Effects of severe mental illness on survival of people with diabetes.

BACKGROUND: People with mental health problems are more likely to die prematurely than the general population but no study has examined this in individuals with diabetes. AIMS: To compare survival rates in people with diabetes with and without schizophrenia or bipolar disorder. METHOD: A total of 43,992 people with diabetes were drawn from the QRESEARCH database population of over 9 million patients. Survival rates during the study period, between 1 April 2000 and 1 April 2005, and hazard ratios for deaths associated with schizophrenia and bipolar disorder were adjusted by age and gender and additionally for socioeconomic status, obesity, smoking and use of statins. RESULTS: Among the participants, we identified 257 people diagnosed with schizophrenia, 159 with bipolar disorder and 14 with both conditions. Although crude survival rates did not show significant differences between the groups during the study period, people with schizophrenia or bipolar disorder and diabetes, compared with those with diabetes alone, had a significantly increased risk of death after adjusting for age and gender, with hazard ratios for schizophrenia of 1.84 (95% CI 1.42-2.40) and for bipolar disorder of 1.51 (95% CI 1.10-2.07). After adjusting for the other factors, hazard ratios were 1.52 (95 CI 1.17-1.97) for schizophrenia and 1.47 (95% CI 1.07-2.02) for bipolar disorder. CONCLUSIONS: People with schizophrenia or bipolar disorder in addition to diabetes have a relatively higher mortality rate. This suggests that diabetes either progresses more rapidly or is more poorly controlled in these individuals, or that they have higher levels of comorbidity and so are more likely to die of other causes.

Widening the scope of the hybrid order.

Hybrid orders under section 45A of the Mental Health Act allow for convicted mentally disordered offenders to be given a sentence of imprisonment and simultaneously transferred to hospital for psychiatric treatment. In England and Wales their use is limited to patients with psychopathic disorder and the order has been little used. Two recent judgments by the House of Lords and the Court of Appeal have interpreted the law in a manner which widens its scope, allowing treatment of a greater range of offenders under the order, including offenders with co-morbid mental illness.

Substance misuse services in secure psychiatric units.

Substance misuse is prevalent amongst patients detained in secure psychiatric hospitals in England, and is associated with more negative outcomes. However, no data has been published on the availability of substance misuse treatment services in secure units. This questionnaire-based study examined staff impressions of the prevalence and impact of substance misuse problems in secure units, and the availability of treatment services. It found that substance misuse was perceived as a major problem with a substantial impact. However, service provision was poor: some units had no access to treatment services at all and, when services were available, they tended to focus on awareness-raising or relapse prevention rather than treatment of current substance misuse. Few units appeared to be able to refer their patients to the local NHS addictions service.

Psychiatrists' experiences of being stalked: a qualitative analysis.

Stalking is a well-recognized social phenomenon, one that particularly affects health care professionals, especially psychiatrists and other mental health workers; however, the nature and effects of stalking of psychiatrists have not been examined in detail. This study is a qualitative thematic analysis of the free-text responses of 2,585 psychiatrists in the United Kingdom (approximately 25% of all U.K. psychiatrists), almost 11 percent of whom described being stalked according to a strict research definition, and 21 percent of whom perceived themselves as having been stalked. It demonstrates that threat minimization, negative psychological impact, awareness of vulnerability, and difficulty obtaining help were major themes in how psychiatrists viewed their experiences of being stalked. It shows how some psychiatrists coped better than others and makes suggestions for appropriate professional support.

Variations in prison mental health services in England and Wales.

In responding to high levels of psychiatric morbidity amongst prisoners and recognising earlier poor quality prison mental health care, prison mental health in-reach teams have been established in England and Wales over the last decade. They are mostly provided by the National Health Service (NHS), which provides the majority of UK healthcare services. Over the same period, the prison population has grown to record levels, such that prisons in England and Wales now contain almost 90,000 of the world's overall prison population of over 10 million people (roughly the size of Paris or Istanbul). This study provides an overview of mental health in-reach services in prisons in England and Wales, including variations between them, through a telephone survey of senior staff in all prisons and young offender institutions in England and Wales. 73% of prisons took part; of them 13% had no in-reach team at all (usually low security establishments) and the majority of services were run by NHS teams, usually according to a generic community mental health team (CMHT) model rather than other specialist models. Team size was unrelated to prison size. Each nurse covered around 500 prisoners, each doctor over 3700. Many provided few or no healthcare cells and 24-h psychiatric cover (including on-call cover) was uncommon. Despite developments in recent years, mental health in-reach services still fall short of community equivalence and there is wide variation in service arrangements that cannot be explained by prison size or function. The aim of community equivalence has not yet been reached in prison healthcare and a more sophisticated measure of service improvement and standardisation would now be useful to drive and monitor future development.

Who stalks? A description of patients at a high security hospital with a history of stalking behaviour.

BACKGROUND: Knowledge about stalking, and in particular the people who do it, is limited in the UK. AIM: This study aims to describe a sample of stalkers drawn from the resident population of Broadmoor high security hospital in the UK. METHODS: Case notes and research database information for 362 consecutive admissions were used to identify stalkers retrospectively. Data were extracted using a stalking behaviour screening checklist. RESULTS: A total of 33 patients (9.1%) were classified as stalkers. They were mostly male (28), young (median age 29), unmarried (30), minimally educated and unemployed. Most had psychosis and personality disorder. They had inflicted a wide range of unwanted intrusions and communications on their victims, and both threats (55%) and assaults (45%) were common. The types of stalkers were more or less equally split between intimacy seeking, rejected suitors, resentful and predatory, with only a tiny group being incompetent suitors. CONCLUSIONS: Although this small group of stalkers had been intrusive and attacking, few had been referred for treatment because of the stalking. The screening questionnaire is easy to use and can be done from records. It may be that such screening should become routine in specialist secure hospitals.