Evaluation of a psychiatric court liaison scheme in north LondonBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7056.531 (Published 31 August 1996) Cite this as: BMJ 1996;313:531
- Nick D Purchase, forensic social work managera,
- Alison K McCallum, senior lecturer in public health medicineb,
- Harry G Kennedy, consultant forensic psychiatrista
- a North London Forensic Psychiatry Service, Camlet Lodge, Enfield Community Care Trust, London EN2 8JL,
- b Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London NW3 2QG
- Correspondence to: Mr Purchase.
- Accepted 22 March 1996
Court diversion schemes were established to ensure that people with mental illness who are brought before the courts obtain appropriate care from health and social services.1 In July 1993 a psychiatric court liaison scheme, one of about 300 in England and Wales, was established at Tottenham Magistrates' Court in north London to cover two boroughs, or one health authority. We evaluated the outcome for all defendants attending the scheme over 18 months.
Subjects, methods, and results
Between July 1993 and December 1994, 104 defendants were seen. We report the data on the 89 local residents. Subjects were monitored by address, postcode, age, ethnic origin, previous contact with psychiatric services, criminal record, and offence. Their outcomes were measured against the rate of discharges of inpatients from the local psychiatric hospitals. The mean age of those referred was 33.1 (SD 10.9) years (range 18-67); 80 were men.
Of 87 patients with full information on accommodation, 16 were homeless, eight being in temporary accommodation. Of the remainder, 68 were owner occupiers or tenants, one lived in a mental health hostel, and one was a traveller and did not consider himself homeless. Homeless people were no more likely to be admitted to hospital than were those who had homes. All those in temporary accommodation had local links and were not temporary residents.
The principal offence was classifiable in 86 of the 89 cases—namely, a public order offence (20 subjects), a property or driving offence (20), violence towards a person (26), a sexual offence (12), and arson (8). Schizophrenia was the most common diagnosis (29 subjects), followed by major affective disorders, mostly mania (22); organic mental illness, predominantly alcohol related disorder (13); neurotic disorders (8); and learning difficulties (2). Fifteen subjects had no mental illness. In addition, 12 subjects misused alcohol alone and nine cannabis, while 29 subjects misused several substances. Those with schizophrenia were more likely to be admitted to hospital (χ2 = 15.9, P<0.003), while those with no mental illness were less likely to be admitted (P<0.002). There was no association between ethnic group and likelihood of admission. Nineteen of the 89 subjects were unknown to the psychiatric services. The rest had received inpatient psychiatric care. All of those with a psychiatric history would have been eligible for inclusion in the supervision register (43 subjects had a history of violence and 61 had been previously convicted) (table 1).
Fifty four patients were admitted to hospital, of whom 36 had been discharged less than a year before. A further 17 were given outpatient appointments for the local services. All admissions were formal and all those admitted were psychotic. The 36 readmissions within a year of discharge through the court diversion scheme can be expressed as 11.5 per 1000 discharges per year. The total of 54 admissions yields a rate of 16.4 per 1000 discharges per year.
Subjects presenting to the court diversion scheme were local residents committing offences locally. Although we expected that most would be homeless, temporary residents, or suffering from mental illness of recent onset, few were homeless and most who required hospital admission were previously known to local services. Despite their vulnerability, none of those previously known to the local services was receiving ongoing care and few were receiving intermittent care. Better formalisation of multidisciplinary care plans2 and supervision registers and close monitoring by community supervision3 may result in a substantial improvement in the health and social functioning of this group.
Funding The court diversion scheme was established with funding from the Home Office and subsequently in contract with Enfield and Haringey Health Agency.
Conflict of interest None.