The homeless mentally disordered defendant facing minor charges poses considerable problems regarding appropriate disposal. Psychiatric assessment may be required in order to facilitate the court's decision, but this is often available only after remand in custody. A psychiatric assessment service based at two inner-London magistrates' courts is described. Over 18 months, 201 defendants were referred. They were predominantly male, single, and of no fixed abode, suffering from serious psychiatric disorder; these defendants had often received previous in-patient treatment, frequently as detained patients. They typically were recidivists charged with minor offences. Following initial assessment, 25% were admitted to hospital, 50% were released, and 25% returned to custody. The Crown Prosecution Service discontinued 29% of cases. For those admitted directly to hospital, the mean (s.d.) time from arrest to hospital admission was 5.8 (6.8) days, significantly quicker than with prison-based assessments.
Two hundred and one referrals to a psychiatric assessment scheme based at two inner-London magistrates' courts were followed up to assess the effect of the scheme on hospital and prison resources. Of the 65 hospital admissions, 50 (77%) derived some or marked benefit from psychiatric treatment. Those who did badly were more likely to be of no fixed abode, and had higher rates of criminality and previous compulsory admission to hospital. Absconding was the largest management problem; 30 (46%) of those admitted did so. Twelve months after admission, all patients except one had been discharged; 10 (15%) had been readmitted to hospital. The scheme generated an extra 21 (64%) hospital admissions per annum from the two courts, compared with the three years before its introduction. The saving in remand time to the prison was approximately double the increased admission time to hospital. However, the overall effect of early diversion on hospital and prison resources was small.
A questionnaire was sent to a random sample of 339 psychiatrists on the Royal College mailing list, enquiring about their practice of screening and risk disclosure in patients at risk of tardive dyskinesia. The response rate was 70%. There was wide variation in the rate of informing patients of the risk. Over half of the respondents felt that knowledge about tardive dyskinesia would reduce compliance, a view which predicted a low rate of informing patients. There was support for the issuing of clinical practice guidelines by the College. Psychiatrists need further education about tardive dyskinesia.
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