Mentally abnormal killers in the UK health care system: issues facing the multidisciplinary team.

In the UK, mentally ill offenders can be assessed and given treatment and rehabilitation in a secure health care setting rather than in a correctional facility. Beds in such health care facilities are limited and evidence suggests that only the most serious offenders, such as those who have committed a homicide, are given priority. This paper examines the role of the Regional Secure Unit, a National Health Service provision, in the assessment and treatment of these offenders. A number of issues facing the multidisciplinary team are raised. A case study is presented to illustrate some of these points.

The grief process in those admitted to regional secure units following homicide.

Although there is considerable literature on grief and grief work, there have been few studies of the grief process in those who have killed someone. This paper reviews the scope of this problem in England and Wales and examines a number of issues in connection with the grieving process in those who have killed but, because they were found to be suffering from an "abnormality of mind" at the time of the offence, were found not guilty of murder. Increasingly, these patients are referred for treatment to Regional Secure Units, under hospital orders of the Mental Health Act of 1983.

Pedophiles' ratings of adult and child photographs using a semantic differential.

Recent knowledge of the widespread extent of child sexual abuse and its consequences has led to an increasing interest in the understanding and treatment of perpetrators. This study examined a group of pedophiles in an English Special Hospital to determine possible characteristics that make children attractive and adults unattractive to them, using Repertory Grid technique and Semantic Differential. A small number of significant findings suggest that pedophiles may perceive some children and women in an unusual way. The large number of insignificant findings are discussed with reference to the sensitivity of the instrument; the pedophiles' desire to give socially acceptable answers; and subject characteristics of low IQ and "psychopathic disorder." Future directions for research are suggested.

Treating mentally abnormal killers in a regional secure unit: some suggested guidelines.

Despite a growing literature on various psychiatric aspects of homicide, there are few guidelines for treating mentally abnormal killers. This paper describes the background to this area and draws upon the author's experience in an English Regional Secure Unit, working with patients who have killed whilst suffering from an 'abnormality of mind'. A number of treatment issues are raised and some treatment guidelines are suggested. A case study is presented to illustrate some of these points.

Mobile community treatment in inner city and suburban Sydney.

Intensive and assertive community based treatment was provided to 27 inner city and 45 suburban severely and chronically mentally ill patients in Sydney. The teams use assertive outreach methods to address the needs of these most difficult to treat patients who have only sporadically complied with outpatient treatment and who frequently required hospitalisation. The staff-patient ratio at 1:10 on both teams is much higher than in the conventional mental health centres. Preliminary outcomes indicate that the number of hospital bed days of the suburban patients dropped by 67%, that stability in accommodation for inner city patients increased, and that functioning improved significantly for patients treated by both teams.

Assertive community treatment for the seriously mentally ill in suburban Sydney: a programme description and evaluation.

Assertive and intensive community treatment for the seriously mentally ill is becoming a widely accepted approach internationally. This type of service is, however, still relatively new in Australia and New Zealand, and it has rarely been fully integrated into a comprehensive catchment area community and hospital mental health service. This paper has two aims. Firstly, it describes an innovative assertive community mental health service in suburban Sydney. This service was initially provided to 64 clients with a serious mental illness, who had previously experienced repeated hospitalisations and were unable to benefit from existing high quality services. Secondly, it presents the results of the ongoing evaluation of this service. Following the implementation of the service, the number of psychiatric bed days occupied by these clients decreased by 62%; the number of clients admitted decreased, client functioning improved and symptom severity decreased, all to a significant degree.