-patient to show anti-social behaviour. It is relatively easy to be tolerant and understanding in a hospital, but when you live 24 hours a day with the problem it can become very difficult. Loss of patience and intolerance soon develop, and may cause the patient to start acting out his frustrations and inade-
Violence and crime
Photo:
quacies by resorting
to anti-social behaviour.
When these facts that our courts see
are so
looked at, is it any wonder many psychiatric ex-hospital
patients? What steps can we take to avoid this? Community has been a by-word for many years, but is it effective? It will take many more years before it can become a useful therapeutic tool. It would be as well for those who discharge these patients to make full and extensive enquiries into the home conditions long care
Daily Mirror
before discharge and to try to organise adequate afterbefore they consider allowing a patient into the
care
community. Herald breakdown Often, social needs may be fulfilled, but industrial not. Industrial therapy in some mental is slowly approaching the pace and efficiency of normal industry, but where patients in industrial therapy have adequate support, one or two patients
needs
are
hospitals
Violence
and crime
forking
on a
line may find that the pace
It may help our approach to the understanding of hospital discharge if this problem is seen and under-
Both mental hospital and prison have a population the support of institutionalisation. It may be relatively immaterial to them which type of institution it is. But the provision ?f hostels, with sheltered workshops attached, might he the answer.
stood in terms of human relations and also in economic terms because the economics of discharge? partial after-care?prison remand?court proceedings ?are heavy. Let us be aware of the question?community care, prison or mental hospital? Let us look at which is the best for the patient.
is
production
too great.
m which many members need
Violence and crime
i
Police carrying
a
child's
body from Saddleworth
Moor.
Photo:
Daily Mirror
