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Scottish Head Injury Forum Head injury and offending

Scottish Head Injury Forum Head injury and offending. Dr Derek Chiswick Consultant Forensic Psychiatrist The Orchard Clinic Royal Edinburgh Hospital Derek.Chiswick@lpct.scot.nhs.uk. Head injury and offending: why?. personality change +/- cognitive impairment pre-injury features

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Scottish Head Injury Forum Head injury and offending

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  1. Scottish Head Injury ForumHead injury and offending Dr Derek Chiswick Consultant Forensic Psychiatrist The Orchard Clinic Royal Edinburgh Hospital Derek.Chiswick@lpct.scot.nhs.uk

  2. Head injury and offending: why? • personality change +/- cognitive impairment • pre-injury features • maladaptive behaviour patterns • impulsivity, self-centredness • sexual disinhibition • carer interactions • alcohol, drugs • secondary mental illness

  3. The head injured person in the criminal justice system • criminal justice system is not a treatment agency • but some offenders with mental disorders only obtain treatment through the criminal justice system

  4. What sort of offence? • any! • breach of peace and minor assaults • damage to property • crimes of dishonesty • more serious assaults • sexual offences • fire-raising • homicide

  5. Arrest • police action, discretion, arrest • police station • questioning, appropriate adult, charge • custody • medical examination • psychiatric assessment • fitness to be detained

  6. Court • representation • plea • bail • remand in custody • remand in hospital (where?) • psychiatric report: procurator fiscal • psychiatric report: solicitor

  7. Trial • fitness to plead • mental responsibility • diminished responsibility (murder only)

  8. Sentence • penal: e.g. prison, probation, CSO, fine, SD • treatment: e.g. condition of probation • hospital treatment: compulsory? security? conditions of detention?

  9. Problems: prison • not a treatment environment • nature of regimens • difficulty/ease of adaptation • victimisation • health care • epilepsy • visiting

  10. Problems: hospital • criteria for detention under MH(S)A 1984 • appropriate treatment • appropriate environment • staff skills • likelihood of improvement • unavailability of continuing care • community provision

  11. Summary • small group within a small group of offenders • problem or deficit may be missed • existing facilities usually unsuitable • few professionals with necessary experience • requirement for continuing (lifelong) care poorly provided (or acknowledged) in today’s NHS

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