Elopements from psychiatric units are a frequent but usually low-grade risk. However, they are sometimes followed by harmful consequences, for which the psychiatrist and the hospital may be held liable. We describe management methods developed to reduce such liability. These include a structured observation system and procedures to return elopers to the hospital or to refer them for community-based treatment. Data on 105 elopers and 360 controls were gathered and analyzed. Acceptance of some risk of elopement is inevitable on wards that follow the principle of treatment in the “least restrictive alternative.”
Data on 225 adult arsonists arrested in a metropolitan county over a four-year period were systematically gathered. In each case 83 variables related to the arsonist and the arson were examined. The presence or absence of a partner in crime clearly differentiated two groups of arsonists. Partner and solo arsonists are characterized by a different level of social functioning and a different burden of mental impairment and criminal history. By focusing on the partner variable, it also becomes clear that the characteristics of the offense are related to those of the offender.
The authors present data on all insanity pleas (N = 202) in Erie County, New York, between 1970 and 1980. No demographic, criminal history, current offense, or history of mental hospitalization factor was associated with acquittal. Of the variables studied, only the recommendation of the forensic examiner was associated with the court's decision to acquit by reason of insanity. When an insanity acquittal was recommended in the examination report, conviction ensued in only 17% of the cases. The proportion of pleas that were successful varied considerably over the 10 years studied. The authors discuss the critical need for more research on the plea stage of insanity defense proceedings.
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