Characteristics, needs and reoffending in a group of patients with schizophrenia formerly treated in medium security

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Abstract
A cohort of 63 patients with schizophrenia formerly treated in medium security and discharged were followed up with case-notes and interview, up to 10 years later. Outcome variables studied included reconviction, reoffending behaviour, contact with psychiatric services, mortality, health and social needs, and patient satisfaction. Previously, the group had high levels of inpatient psychiatric care (86%), violent offending (68%), substance abuse (71%), alcohol abuse (29%), history of conduct disorder (48%) and periods in care (22%). At follow-up, 2 were dead (by suicide); of the remainder, 92% had retained links with psychiatric services, 30% had been reconvicted of at least one violent offence, and more than this proportion, again, had reoffended violently. Episodes of violent reoffending outnumbered violent reconviction by nearly 4:1. Most violence was ‘non-serious’. In terms of violence, comorbidity with conduct disorder or problem alcohol use doubled reoffending rates compared with schizophrenia alone, while young age or polydrug use or conduct disorder predicted increased reconviction rates by factors between 2 and 3; restriction orders reduced reconviction rates with a trend to reduced reoffending. Patients and staff disagreed over the level of help given to and needed by patients, who expressed a broad range of opinion, from satisfaction to dissatisfaction. It is concluded that adequate specialist forensic provision, the development of specialist services and proper implementation of the care programme approach may be apparent service solutions.