Editorial: Criminality and psychiatric disorder.
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The results of a survey carried out at Rampton and Moss Side Special Hospitals into physical and behavioural incapacity associated with mental handicap are described and compared with the findings of the 1970 National Survey. The Special Hospital patients were found to be less mentally handicapped than similar patients in subnormality hospitals in the National Health Service. The prevalence of physical incapacity associated with mental handicap was also lower in the Special Hospitals but the Special Hospital patients were assessed as more behaviourally disordered. In both surveys the incapacities present were concentrated in the severely mentally handicapped patients. In the Special Hospitals survey the women, when compared with the men, were found to be more behaviourally disordered and to suffer from a greater degree of multiple severe incapacity. All the differences found between the two surveys are consistent with the statutory criteria for admission to a Special Hospital.
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To summarize briefly, it can be said that the new Patuxent admissions are approximately in the same age range, but more often black and from urban areas. The seriousness of their crimes is significantly higher than in the old Patuxent population. It may be said with some assurance that the change of the law has been a positive step towards making the Patuxent Institution a more treatment-oriented place, since there is no more mandatory indeterminate incarceration of persons unwilling to participate in the program. On the other hand, a number of persons who could eventually be reached by the prolonged stay at the Institution under the indeterminate sentence are now lost to the treatment process and they will be eventually released as potentially dangerous persons into society.
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The authors present clinical material to illustrate the special treatment and management problems posed by different types of mentally ill offenders; they suggest that court-mandated hospital treatment is often destructive and unrelated to the needs of the patient, the community, and the mental institution. The failure to create new kinds of institutions, combining modalities derived from the hospital and correctional systems, is traced to poor communication among the disciplines involved. The "mentally ill offender" is caught in the interplay of these systems and is consequently both their victim and victimizer.
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