Predictors of improvement in maximum security forensic hospital patients

In a maximum security forensic hospital population (n = 376), relationships between three groups of patient factors (diagnostic data patient histories, and hospital course) and two indicators of treatment effectiveness (length of hospitalization [LOH] and restoration of competency to stand trial) were analyzed. Schizophrenia, previous hospitalizations, felony charges, drug treatment refusal, involuntary medication, physical restraint, and absence of personality disorders were associated with increased LOH. Nonschizophrenic patients without histories of previous incarceration, and, paradoxically, drug treatment refusers were relatively successful with competency restoration. Implications of these findings and questions for future research are discussed.     

Effect of a total smoking ban in a maximum security psychiatric hospital

An archival study was performed in a maximum security forensic hospital to evaluate the effects of a total ban on smoking and all tobacco products. One hundred and forty patients were characterized as nonsmokers or light, moderate or heavy smokers. Patient records for the four weeks prior to the ban were compared with their records for the four weeks subsequent to the ban. Numbers of sick calls, total disruptive behaviors and verbal aggression declined markedly and significantly following the ban in those patients previously classified as moderate or heavy smokers. Weight increased significantly, but almost equally regardless of previous smoking status. Patients, and eventually staff, tolerated the smoking ban without significant negative effects. Patients relied very little on treatment modalities to alleviate nicotine withdrawal. Pre-ban apprehension by staff and patients dissipated with time after the smoking ban started.     

Comparing patients treated in special security civil state hospital units with patients in forensic programs

Psychiatric inpatients in special units designed for the treatment/management of violence (secure care) are compared with inpatients in three forensic programs. Although program designers anticipated that secure care and forensic patients would be similar, they were not. Principally, secure care patients were lower functioning in the psychiatric areas and were more likely to have engaged in a physical assault in the last 30 days.     

Elderly offenders in a maximum security mental hospital

Elderly offenders aged 60 and above constitute less than 8% of the population in a maximum security mental hospital. These offenders fall into 2 groups: 1) first admission at or after the age of 50 and 2) first admission before 50. Fewer first time offenders committed homicide in the first group than those in the second group. Neuropsychiatric disturbance and sex offending was common among male first time offenders in the first group; in contrast, schizophrenia and violent offending against persons was found more often in the second group. It is argued that elderly first time offenders should be given adequate neuropsychiatric assessment. © 1995 Wiley-Liss, Inc.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Architectural design of a secure forensic state psychiatric hospital

This article describes the architectural design of a secure forensic state psychiatric hospital. The project combined input from staff at all levels of the client organization, outside consultants, and a team of experienced architects. The design team was able to create a design that maximized patient dignity and privacy on one hand, and the ability of staff to observe all patient activity on the other. The design centers around 24-bed units, broken into smaller living wings of eight beds each. Each eight-bed living wing has its own private bathrooms (two) and showers (two), as well as a small living area solely reserved for these eight patients and their guests. An indoor-outdoor dayroom allows patients to go outside whenever they choose, while allowing staff to continue observing them. The heart of the facility is a large treatment mall, designed to foster the acquisition of social, emotional, cognitive, and behavioral skills that will help patients to safely return to their communities.     

Seclusion rates and patient census in a maximum security hospital

Seclusion incidents were studied irr an undercrowded maximum security hospital where seclusion is used in response to episodes of violent or disruptive behavior. Population-based seclusion rates for days with an above-mean census were compared with those for days with a below-mean census. Contrary to expectations derived from studies of overcrowded prisons, the total seclusion rate was higher under low census conditions. Although the seclusion rate for parasuicide incidents was higher under high census conditions, seclusion rates for battery, assault, and disorderly conduct incidents were each higher under low census conditions. These findings are interpreted as indicating that correctional officers observe a smaller proportion of battery, assault, and disorderly conduct incidents under high census conditions. Such underdetection must be taken into account, along with underreporting, in studies of intrainstitutional incidents.     

An empirical approach to the classification and treatment of maximum security psychiatric patients

Treatment approaches with forensic patients have traditionally been nonspecific and have been based primarily on legal or diagnostic categories. The current study, stimulated by the need to reorganize treatment and assessment services, examined the incidence among 189 maximum security psychiatric patients of 70 problems commonly exhibited either in the community prior to admission or within the institution. Through a series of factor and cluster analyses, a model for the placement and treatment of these patients was developed that included assaultiveness, level of functioning, social withdrawal, and active psychotic symptoms.     

A systematic program to enhance clinician group skills in an inpatient psychiatric hospital

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.     

Early suicide following discharge from a psychiatric hospital

Social and clinical risk factors for completed suicide occurring shortly after discharge from a psychiatric hospital were examined in this case-control study. Seventy-seven individuals who received "suicide" or "undetermined death" verdicts at inquest, and who had been previously discharged from psychiatric hospitals in Bradford, U.K., were compared with a control group. A history of deliberate self-harm was significantly associated with early suicides compared with both late suicides and controls. A diagnosis of mood disorder, specifically depression, and longer case-notes were also significantly associated with early suicides compared to controls. This study has implications for risk management of recently discharged psychiatric patients.     

Conversational skills training with a chronically hospitalized psychiatric inpatient

While conversational skills training has been conducted with select psychiatric populations, it has rarely been used with severely debilitated inpatients. The purpose of this study was to use a multiple baseline design across conversational components to evaluate the effectiveness of a conversational skills training package to enhance the conversational repertoire of a severely impaired inpatient. Audiotaped conversations with a standard confederate were evaluated for the frequency of questions, self-disclosures, and reinforcing/acknowledging comments. Generalization probe conversations to novel partners were also obtained. Training effects were noted for the 3 conversational units. Mixed results were obtained for generalization and follow-up.     

Sequences of staff-child interactions on a psychiatric inpatient unit

Six psychiatry inpatients were observed during mealtimes to determine and evaluate staff intervention techniques. To extend and further elaborate the findings of a previous work (Pines, Kupst, Natta, & Schulman, 1985), staff behaviors (positive, punitive, isolating, and neutral) were investigated for their potential relationship to subsequent child behaviors (positive, negative, and inactive) via a lag sequential analytic approach. Staff punitive and isolating behaviors tended to be associated with significant increases in the likelihood of subsequent child negative behaviors and with significant decreases in child positive behaviors. Staff positive behaviors tended not to be related to a subsequent increase or decrease in any of the coded child behaviors. Findings demonstrate the utility of assessing conditional probabilities of sequences of staff-child behaviors in psychiatric inpatients.     

Teaching social‐learning procedures to paraprofessionals working with individuals with severe mental illness in a maximum‐security forensic hospital

This study describes an integrated technical method for teaching learning‐based interventions to paraprofessionals working in a maximum‐security psychiatric facility as a social‐learning program was implemented. This training approach combines brief didactic instruction with live demonstration and guided practice in specific procedures. Comparisons between baseline and post‐training functioning of staff were made using ongoing direct observational assessment data. Results revealed that following training and program implementation staff were much more active overall, interacted with clients far more often, and engaged in much lower rates of job‐irrelevant activity. Moreover, following training direct observational data of the patterns of staff–client interactions showed that staff were much more likely to demonstrate interactions reflective of learning‐based interventions than at baseline. These results have important implications for clinicians and administrators attempting to implement behavioral rehabilitation programs. Copyright © 2001 John Wiley & Sons, Ltd.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Gender differences in aggressive behavior at admission to a psychiatric hospital

As aggressive behavior has a negative impact in general psychiatry, its influence specifically from a gender-related point of view in an in-patient population of a psychiatric clinic was assessed at the time of admission. A group of 521 successively admitted psychiatric in-patients was investigated at admission with the help of the "Social Dysfunction and Aggression Scale". A slightly higher frequency and intensity of "verbal aggressive behavior" was observed in males. Within the other categories of aggressive behavior ("tension", "physical violence to things", and "assaults"), however, the percentages and intensities of gender-related aggressive behavior did not differ significantly. Furthermore, under the covarying impact of various psychiatric diagnoses, the gender-related differences concerning the intensity of "verbal aggressive behavior" disappeared. When comparing male and female subgroups, it was notable that male schizophrenic patients were younger than female patients when displaying comparable risks of showing at least one kind of aggressive behavior. In addition, in the female subgroup, "self-injurious behavior" was more strongly correlated to the category "tension" than in the male subgroup. Although there are some methodological shortcomings, the present results show that there are small qualitative differences in gender-related aggressive behavior in addition to minimal quantitative differences in the frequency and intensity of "verbal aggressive behavior" at admission.     

Reflections on suicide in a psychiatric hospital

Taking into consideration topical bibliography suicidal events of the psychiatric clinic of the special county hospital for neurology and psychiatry Ueckermünde are introduced and discussed from the point of view of therapeutical and organizational-structural conditions. Hereby practical procedures in the handling of suicidal patients are described.     

Rorschach predictors of therapeutic outcome in a child psychiatric inpatient service

This study tested the hypothesis that Rorschach indicators of psychological instability and perceptual sensitivity are predictive of therapeutic outcome in a child psychiatric inpatient service. Thirty-four children, matched for age, were divided into two groups, Improvers and Decliners, based on changes in behavioral problems over 60 days of hospitalization. The groups were not distinguishable by scores on intellectual tests, sex, or the initial quality or severity of psychological disturbance. Analyses of Rorschach protocols indicated that children who obtained higher ep, ep-EA, Blends, Zf, and Z sum and lower Lambda had improved in treatment. The results suggest that children who are less stabilized and manifest perceptual sensitivity do achieve the greatest gains.