Mentally disordered offenders with a history of previous head injury: are they more difficult to discharge?

Primary objectives : To identify the incidence of head injury (HI) amongst mentally disordered offenders (MDOs) in UK medium secure units (MSUs) and test the hypothesis that patients with a history of HI are more difficult to discharge than patients without HI. Design, methods and procedures : One hundred and thirteen MDOs being discharged to community settings from five MSUs in England were recruited consecutively between 1 April 1999 and 31 December 2000. Data on previous HI, offending history and discharge planning were collected from clinical casenotes, structured questionnaires and interviews with clinical staff. Main outcomes and results : More patients with HI (57.4%) than patients without HI (47%) had a violent index offence. Risk assessments carried out prior to discharge showed patients with HI to be at greater risk of violence to others and of self-harm than patients without HI ( p &#104 0.05). All but two patients in the HI group were difficult to discharge (43, 95.6%), compared to 52 (82.5%) in the non-HI group. Conclusions : Information on previous HI should be collected on admission to MSUs and considered when planning for discharge.