Aims: To compare the clinical characteristics of patients who absconded and those who did not abscond; and to show the types of absconding behaviour in a low secure challenging behaviour mental health unit.

Method: A retrospective case control study was conducted. Details of the absconding incidents were collected from an electronic incident database. Clinical predictors of patients who absconded (cases) and those who did not (controls) were compared. Statistical analysis was performed to determine statistical significance of the observed differences.

Results: 80 admissions resulted from 78 patients during a period of 6½ years. 22% of the inpatients absconded from the unit. 84% of the incidents occurred while patients were utilising their unescorted leave. Only one patient escaped from the building. No serious incidents resulted from any of the abscondings. On univariate analysis, the following predictors were more likely to be statistically associated with patients who absconded from the unit: a history of absconding behaviour and a history of substance misuse or dependence. A history of non-compliance with treatment, a history of sexually inappropriate behaviour and a history of childhood conduct problems showed a trend towards statistical significance.

Conclusion: The clinical characteristics of patients who abscond from low secure units show similarities with those who abscond from other psychiatric inpatient settings.

Declaration of interests: None.

Aims: To describe the methods of self harm incidents in a low secure unit population and to identify and compare the clinical characteristics of patients displaying inpatient self harming behaviours with those who do not display such behaviours.

Method: A retrospective case control study was conducted. Details about the inpatient self harming incidents were collected from an incident database. Clinical characteristics of those who displayed inpatient self harming incidents (cases) and those who did not display such behaviours (controls) were compared. Analysis was performed to establish statistical significance on the observed differences.

Results: 80 admissions resulted from 78 patients during a 6½ year period. 21% of patients presented with inpatient self harming behaviours. 57% of the incidents were caused by 13% of patients. Clinical characteristics such as white ethnic background, histories of self harm, physical or sexual abuse, childhood conduct problems and lack of educational qualifications and having a diagnosis of schizoaffective disorder were more likely to be associated with inpatients self harming in low secure settings. Sexually inappropriate behaviours and a diagnosis of schizophrenia were less likely to be associated with this group.

Conclusion: The majority of self harm incidents are caused by a minority of patients. Most of the clinical characteristics associated with the low secure inpatient self harming patients are similar to those observed in other psychiatric inpatient settings.

This paper shows that, throughout its 150 year history, the concept of ‘psychosis’ has not been static, but has reflected the intellectual and social contexts in which it has been employed. Initially the concept reflected the Romantic psychiatrists' emphasis on the whole personality. With the advent of materialism the concept was applied to all mental disorders. Because of the claims for organic cerebral findings in dementia praecox, it was described by Meyer as fitting the disease concept, with characteristic pathology, symptomatology, course and prognosis. However, the different social milieux of patients being treated by psychiatrists such as Kraepelin and Bonhoeffer led to different emphases regarding the aetiology of the psychoses. In the later twentieth century the influence of urbanization in Europe and Africa and also the rise of Nazism led to changes in relation to the use of the concept of psychosis.

The assessment of judgment has a central role in court-appointed evaluation, especially when criminal responsibility is in debate. Psychiatry and the law view the concept of judgment differently. The legal system aims for clear determinations of right or wrong, guilty versus not guilty. In psychiatry, judgment is a more complex concept; it involves analytical thinking, socio-ethical behaviors and insight. In clinical practice, these are inter-related and affect each other. The two viewpoints meet in court where they sometimes clash. Judgment is considered preserved when all three components are intact, or when only one is impaired. Impairment of two components inevitably leads to compromise of the third and to judgment impairment as a whole, resulting in criminal non-responsibility.

Clinical vignettes, mainly from acute secured wards, will illustrate the dynamic inter-relation among the different components of judgment and show the influence of judgment evaluation as a whole in criminal law.

Aims: To describe the pattern of aggressive incidents, compare clinical characteristics of aggressive and non aggressive inpatients and determine predictors of inpatient aggressive behaviours in a low secure mental health unit population.

Method: Clinical data were extracted from inpatient records and a critical incident database for a low secure unit population. Clinical variables between those with inpatient aggressive behaviours (inpatient aggressors) and those without inpatient aggressive behaviours (inpatient non aggressors) were compared. Statistical analysis was carried out on the differences to establish predictors of inpatient aggression.

Results: 80 admissions resulted from 78 patients during a 6½ year period. 44% of patients presented with inpatient aggressive incidents. 64% of aggressive incidents resulted from 15% of patients. 54% of aggressive incidents were directed towards staff, 16% towards property and 15% towards other patients. 8% and 4% contributed to disturbed behaviour (non-directed aggression) and sexually inappropriate behaviour respectively. Most aggressive incidents are perpetrated by males and directed towards staff though a larger proportion of females (compared to males) were aggressive. On univariate analysis, clinical variables of more than one previous psychiatric admission, auditory hallucinations and delusions of control and persecution were significantly higher in patients displaying inpatient aggression. Logistic regression analysis identified the former two as predictors of inpatient aggression.

Conclusion: In a low secure inpatient population, the majority of aggressive incidents are perpetrated by a minority of patients. Clinical variables such as history of more than one previous psychiatric admission and psychopathological symptoms such as presence of auditory hallucinations and delusions of control and persecution can influence inpatient aggression.

Aims: Evaluation of users’ perspectives on ward meetings on a low secure challenging behaviour unit with high levels of morbidity as a means towards increasing their sense of empowerment.

Method: Semi-structured questionnaire designed and administered by a user to all users on the unit over the period of June–Aug 2004 and review of ward meeting minutes over the same period.

Results: 60% response rate. Issues were analysed and issues of importance highlighted and changes made.

Conclusion: On challenging behaviour wards with very high morbidity and long stays, involving the users actively in ward meetings and addressing concerns with feedback is empowering and can be therapeutic. This study highlights this need.

This longitudinal audit aimed to determine the ethnic groups and other characteristics of patients referred to a Low Secure Unit in South East London over a period of 9 years between 1997 and 2005. The data provide a picture of the characteristics of those most likely to be referred to a Low Secure Unit, and highlights an over-representation of Black Caribbean and Black African people. Discussion is provided for this latter finding.

The last decade has seen clinicians and policy makers develop psychiatric intensive care units and low secure units from the so-called ‘special care wards’ of the 1980s and 1990s. Psychiatric intensive care units are for short-term care, while low secure units are for care for up to about 2 years. Department of Health standards have been set for these units. A national survey has shown that there are two main patient groups in the low secure units: patients on forensic sections coming down from medium secure units and those on civil sections who are transferred from general psychiatric facilities. Recent clinical opinion has emphasised the important role both psychiatric intensive care units and low secure units play in providing a bridge between forensic and general mental health services.

Aims: To measure the effectiveness of treatment in a low secure challenging behaviour unit and to identify predictors of change.

Method: Routine clinical data and outcome scores were collected on a case series of 86 patients admitted to and discharged from one low secure unit.

Results: Significant improvements were found on Health of the Nation Outcome Scale (HoNOS), Staff Observed Aggression Scale (SOAS) and the Global Assessment Scale (GAS). Improvements in GAS and HoNOS were associated with moves to a lower level of security. Patients with a history of conviction for property damage, cannabis use, who were admitted on a forensic section or with a diagnosis of personality disorder were more likely to move to a higher level of security. Increased length of stay was related to the presence of physical assault, physical health problems and anxiety symptoms.

Conclusions: Clinical outcomes and behaviour improve during admission to one low secure unit and characteristics of the type of patients who respond to this form of treatment are proposed.