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Автор: Grafiati

Опубліковано: 26 липня 2024

Оновлено: 27 липня 2024

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1

Khosla, Vivek, Phil Davison, Harvey Gordon, and Verghese Joseph. "The interface between general and forensic psychiatry: the present day." Advances in Psychiatric Treatment 20, no. 5 (September 2014): 359–65. http://dx.doi.org/10.1192/apt.bp.109.007336.

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SummaryWith the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface between general and forensic psychiatry is subject to varying influences. Important interface issues include: the definition of a ‘forensic patient’; the remit and organisation of services; resources; clinical responsibility; and care pathways. This article also discusses a general overview of how to improve collaboration between forensic and general adult psychiatric services.Learning Objectives•Develop an understanding of important issues at the forensic/general adult psychiatry interface.•Be aware of areas of conflict that may arise at the forensic/general adult psychiatry interface.•Be aware of options for optimum cooperation at the interface.

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O'Neill, Conor, Hamish Sinclair, Alan Kelly, and Harry Kennedy. "Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?" Irish Journal of Psychological Medicine 19, no. 2 (June 2002): 48–54. http://dx.doi.org/10.1017/s0790966700006959.

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AbstractObjective:General psychiatric bed numbers in Ireland have reduced markedly in recent decades. In other jurisdictions such reductions have been accompanied by increases in the prevalence rates of severe mental illness among prisoners. We examined variations in per capita provision of local psychiatric beds and community residential places in Ireland for associations with forensic psychiatric service utilisation.Method:All admissions via the courts and prisons to the national forensic psychiatry service during the years 1997-1999 were assigned to the appropriate health board. Forensic admission and bed utilisation rates were compared with measures of general psychiatric service provision.Results:There were 476 admissions via the criminal justice system during the study period (0.74% of all psychiatric admissions in Ireland). A disproportionate number came from the most urbanised area. There were fivefold differences in overall bed and hostel place allocation between Irish health boards. Combined general psychiatric beds were inversely correlated with forensic bed utilisation (Spearman r = -0.75, p = 0.013). These differences showed a strong inverse correlation with forensic service utilisation.Conclusions:General psychiatric services are relatively under-resourced in areas of greatest predicted need in Ireland. This is associated with increased use of forensic psychiatric services and may reflect accumulation of the mentally ill in Irish prisons.

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Leonard, P., A. Morrison, M. Delany-Warner, and G. J. Calvert. "A national survey of offending behaviour amongst intellectually disabled users of mental health services in Ireland." Irish Journal of Psychological Medicine 33, no. 4 (August 18, 2015): 207–15. http://dx.doi.org/10.1017/ipm.2015.21.

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BackgroundOffenders with an intellectual disability pose a major challenge to Intellectual Disability Service providers in the Republic of Ireland. This is especially so as no national Forensic Intellectual Disability Service currently exists.The Forensic Intellectual Disability Working Group of the Irish College of Psychiatrists was established in order to take steps to address this issue by establishing the level of need for a Forensic Intellectual Disability Service in Ireland and developing a college position paper.No previous study has been carried out to measure offending behaviour amongst persons with an intellectual disability attending mental health services in Ireland.MethodsA postal survey was undertaken targeting the lead clinicians of all Intellectual Disability Psychiatry, General Adult Psychiatry and Forensic Psychiatry Services in the Republic of Ireland. This survey requested anonymous data regarding service users with an intellectual disability and offending behaviour in this population.ResultsData relating to 431 service users was returned. Those reported to engage in offending behaviour were predominantly young males. Assault was the most common offence type. A significant number of serious offences such as unlawful killing, sexual assault and arson were reported.ConclusionsThere is an urgent need for the development of a Forensic Intellectual Disability Service in the Republic of Ireland. The current efforts of the National Forensic Mental Health Service to establish such a service by the creation of a post of Consultant Forensic Psychiatrist (special interest in intellectual disability) are to be welcomed.

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Gordon, Harvey, and Vivek Khosla. "The interface between general and forensic psychiatry: a historical perspective." Advances in Psychiatric Treatment 20, no. 5 (September 2014): 350–58. http://dx.doi.org/10.1192/apt.bp.113.011999.

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SummaryMental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved overtime.Learning Objectives•Have an understanding of the evolution of general and forensic psychiatry in the UK over the past 200 years.•Comprehend the similarities and differences between general and forensic psychiatry.•Be aware of some of the roots of conflict between general and forensic psychiatry.

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Linehan, Sally A., Dearbhla M. Duffy, Helen O'Neill, Conor O'Neill, and Harry G. Kennedy. "Irish Travellers and forensic mental health." Irish Journal of Psychological Medicine 19, no. 3 (September 2002): 76–79. http://dx.doi.org/10.1017/s0790966700007102.

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AbstractObjectives: To determine whether Irish Travellers are over-represented amongst transfers from prison to psychiatric hospital. If so, to determine whether this represents an excess over the proportion of Irish Travellers committed to prison.Method: Irish Travellers admitted to the National Forensic Psychiatry service were identified from a case register over three years 1997-1999. New prison committals were sampled and interviewed as part of the routine committal screening to identify ethnicity.Results: Irish Travellers accounted for 3.4% of forensic psychiatric admissions compared to 0.38% of the adult population. Travellers transferred from prison to psychiatric hospital had more learning disability and less severe mental illness than other groups, while black and other ethnic minorities had a higher proportion of severe mental illness. Travellers accounted for 6% (95% CI 3-11) of 154 male committals and 4% (95% CI 2-12) of 70 female committals. The estimated annualised prison committal rate was 2.8% (95% CI 2.4-3.3) of all adult male Travellers in Ireland and 1% for female Travellers (95% CI 0.8-1.3). Male Travellers had a relative risk of imprisonment compared to the settled community of 17.4 (95% CI 2.3-131.4), the relative risk for female Travellers was 12.9 (95% CI 1.7-96.7). Imprisoned Travellers had greater rates of drugs and alcohol problems than other prisoners (Relative risk 1.46, 95% C11.11-1.90).Conclusion: There is gross over-representation of Travellers in forensic psychiatric admissions. This reflects the excess of Travellers amongst prison committals.

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6

O'Neill, Conor, Patrick Heffernan, Ray Goggins, Ciaran Corcoran, Sally Linehan, Dearbhla Duffy, Helen O'Neill, Charles Smith, and Harry G. Kennedy. "Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment." Irish Journal of Psychological Medicine 20, no. 4 (December 2003): 119–25. http://dx.doi.org/10.1017/s0790966700007916.

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AbstractObjectives:To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.Method:All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.Results:There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.Conclusions:Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.

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Tong, K., A. Gibbons, O. Byrne, T. Conlon, H. Kennedy, and M. Davoren. "Zero violence or zero seclusion. Which is more acceptable in our hospitals?" European Psychiatry 65, S1 (June 2022): S601. http://dx.doi.org/10.1192/j.eurpsy.2022.1539.

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Introduction There is an established association between serious mental illness and violence. Secure forensic psychiatric services provide care and treatment to mentally disordered offenders. The majority of patients in forensic services suffer from severe mental illnesses such as schizophrenia, with co-morbid polysubstance abuse and maladaptive personality traits. Psychiatric services are under significant pressure to reduce the use of seclusion and restrictive practices, whilst mandated to provide safe environments for patients and staff. Objectives To determine the number and characteristics of violent incidents in a secure forensic hospital in Ireland. Methods A retrospective review of all incidents in Central Mental Hospital, Ireland between 1st March 2019 and 31st August 2021 was completed. Incidents were categorised into physical assaults and other violent incidents. Demographic measures and measures of violence risk (HCR-20), functioning (GAF), programme completion and recovery (DUNDRUM tool) were collated. Results A total of 321 incidents took place during the period examined, of which 47 (14.6%) involved physical assaults perpetrated by patients. Between March 2020 and August 2021, numbers of assaults increased by 50% and 78% compared to the preceding six-month period respectively. The majority of assaults were committed by a relatively small group of patients. Victims of assaults were more likely to be patients (n=27, 57.4%) and more likely to be males (n=43, 91.9%). Conclusions Physical assaults and other violent incidents happen in forensic and general psychiatric units. Restrictive practices, used in accordance with the law, are necessary at times to prevent serious harm to patients and staff in psychiatric hospitals. Disclosure No significant relationships.

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8

Kelly, Brendan D. "Folie à plusieurs: forensic cases from nineteenth-century Ireland." History of Psychiatry 20, no. 1 (March 2009): 47–60. http://dx.doi.org/10.1177/0957154x08094236.

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Campbell, Philip, and Keith Rix. "Fusion legislation and forensic psychiatry: the criminal justice provisions of the Mental Capacity Act (Northern Ireland) 2016." BJPsych Advances 24, no. 3 (April 25, 2018): 195–203. http://dx.doi.org/10.1192/bja.2017.9.

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SUMMARYFusion legislation is the latest in a long line of reforms in mental health law that have sought to increase patient autonomy. It has not been without controversy, having been proposed and rejected in various jurisdictions throughout the UK and internationally, while causing considerable debate in the academic literature. This article considers some of the history and debate, along with the criminal justice provisions of the first piece of fusion legislation internationally, the Mental Capacity Act (Northern Ireland) 2016, and their potential implications.LEARNING OBJECTIVES•Understand the history of fusion legislation in the UK and internationally•Understand the advantages and disadvantages of fusion legislation•Understand the Mental Capacity Act (Northern Ireland) 2016 criminal justice provisionsDECLARATION OF INTERESTNone.

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Murphy, F., A. Mcloughlin, A. Butler, M. Davoren, and H. Kennedy. "Frailty in Secure Forensic Mental Health Settings: A Study from Dundrum Hospital, Ireland." European Psychiatry 65, S1 (June 2022): S348—S349. http://dx.doi.org/10.1192/j.eurpsy.2022.885.

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Introduction Frailty is defined as a clinical syndrome that encompasses a combination of decreased physiological reserve and low resistance to stressors. There is an association between mental illness and frailty among elderly cohorts. Frailty is also associated with obesity and smoking. There are high rates of treatment resistant schizophrenia among patients in secure forensic services. Patients with schizophrenia have high rates of morbidity and early mortality. Objectives The primary aim of this study was to examine the rates of frailty present in a complete cohort of forensic in-patients. Methods An assessment using Fried Frailty criteria was offered to all in-patients (n=95) in Ireland’s National Forensic Service, which included measures of walking speed, grip strength, low physical activity and exhaustion. Demographic details and details pertaining to diagnoses and medications were also gathered. Results Of the 95 in-patients, 92 patients agreed to participate. The majority were male (89%). The most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42), and 58.2% met criteria for obesity. Of the total group, 47 patients met criteria for ‘pre-frail’ and 10 met criteria for ‘frail’ using Fried criteria. Conclusions This is the first study examining frailty in a cohort of patients in secure forensic settings. We found high rates of patients meeting frailty criteria at very young ages. Rates of frailty in this group were comparable to those found amongst elders in community settings. We consider this demonstrates significant medical vulnerability in this patient group. Disclosure No significant relationships.

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Jordan, L., G. Crudden, D. Mohan, H. Kennedy, and M. Davoren. "Stratified therapeutic security and understanding backwards care pathway moves. A 5-year retrospective cohort analysis from the Dundrum Forensic Redevelopment Evaluation (D-FOREST) study in Dublin, Ireland." European Psychiatry 66, S1 (March 2023): S429—S430. http://dx.doi.org/10.1192/j.eurpsy.2023.923.

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IntroductionSecure forensic hospital settings provide care and treatment to mentally disordered offenders with a history of serious violence. Most modern forensic hospitals operate a system of stratified therapeutic security, where patients are placed on the internal care pathway according to individual risks and needs. Unfortunately, at times patients move ‘backwards’ from a unit of lower to a unit with higher therapeutic security. This is a challenge to manage from an individual patient and service perspective.ObjectivesThe aim of this study was to analyse backwards moves along the care-pathway within a complete national cohort of forensic in-patients in Ireland over a five-year period. We aimed to clarify the reasons for these moves and ascertain if they were linked to mental illness, security or other issues.MethodsA naturalistic retrospective five-year observational cohort study was completed. All in-patients in the Central Mental Hospital, Dundrum, Ireland or associated high support hostels between January 2016 and January 2021 were included (60 months). Demographic data, data pertaining to diagnosis, data pertaining to backwards moves and reasons for those moves were gathered. Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation study (D-FOREST study).ResultsA total of n=231 patients were included; the majority (n= 203; 87.9%) were male. The most common diagnosis was schizophrenia (64.1%), followed by schizoaffective disorder (12.6%), bipolar affective disorder (4.8%) and autistic spectrum disorder (3.5%). Mean age at admission was 35.9 years, SD 9.5.Over the 60-month period, a total of 93 backwards moves relating to 50 patients occurred. Reasons for backward moves included deteriorating mental state (8.7%), assaults (4.3%), challenging behaviour (4.3%), security (1%) and others. Binary logistic regression demonstrated that lacking capacity to consent to medication (Odds ratio 0.352, 95%CI 0.198-0.627, p<0.001) and higher (worse) scores on HCR-20 Historical scale (Odds ratio 1.13, 95%CI 1.01-1.27, p=0.035) were associated with backwards moves, when adjusting for age and Dundrum-1 need for therapeutic security scores.ConclusionsBackwards care pathway moves are a major issue in forensic hospitals both nationally and internationally. We were surprised at the strength of association between lacking capacity to consent and backwards moves. Understanding backwards moves will assist in supporting patients and minimising length of stay.Disclosure of InterestL. Jordan Grant / Research support from: This study was funded by the Health Service Executive for the Republic of Ireland as part of the Dundrum Forensic Redevelopment Evaluation (D-FOREST) study, G. Crudden: None Declared, D. Mohan: None Declared, H. Kennedy: None Declared, M. Davoren: None Declared

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Gibbons, A., T. Hoare, K. Kirrane, H. Kennedy, and M. Davoren. "Sedentary Behaviour in the Secure Forensic Hospital Setting: A Study from Dundrum Hospital Ireland." European Psychiatry 65, S1 (June 2022): S604. http://dx.doi.org/10.1192/j.eurpsy.2022.1548.

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Introduction Secure forensic mental health services offer care and treatment to mentally disordered offenders, with high rates of schizophrenia and major mental illness in these groups. Much of the excess morbidity and mortality seen among patients with schizophrenia is due to cardiovascular disease and obesity. Sedentary behaviour is associated with negative symptoms of schizophrenia and obesity. Objectives The aim of this study was to ascertain the level of sedentary behaviour among inpatients in a secure forensic psychiatric hospital, Dundrum, Ireland, using a structured self-report measure of sedentary behaviours, the SIT-Q tool. Methods A cross sectional study of self-reported sedentary behaviour was completed amongst the secure forensic inpatient population of Dundrum Hospital (N=94). Demographic details, details pertaining to diagnoses, ward level of dependency and length of stay were collated. Results The majority of patients in the sample were male (89%) and the most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42). 58.2% met criteria for obesity. We found high rates of self-reported sedentary behaviour across all wards of the service, with significantly high rates of sedentary behaviour being associated with screen time use in the hospital, including both personal screen time and therapeutic sessions based on screen time. Conclusions Sedentary behaviour among in-patients in secure forensic hospitals is a significant issue. Measuring sedentary behaviour in a systematic manner is possible and identifies a potentially modifiable target to reduce co-morbidity and pre-mature mortality independent of other risk factors in this vulnerable patient group. Disclosure No significant relationships.

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Byrne, F., R. Murphy, L. O’Rourke, D. Cotter, K. C. Murphy, A. Guerandel, D. Meagher, et al. "A comparison of undergraduate teaching of psychiatry across medical schools in the Republic of Ireland." Irish Journal of Psychological Medicine 37, no. 2 (July 8, 2016): 77–88. http://dx.doi.org/10.1017/ipm.2016.22.

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ObjectivesTo examine the delivery and assessment of psychiatry at undergraduate level in the six medical schools in the Republic of Ireland offering a medical degree programme.MethodsA narrative description of the delivery and assessment of psychiatry at undergraduate level by collaborative senior faculty members from all six universities in Ireland.ResultsPsychiatry is integrated to varying degrees across all medical schools. Clinical experience in general adult psychiatry and sub-specialities is provided by each medical school; however, the duration of clinical attachment varies, and the provision of some sub-specialities (i.e. forensic psychiatry) is dependent on locally available resources. Five medical schools provide ‘live’ large group teaching sessions (lectures), and all medical schools provide an array of small group teaching sessions. Continuous assessment encompasses 10–35% of the total assessment marks, depending on the medical school. Only one medical school does not provide a clinical examination in the form of an Objective Structured Clinical Examination with viva examinations occurring at three medical schools.ConclusionsMany similarities exist in relation to the delivery of psychiatry at undergraduate level in Ireland. Significant variability exists in relation to assessment with differences in continuous assessment, written and clinical exams and the use of vivas noted. The use of e-learning platforms has increased significantly in recent years, with their role envisaged to include cross-disciplinary teaching sessions and analysis of examinations and individual components within examinations which will help refine future examinations and enable greater sharing of resources between medical schools.

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Gibbons, Pat, Niamh Mulryan, and Art O'Connor. "Guilty but insane: the insanity defence in Ireland, 1850–1995." British Journal of Psychiatry 170, no. 5 (May 1997): 467–72. http://dx.doi.org/10.1192/bjp.170.5.467.

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BackgroundThis is a retrospective study describing sociodemographic and clinical characteristics of an almost complete sample of insanity acquittees in Ireland between 1850 and 1995.MethodCase records and legal files were examined for each of the 437 patients admitted to the Central Mental Hospital under guilty but insane criteria, and a profile of sociodemographic, forensic and clinical data completed on each.ResultsThe number of insanity acquittees has fallen five-fold since the 19th century. Acquittees were usually single males from rural areas, aged in their 30s, who had committed a violent crime while suffering from a major psychiatric illness. Female insanity acquittées were relatively few in number and were equally likely to have been charged with violent crime, especially against their own children. The mean length of detention was 14.5 years.ConclusionsThe insanity defence is rarely used in Ireland, is largely confined to serious offences (especially homicide), and generally results in prolonged detention.

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McClean, Rowan James. "Assessing the security needs of patients in medium secure psychiatric care in Northern Ireland." Psychiatrist 34, no. 10 (October 2010): 432–36. http://dx.doi.org/10.1192/pb.bp.109.027672.

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Aims and methodTo determine the security needs of patients in medium secure services in Northern Ireland and to identify those requiring long-term secure care. Patients were rated on the Security Needs Assessment Profile.ResultsFifteen patients (45%) could be managed in conditions of low security. Twelve patients (36%) require over 5 years' further treatment in secure care. Particular security needs include relational nursing skills, restricted access to alcohol and drugs, and robust physical security.Clinical implicationsThis study should be replicated across the UK to determine whether forensic services are responding to patients' needs. Pathways out of medium security need to be better developed, with regional expansion of low secure services.

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Curley, Aoife, Ruth Murphy, Róisín Plunkett, and Brendan D. Kelly. "Categorical mental capacity for treatment decisions among psychiatry inpatients in Ireland." International Journal of Law and Psychiatry 64 (May 2019): 53–59. http://dx.doi.org/10.1016/j.ijlp.2019.02.001.

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Iqbal, M. U., M. U. Waqar, B. Ogunnaike, H. G. Kennedy, and M. Davoren. "Obesity in secure hospital settings: Changes in BMI over time among a complete national cohort of forensic in-patients in Dundrum Hospital, Ireland." European Psychiatry 66, S1 (March 2023): S61. http://dx.doi.org/10.1192/j.eurpsy.2023.218.

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IntroductionThere are high rates of treatment resistant psychoses and medical complexity among patients in secure forensic hospitals (Basrak et al., BJPsych Open (2021) 7, e31,1-7). Patients with schizophrenia in secure settings have a lower life expectancy compared to community peers of approximately 16 years. Evidence suggests patients in secure settings often gain significant amounts of body weight during their in-patient stays, many of whom develop complex obesity presentations.ObjectivesTo ascertain changes in Body Mass Index (BMI) among patients in a secure forensic hospital setting over a 3.5 year period.MethodsA prospective longitudinal study of repeated measures of BMI for all (n=91) patients in a National Forensic Mental Health Service (CMH Dundrum, Dublin, Ireland). BMI was measured six-monthly, giving up to seven time points for each patient. Generalized Estimating Equations (GEE) analysis was conducted to ascertain changes in BMI over time. This study formed part of the DUNDRUM Forensic Redevelopment Evaluation Study (D-FOREST) (Davoren et al., BMJ Open (2022) 12(7): e058581).ResultsA total of 91 patients were included in the study, mean age 33.46 years (SD 9.23). Mean length of stay was 8.09 years (SD 9.23). The most common diagnosis was schizophrenia (67%), followed by schizoaffective disorder (17.5%) and Autistic spectrum disorder (6.2%). Using GEE with BMI as the dependent variable, for the complete patient cohort, BMI changed significantly with diagnosis (Wald X2=5817.58, df=7, p<0.001). Those with severe mental illnesses (psychoses) had the highest BMI of the group, and BMI tended to increase over time (p=0.109). Among patients who were in the secure hospital for four years or less, their weight gain was significant over time (Wald X2 =10.0, df=1, p=0.002).ConclusionsWe have shown high rates of obesity particularly in patients with psychoses and we have shown weight gain is significant during the first four years after admission to a national forensic service. This is a significant health concern and an area of unmet treatment need which is likely generalizable across secure hospitals in the EU.Disclosure of InterestNone Declared

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Davoren, Mary, Ken O’Reilly, Damian Mohan, and Harry G. Kennedy. "Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol." BMJ Open 12, no. 7 (July 2022): e058581. http://dx.doi.org/10.1136/bmjopen-2021-058581.

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IntroductionSecure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefit in multiple domains. These should include physical and mental health outcomes, as well as offending related outcomes. The aim of Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) is to complete a structured evaluation study of a complete national forensic mental health service, at the time of redevelopment of the National Forensic Mental Health Service for the Ireland.Methods and analysisD-FOREST is a multisite, prospective observational cohort study. The study uses a combination of baseline and repeated measures, to evaluate patient benefit from admissions to forensic settings. Patients will be rated for physical health, mental health, offending behaviours and other recovery measures relevant to the forensic hospital setting at admission to the hospital and 6 monthly thereafter.Lagged causal model analysis will be used to assess the existence and significance of potential directed relationships between the baseline measures of symptomatology of schizophrenia and violence risk and final outcome namely length of stay. Time intervals including length of stay will be measured by median and 95% CI using Kaplan-Meier and Cox regression analyses and survival analyses. Patient related measures will be rated as changes from baseline using general estimating equations for repeated measures, analysis of variance, analysis of covariance or logistic regression.Ethics and disseminationThe study has received approval from the Research Ethics and Effectiveness Committee of the National Forensic Mental Health Service, Ireland. Results will be made available to the funder and to forensic psychiatry researchers via international conferences and peer-reviewed publications.Trial registration numberNCT05074732.

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Kelly, Brendan D. "Clinical and social characteristics of women committed to inpatient forensic psychiatric care in Ireland, 1868–1908." Journal of Forensic Psychiatry & Psychology 19, no. 2 (June 2008): 261–73. http://dx.doi.org/10.1080/14789940801999710.

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Clarke, Ciaran, Mary Cannon, Norbertas Skokauskas, and Pauline Twomey. "The debate about physician assisted suicide and euthanasia in Ireland – Implications for psychiatry." International Journal of Law and Psychiatry 79 (November 2021): 101747. http://dx.doi.org/10.1016/j.ijlp.2021.101747.

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Walker, Helen, Lindsay Tulloch, Karen Boa, Gordon Ritchie, and John Thompson. "A multi-site survey of forensic nursing assessment." Journal of Forensic Practice 21, no. 2 (May 13, 2019): 124–38. http://dx.doi.org/10.1108/jfp-11-2018-0045.

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Purpose A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues. Design/methodology/approach A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire. Findings Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning. Research limitations/implications Studies using cross-section can only provide information at fixed points in time. Practical implications The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility. Originality/value This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.

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Waqar, M. U., H. Amin, E. Ní Mhuircheartaigh, H. G. Kennedy, and M. Davoren. "Prevalence of Treatment Resistant Psychoses in a Complete National Forensic Mental Health Service: A Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)." European Psychiatry 66, S1 (March 2023): S431—S432. http://dx.doi.org/10.1192/j.eurpsy.2023.928.

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IntroductionTreatment resistant schizophrenia and other treatment resistant psychotic disorders are believed to be over-represented in forensic patient clusters. The true rates of treatment resistant psychoses in secure forensic hospitals remain unexplored.ObjectivesThis study aimed to ascertain the prevalence of treatment resistant psychoses within a complete national forensic mental health service. In addition, the study sought to examine the relationships between treatment resistance for psychotic symptoms and treatment resistance in other domains, such as offending behaviour.MethodsThis is a cross-sectional study of a complete cohort of patients admitted to the National Forensic Mental Health Service in Ireland during the period 01/11/2021 to 31/01/2022. All inpatients at the time of the study were included. Demographic details, data appertaining to diagnosis, medication, measures of risk (HCR-20), recovery (DUNDRUM toolkit), functioning (GAF), and symptoms (PANSS) were collated. Data were gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).ResultsThe sample consisted of 170 patients. Majority (n=162) 95.3% were male. The majority (n=116), 68.2%, were admitted from prisons, while a smaller number (n=35), 20.6%, were admitted from other psychiatric facilities. The insanity defense (n=94) 55.3% was the most common legal status, followed by unfit to plead (n=16) 9.4%. The commonest diagnosis was schizophrenia (n=97) 57.1%, followed by schizoaffective disorder (n=27) 15.9% and autism spectrum disorder (n=5) 2.9%. The mean age at admission was 35.52 years and the median age was 34.37 ± 9.43 SD.Of the total sample, 25.9% of patients were on more than 1000 mg per day chlorpromazine equivalent (CPZE) doses. Those whose psychotic symptoms required treatment with CPZE doses over 1000 mg per day scored poorly on DUNDRUM-3 programme completion, DUNDRUM-4 recovery scale, HCR-20 historical, HCR-20 clinical, HCR-20 risk, HCR-20 dynamic, and had poorer overall functioning (all P<0.001) than those who required lower antipsychotic doses. On binary logistic regression, correcting for age and gender, the only variable that remained significant was GAF (adjusted odds ratio = 0.979, 95% CI 0.962-0.996, P=0.014). In forward entry model regression, only the DUNDRUM-4 recovery scale (odds ratio = 1.13, 95% CI 1.07-1.19, P<0.001) and GAF (adjusted odds ratio = 0.979, 95% CI 0.962-0.996, P<0.001) were significant. This model had a robust forward and backward likelihood ratio.ConclusionsRates of treatment resistant psychoses in forensic hospital groups are indeed elevated. Overall functioning on GAF and recovery across a wide range of components in the DUNDRUM-4 scale are the best predictors of treatment resistant psychosis.Disclosure of InterestNone Declared

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Elamin, Mohamed Elhassan, Anthony Kearns, and Aidan Cooney. "Listen to hard topics with soft ears - domestic violence and family carer; a survey of referrals to a MHIDD forensic mental health service in Ireland." BJPsych Open 7, S1 (June 2021): S320—S321. http://dx.doi.org/10.1192/bjo.2021.844.

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AimsA number of studies sought to explore and define families needs, experiences and concerns associated with being a carer for a detained person and their interaction with Forensic services (McKeown et al, 1995, MacInnes et al, 2002, Tsang et al, 2002, Absalom et al, 2012 Horberg et al, 2015).Relatives can be victims of the service user's offence (Ferriter & Huband, 2003, Tsang et al 2002), and may even blame the service user for their behaviour (Barrowclough et al., 2005). Service user becomes violent and aggressive family members are less likely to be motivated to participate, due to the service user's behaviour (MacInnes, 2000).An initial domestic violence survey of in-patient case files found that in 66%of the patients files, there were reported incidents of domestic violence in family caring relationships prior to the index offence and subsequent admission to NFMHS (Cooney, 2018).MethodA quantitative methodology was used. A domestic violence survey of referrals was conducted of 100 referrals to the National Forensic Mental Health Services – Mental Health and Intellectual & Development Disability Services between 2016-2019.Result22% of the referrals reported Domestic Violence in the family care-giving relationships.The father was recorded as the parent to be experience most Domestic Violence; 40%. Other family members who experienced domestic violence ranged from the mother 32%, brother 12% and sister 8%. Other family members were 8%.100% of the referrals did not report the domestic violence in the carer relationships, nor did referring agencies recorded safeguarding adults concerns.ConclusionThe findings from this audit raises a couple of clinical, legal and safeguarding adults work in National Forensic Mental Health Services with regards to family work. Firstly, the need to (re)conceptualising family work in the context of trauma informed care. Secondly, family work should offer some families, who are victim of crime, a restorative approach. Thirdly, safeguarding adults will need to consider complex caring relationships and acknowledged this as part of care planning and support.

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Cregg, M. T., and J. A. Tracey. "Ecstasy abuse in Ireland." Journal of Clinical Forensic Medicine 1, no. 1 (June 1994): 51. http://dx.doi.org/10.1016/1353-1131(94)90065-5.

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Sandbrook, Jeremy, Tom Clark, and Karen Amanda Cocksedge. "Addressing substance misuse in medium secure settings in the UK and Ireland – a survey of current practice." Journal of Forensic Practice 17, no. 3 (August 10, 2015): 192–203. http://dx.doi.org/10.1108/jfp-01-2015-0006.

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Purpose – Rates of co-morbid substance misuse are high within forensic populations. Addressing these problems should be a priority as mental disorder with co-morbid substance misuse is associated with worse outcomes, including rates of re-offending and violence recidivism. A study undertaken in 2006 by the Royal College of Psychiatrists’ Research and Training Unit concluded that the provision of substance misuse treatments in medium-secure units (MSUs) at that time was inadequate. The purpose of this paper is to investigate how services may have developed since then to inform discussion over future development and best practice. Design/methodology/approach – A postal survey, supported by the Quality Network for Forensic Mental Health Services, was sent to 62 MSUs across the UK and Ireland. This questioned prevalence, interventions and staff training in substance misuse. Findings – In total, 41 units responded (66 per cent). The data suggest rates of substance misuse within MSUs have reduced and provision of treatment has increased in recent years. The majority of MSUs provide a variety of interventions to address substance misuse and are internally resourced, in tune with current national guidance. However, the data suggest many MSU staff are not receiving adequate training in substance misuse treatments and some MSUs do not appear to have a cohesive strategy that would be consistent with best practice. Practical implications – This study provides an up-to-date overview of the provision of treatment for substance misuse within MSUs. Originality/value – There is no other source for this information, which will provide an invaluable reference point for services seeking to develop or improve their clinical services.

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Feeney, Anna, Emmanuel Umama-Agada, Jane Gilhooley, Muhammad Asghar, and Brendan D. Kelly. "Gender, diagnosis and involuntary psychiatry admission in Ireland: A report from the Dublin Involuntary Admission Study (DIAS)." International Journal of Law and Psychiatry 66 (September 2019): 101472. http://dx.doi.org/10.1016/j.ijlp.2019.101472.

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East, Adrian. "Prison mental health care in Northern Ireland." Criminal Behaviour and Mental Health 28, no. 3 (June 2018): 223–26. http://dx.doi.org/10.1002/cbm.2080.

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Kurz, R. "Poor Quality of Mental Health Assessment Reports in UK Family Courts: A ‘call to Action’." European Psychiatry 33, S1 (March 2016): S460. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1674.

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IntroductionProf. Jane Ireland found that 65% of assessment reports sampled from UK family courts were ‘poor’ or ‘very poor’.ObjectiveThe presentation raises international awareness of the problem and explains the contextual factors that contribute to malpractice.AimsThe paper highlights typical deficiencies in family court assessments and forensic processes in order to reduce the risk of unsafe custody rulings.MethodDue to the paucity of published academic literature ‘ad hoc’ Internet searches were utilised to collect source material and identify advocates. A range of conferences, seminars and continued professional development (CPD) events revealed the background for some of the persistent problems.ResultsThe suppression of the trauma-centric approach to mental health issues and its re-emergence are central to understanding the trajectory and how to improve professional practice.Organised Ritualised Crime Abuse Networks (ORCANs) seem to be at work infiltrating institutions that are supposed to uphold law and order.Inadequate psychometric instruments appear to beguile some mental health professionals into wrong diagnosis and testimony.ConclusionThe standard of UK family court assessments must improve. Scrapping ‘forced adoption’ legislation that drives the ‘child snatching’ culture in UK social services department would benefit society including citizens from abroad whose governments vocally criticise the removal of their children through clandestine UK ‘child protection’ procedures.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Gudjonsson, Gisli H., and Ian Bownes. "The attribution of blame and type of crime committed: Data for northern ireland." Journal of Forensic Psychiatry 2, no. 3 (December 1991): 337–41. http://dx.doi.org/10.1080/09585189108407668.

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Knapman, Paul A. "Coroners' law and practice in Northern Ireland." Journal of Clinical Forensic Medicine 6, no. 1 (March 1999): 61. http://dx.doi.org/10.1016/s1353-1131(99)90198-0.

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Kurz, R. "Fitness to practice and fitness to regulate." European Psychiatry 41, S1 (April 2017): S581. http://dx.doi.org/10.1016/j.eurpsy.2017.01.873.

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IntroductionIn 2012, forensic psychology Professor Jane Ireland published initial research claiming that two third of psychological assessment reports sampled from UK family courts were ‘poor’ or ‘very poor’. ‘Fitness to practice’ concerns were raised by vested interest and dismissed after a 1-week hearing – four years later.ObjectivesThe presentation outlines the nature of various UK institutions, such as family courts, HCPC and GMC as well as their practices which raise questions about their fitness to regulate.AimsDelegates will start to learn how institutions that purport to serve public interest yet can be easily exploited by vested interests.MethodsCase studies are used to illustrate how extremely serious concerns were ignored but persecution concerns upheld.ResultsIn one case, four courts appointed experts ignored an obvious child trafficking process where a toddler was raped to cover up birth and disappearance of a newborn baby that succeeded from incestuous rape. In spite of a clinical psychologist failing to cover the two index incidents, the concerns did not meet the HCPC ‘Standard of Acceptance’. A ‘revenge concern’ was raised by vested interests. In another case, the GMC refused to investigate a psychiatrist who had lied and rather absurdly claimed that repeatedly seeking return of her children was evidence for a mother's personality disorder. In a widely publicized case Psychiatrist Dr Hibbert accused of unnecessarily, breaking up families was investigated but cleared of misconduct by the GMC.ConclusionsInstitutions tasked with protecting public safety and fairness appear to be unduly biased towards shielding inadequate professionals and persecuting whistle-blowers.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Kelly, Brendan D. "Criminal insanity in 19th-century Ireland, Europe and the United States: Cases, contexts and controversies." International Journal of Law and Psychiatry 32, no. 6 (November 2009): 362–68. http://dx.doi.org/10.1016/j.ijlp.2009.09.005.

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Schudson, Charles B. "Forgive and Forget: Ireland, America, and Surviving the Statute of Limitations." Journal of Child Sexual Abuse 8, no. 2 (January 1, 1999): 109–11. http://dx.doi.org/10.1300/j070v08n02_08.

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34

Campbell, Jim, Gavin Davidson, Pearse McCusker, Hannah Jobling, and Tom Slater. "Community treatment orders and mental health social work: Issues for policy and practice in the UK and Ireland." International Journal of Law and Psychiatry 64 (May 2019): 230–37. http://dx.doi.org/10.1016/j.ijlp.2019.04.003.

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Kelly, Brendan D. "Emergency mental health legislation in response to the Covid-19 (Coronavirus) pandemic in Ireland: Urgency, necessity and proportionality." International Journal of Law and Psychiatry 70 (May 2020): 101564. http://dx.doi.org/10.1016/j.ijlp.2020.101564.

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Anderson, Phil, Gavin Davidson, Francess Doherty, Heather Hanna, Colin Harper, Gerry Lynch, Roy McClelland, and Claire McKenna. "Legal capacity, developmental capacity, and impaired mental capacity in children under 16: Neurodevelopment and the law in Northern Ireland." International Journal of Law and Psychiatry 87 (March 2023): 101872. http://dx.doi.org/10.1016/j.ijlp.2023.101872.

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Iles, Andrew. "Violent and sexual offenders: assessment, treatment and management. Edited by Jane L. Ireland, Carol A. Ireland and Philip Birch. Willan Publishing, Devon, UK, 2008, 314 pp. Paperback, ISBN 978-1-84392-382-4." Criminal Behaviour and Mental Health 20, no. 2 (April 2010): 158–59. http://dx.doi.org/10.1002/cbm.739.

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Gulati, Gautam, Alan Cusack, John Bogue, Anne O'Connor, Valerie Murphy, Darius Whelan, Walter Cullen, et al. "Challenges for people with intellectual disabilities in law enforcement interactions in Ireland; thematic analysis informed by 1537 person-years' experience." International Journal of Law and Psychiatry 75 (March 2021): 101683. http://dx.doi.org/10.1016/j.ijlp.2021.101683.

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39

Morgan, Leanne, Andrew Forrester, Mick Burns, Theresa Nixon, and Emer Hopkins. "A review of services for vulnerable people detained in Northern Ireland prisons: The impact of underfunding." Criminal Behaviour and Mental Health 32, no. 1 (February 2022): 1–4. http://dx.doi.org/10.1002/cbm.2227.

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40

Farrell, Anne-Maree, and Patrick Hann. "Mental health and capacity laws in Northern Ireland and the COVID-19 pandemic: Examining powers, procedures and protections under emergency legislation." International Journal of Law and Psychiatry 71 (July 2020): 101602. http://dx.doi.org/10.1016/j.ijlp.2020.101602.

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41

Finnerty, Aoife M., and Judy Laing. "Best interests, benefit, will and preference: The influence of international human rights and external actors on decision-making frameworks in the United Kingdom and Ireland." International Journal of Law and Psychiatry 85 (November 2022): 101841. http://dx.doi.org/10.1016/j.ijlp.2022.101841.

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Pounder, Derrick. "The future of the coroner service in England, Wales and Northern Ireland. A medical examiner system in all but name?" Journal of Clinical Forensic Medicine 11, no. 5 (October 2004): 229–30. http://dx.doi.org/10.1016/j.jcfm.2004.01.003.

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Kelly, B. D. "Poverty, Crime and Mental Illness: Female Forensic Psychiatric Committal in Ireland, 1910-1948." Social History of Medicine 21, no. 2 (June 3, 2008): 311–28. http://dx.doi.org/10.1093/shm/hkn027.

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Sgroi, Suzanne M. "The McColgan Case: Increasing Public Awareness of Professional Responsibility for Protecting Children from Physical and Sexual Abuse in the Republic of Ireland." Journal of Child Sexual Abuse 8, no. 1 (July 30, 1999): 113–27. http://dx.doi.org/10.1300/j070v08n01_07.

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TIMMONS, D. "Forensic psychiatric nursing: a description of the role of the psychiatric nurse in a high secure psychiatric facility in Ireland." Journal of Psychiatric and Mental Health Nursing 17, no. 7 (August 15, 2010): 636–46. http://dx.doi.org/10.1111/j.1365-2850.2010.01581.x.

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Duffy, R. M., and B. D. Kelly. "Steroids, psychosis and poly-substance abuse." Irish Journal of Psychological Medicine 32, no. 2 (October 13, 2014): 227–30. http://dx.doi.org/10.1017/ipm.2014.57.

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ObjectiveTo review consequences of the changing demographic profile of anabolic-androgenic steroid (AAS) use.MethodCase report and review of key papers.ResultsWe report here a case of a 19-year-old Irish male presenting with both medical and psychiatric side effects of methandrostenolone use. The man had a long-standing history of harmful cannabis use, but had not experienced previous psychotic symptoms. Following use of methandrostenolone, he developed rhabdomyolysis and a psychotic episode with homicidal ideation.DiscussionNon-medical AAS use is a growing problem associated with medical, psychiatric and forensic risks. The population using these drugs has changed with the result of more frequent poly-substance misuse, potentially exacerbating these risks.ConclusionA higher index of suspicion is needed for AAS use. Medical personnel need to be aware of the potential side effects of their use, including the risk of violence. Research is needed to establish the magnitude of the problem in Ireland.

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Kutlesic, Vesna. "The McColgan Case: Increasing the Public Awareness of Professional Responsibility for Protecting Children from Physical and Sexual Abuse in the Republic of Ireland: A Commentary." Journal of Child Sexual Abuse 8, no. 2 (January 1, 1999): 105–8. http://dx.doi.org/10.1300/j070v08n02_07.

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Amin, H., I. Edet, N. Basrak, G. Crudden, H. Kennedy, and M. Davoren. "Quality of Life, Risk and Recovery in a National Forensic Mental Health Service: A D-FOREST study from DUNDRUM Hospital." European Psychiatry 65, S1 (June 2022): S603. http://dx.doi.org/10.1192/j.eurpsy.2022.1545.

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Introduction Secure forensic mental health services have a dual role, to treat mental disorder and reduce violent recidivism. Quality of life is a method of assessing an individual patients’ perception of their own life and is linked to personal recovery. Placement in secure forensic hospital settings should not be a barrier to achieving meaningful quality of life. The WHO-QuOL measure is a self-rated tool, internationally validated used to measure patients own perception of their quality of life. Objectives This aim of this study was to assess self-reported quality of life in a complete National cohort of forensic in-patients, and ascertain the associations between quality of life and measures of violence risk, recovery and functioning. Methods This is a cross sectional study, set in Dundrum Hospital, the site of Ireland’s National Forensic Mental Health Service. It therefore includes a complete national cohort of forensic in-patients. The WHO-QuOL was offered to all 95 in-patients in Dundrum Hospital during December 2020 – January 2021, as was PANSS (Positive and Negative Symptoms for Schizophrenia Scale). During the study period the researchers collated the scores from HCR-20 (violence risk), therapeutic programme completion (DUNDRUM-3) and recovery (DUNDRUM-4). Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). Results Lower scores on dynamic violence risk, better recovery and functioning scores were associated with higher self-rated quality of life. Conclusions The quality of life scale was meaningful in a secure forensic hospital setting. Further analysis will test relationships between symptoms, risk and protective factors and global function. Disclosure No significant relationships.

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Wright, Brenda, Dearbhia Duffy, Katherine Curtin, Sally Linehan, Stephen Monks, and Harry G. Kennedy. "Psychiatric morbidity among women prisoners newly committed and amongst remanded and sentenced women in the Irish prison system." Irish Journal of Psychological Medicine 23, no. 2 (June 2006): 47–53. http://dx.doi.org/10.1017/s0790966700009575.

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AbstractObjectives: To estimate the prevalence of psychiatric morbidity, substance misuse problems and related health and social problems among women prisoners newly committed and a cross-section remanded and sentenced in the Irish prison population. In 2002 women represented 10.7% (1043) of all persons committed to the Irish Prison system, and 3.3% (104) of the daily average number of persons in custody. We surveyed psychiatric morbidity in these two groups to assess the need for psychiatric services for women prisoners, and to compare Irish morbidity with an international average.Method: We interviewed 94 newly committed women prisoners within 72 hours of committal, representing approximately 9% of female committals per year. We also interviewed a cross sectional sample of 92 women, representing approximately 90% of all women in custody. Mental illness and substance misuse was measured using the SADS-L, SODQ and a structured interview.Results: Five (5.4%) of the committal and 5 (5.4%) of the cross-sectional sample had a psychotic illness within the previous six months. 8 (8.5%) of the committals and 15 (16.3%) of the women in the cross-sectional sample had a major depressive disorder in the last six months. 8 (8.6%) committals and 14 (15.2%) in the cross-sectional sample had an anxiety disorder within the last six months. 61 (65.6%) of the women interviewed at committal and 61 (65.2%) of the cross-sectional sample had a substance misuse problem in the last six months.Conclusions: There is a high prevalence of mental illness and substance misuse problems amongst women newly committed to prison and in a cross section of those remanded or sentenced in prison in Ireland. We found evidence of a cycle of deprivation and institutionalisation. These findings highlight the need for the integration of community and forensic psychiatric services, and for ongoing collaboration with drug services.

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Wahab, Afwan Abdul, Calvin Har, Sarah Casey, Hugh Ramsay, Brendan McCormack, Niamh Mulryan, Anita Ambikapathy, and Anthony Kearns. "Forensic mental health intellectual and developmental disability service: an analysis of referral patterns and comparison with community mental health intellectual disability (MHID) services in Ireland." Advances in Mental Health and Intellectual Disabilities, November 1, 2023. http://dx.doi.org/10.1108/amhid-06-2023-0020.

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Purpose The purpose of this study is to analyse the characteristics of all the referrals to the forensic MHIDD service over the past five years and to compare these characteristics to the cohort of service users attending the three general MHID services based in Dublin which are Service 1, Service 2 and Service 3. Design/methodology/approach This is a cross-sectional study of adults attending the three generic MHID services and the national forensic MHIDD service. The medical files of service users attending the MHID services were reviewed, and data such as age, gender, level of intellectual disability and psychiatric diagnoses were extracted and compiled into a database. The forensic MHIDD service has since its inception maintained a database of all referrals received and reviewed. The characteristics data needed were extracted from the forensic MHIDD database. All these data were then analysed using the Statistical Package for Social Sciences (SPSS). Findings The majority of the three MHID service users were in the moderate to profound range of intellectual disability, while the majority of the cases assessed by forensic MHIDD had normal IQ, borderline IQ and mild intellectual disability with 66.1%. The prevalence of neurodevelopmental disorder, schizophrenia and emotionally unstable personality disorder in the forensic MHIDD is comparable to the three MHID services. The prevalence of depression, bipolar affective disorder (BPAD), anxiety disorder and obsessive-compulsive disorder (OCD) is higher in the three MHID services than in the forensic MHIDD service. Originality/value The FHMIDD received referrals at a greater level of overall ability, with two-thirds of the service users having mild intellectual disability to normal IQ. The prevalence of neurodevelopmental disorder such as ASD and schizophrenia is comparable between the forensic MHIDD and the three MHID services. There is a higher prevalence of depression, BPAD, anxiety disorder and OCD in the three MHID services as compared to the forensic MHIDD service.

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