Psychosis in high-security and general psychiatric services: Report from the UK700 and special hospitals' treatment resistant schizophrenia groups

Background: Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services. Aims: To examine diagnostic and sociodemographic differences between high-security psychiatric service users from their peers in community services. Method: Two groups of patients with psychosis were compared: A national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services. Results: Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African-Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African-Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group. Conclusions: Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.