Editor—Offending by psychiatric patients is of great public concern, and offending by former patients in medium secure units who are, or should be, receiving psychiatric supervision in the community is particularly interesting. The paper by Maden et al, although a welcome addition to the literature, obscures important aspects of the issue by its brevity.1
Previous studies have reported only a quarter of discharges from medium secure units as being directly into the community.2,3 The commonest discharge location was non-secure psychiatric wards, and about a third of patients were discharged to prison or other secure psychiatric units. The opportunities for offending and the likelihood of violence leading to a conviction vary widely between these settings, with those in the community more likely to gain convictions. This makes an overall rate of conviction difficult to interpret.
Conviction data from the offenders' index also need to be used with caution. Previous studies have reported 20% discrepancies between these data and clinical records.4,5 The use of multiple data sources including the offenders' index, clinical records, and national computer records from the police is recommended.4
The two year rate of conviction for violent offences among former patients from medium secure units in the community is likely to be higher than the 6% implied. This is because of greater opportunities to offend, more likelihood of offending resulting in conviction, and underestimates of offending because a single data source is being used. This has implications for both risk management and allaying public concern.
Competing interests: None declared.
References
- 1.Maden A, Scott F, Burnett G, Lewis GH, Skapinakis P. Offending in psychiatric patients after discharge from medium secure units: prospective national cohort study. BMJ 2004;328: 534. (26 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Maden A, Rutter S, McClintock T, Friendship C, Gunn J. Outcome of admission to a medium secure psychiatric unit: I. short- and long-term outcome. Br J Psychiatry 1999;175: 313-6. [DOI] [PubMed] [Google Scholar]
- 3.Ricketts D, Carnell H, Davies S, Kaul A, Duggan C. First admissions to a regional secure unit over a 16-year period: changes in demographic and service characteristics. J Forensic Psychiatry 2001;12(1): 78-89. [Google Scholar]
- 4.Jamieson E, Taylor PJ. Follow-up of serious offender patients in the community: multiple methods of tracing. Int J Methods Psychiatr Res 2002;11: 112-24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Edwards J, Steed P, Murray K. Clinical and forensic outcome 2 years and 5 years after admission to a medium secure unit. J Forensic Psychiatry 2002;13(1): 68-87. [Google Scholar]