A Follow-Up of Patients Found “Unfit to Stand Trial” or “Not Guilty” Because of Insanity*

Quinsey, Vernon L.; Pruesse, Manfred; Fernley, Robert

doi:10.1177/070674377502000607

Cited by 35 publications

(9 citation statements)

References 14 publications

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“…Conversely, habitually violent paranoid schizophrenics are not unusually model patients (Krakowski et al, 1986). Studies have failed to establish that assessm ents based solely on inpatient variables are useful, although possible protective factors could be lengthy hospitalization and advancing age (Quinsey et al, 1975;Robertson, 1993).…”

Section: Selection Of Patients Into Structured Programm Esmentioning

confidence: 98%

“…In other instances, where fam ily circum stances are chaotic rather than purely fearful or rejecting,`night patient' status may be im portant, with the patient working and largely living outside the unit by day but retaining, in effect, a stable hom e in the hospital. M ost units use an eclectic approach in which patients progress step-wise from high containment to relative freedom, with porous and¯exible boundaries between the levels (Estroff & Zim mer, 1994;Grounds et al, 1995;Quinsey et al, 1975;Tong & M acK ay, 1959). This gradual transition assumes that constant, regular monitoring of functioning, m ental state and behaviour occurs so that modi® cations can be applied rapidly.…”

Section: The Facilitiesmentioning

confidence: 98%

“…There is still not enough outcome research into various pre-discharge interventions. The ® ndings of Quinsey et al (1975) probably remain relevant. In their study of the follow-up of discharged insanity acquitees (over variable periods) 50% were living in the comm unity, 42.9% had been re-adm itted to hospital and only 5.4% had been reconvicted.…”

mentioning

confidence: 93%

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Risk management during the transition from hospital to community care

Kaliski

1997

International Review of Psychiatry

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There is a dearth of research on risk management of violent patients during the phase of transition from hospital to community care. D ischarge can only be contemplated when identi® ed risk factors are managed and tested in non-secure environments. Therefore this process should proceed cautiously and over as protracted a period as circumstances allow. A gradated programme which caters for various levels of risk allows for the testing of measures within a relatively well controlled milieu. Initial measures would include anticipating and preparing for future living arrangements (especially accommodation, supervision, ® nances) and psychoeducation for the patient and care givers. Speci® c risk factors, such as co-morbidity (especially alcohol and substance abuse), and relationship dif® culties may need specialized or particular individual interventions. Increasingly cultural issues will have to be considered and incorporated into management plans.M ost clinicians contem plate the discharge of dif® cult and previously violent patients with trepidation. The clinical team is confronted with competing interests: the need to treat and return the individual to the com munity, and the necessity of protecting others from possible harm. Various other factors have to be considered, such as the requirem ents of relevant legislation, problems encountered during previous attem pts at rehabilitation, and the resources available in the region. Unfortunately, the m ilieu of secure units is generally far removed from the demands and realities patients will confront outside' (Prins, 1990; Tong & M acKay, 1959). There will always be a sm all nucleus of treatm entresistant psychotic individuals with im pressive histories of sym ptom-driven violence for whom inde® nite institutionalization is appropriate, even though their behaviour in hospital m ay be exemplary. Som e will only be allowed brief (albeit frequent) supervised forays into the local surrounds. But for most, risk m anagement will have progressed as a counterpoint to risk assessm ent such that their eventual re-integration into society becomes possible. This process begins on admission and continues throughout rehabilitation. The pre-discharge period, during which the recent m em ories of containm ent in a secure unit com bine with the patient' s impatience to leave, is an exquisitely sensitive (and often precarious) opportunity to achieve long-lasting therapeutic gains.A com plicating factor is that m ost patients possess little insight into their disorder (or behaviour that precipitated the adm ission), and have had to submit to treatment under varying degrees of coercion. Whether continued m onitoring and m anagem ent in the com munity should be enforced by resorting to legislative measures rem ains contro-

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Section: Selection Of Patients Into Structured Programm Esmentioning

confidence: 98%

Section: The Facilitiesmentioning

confidence: 98%

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Risk management during the transition from hospital to community care

Kaliski

1997

International Review of Psychiatry

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show abstract

“…7,No. treatment (Quinsey & Maguire, 1983). They lack the precise information about the offender and his or her difficulties in the real world that are necessary to develop and carry out effective treatment programs (Bergin & Garfield, 1978;Seechrest, White, & Brown, 1979;Martin, Seechrest, & Redner, 1981). The organization of the treatment services for this population is usually based more on the patients' legal status than on his or her needs for treatment (Hodgins, 1989; in press).…”

Section: Introductionmentioning

confidence: 98%

“…With respect to Canadian studies see Hodgins (1987 a,b). By presuming a homogeneity of the samples, researchers (Greenland, 1979;Pasewark, Pantle, & Steadman, 1979;Quinsey, Pruesse, & Fernley, 1975;Steadman, 1980) have looked for correlates of criminal recidivism for the entire cohorts or samples under study. However, as Steadman and his colleagues, (Steadman, Cocozza, & Melick, 1978) have shown, there is a group of young men within these samples with histories of criminal activity who are responsible for most of the recidivism.…”

Section: Introductionmentioning

confidence: 99%