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The need for age-appropriate forensic services

Published online by Cambridge University Press:  02 January 2018

Pratish B. Thakkar
Affiliation:
Tees, Esk and Wear Valleys NHS Foundation Trust, Ridgeway, Roseberry Park Hospital, Middlesbrough TS4 3AF, email: pratish.thakkar@tewv.nhs.uk
Ipsita Ray
Affiliation:
Tees, Esk and Wear Valleys NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough
Laavanya Damodaran
Affiliation:
Tees, Esk and Wear Valleys NHS Foundation Trust, Roseberry Park Hospital, Middlesbrough
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Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2012

Dr Connolly has rightly pointed out that planning for the development of mental health services requires an understanding of the changing demographics in the country. Reference Connolly1 We feel every directorate within psychiatry will need to prepare for the demographic transition through thoughtful planning in service development that can provide quality as well as appropriate care to the elderly. Within forensic services, serious thought should be given to development of geriatric forensic service.

Traditionally, it is believed that there is a low crime rate in the elderly. However, studies have shown that there is an increase in criminal behaviour among those 60 or over, Reference Fazel, Hope, O'Donnell and Jacoby2 and the number of people in prison over the age of 60 has grown from 1.3 to 2.4% in England. 3

A study by Needham-Bennett et al concluded that there is a high prevalence (28%) of psychiatric disorders in alleged offenders in the community aged 60 years and over. Reference Needham-Bennett, Parrott and MacDonald4 Studies done in the prison populations have shown that the prevalence of psychiatric disorders among remanded male prisoners aged 55 years and over was 50% Reference Taylor and Parrott5 and in sentenced male prisoners 53%. Reference Fazel, Hope, O'Donnell and Jacoby2

Moreover, up to a half of elderly offenders with psychiatric disorders have a physical illness. In addition, they may have visual impairment, auditory impairment, mobility problems and cognitive impairment. Currently, forensic mental health units with long-term rehabilitation wards provide care for elderly individuals. This longer-term admission is usually due to ongoing risks combined with difficulties in rehabilitating this patient group because of ‘institutionalism’ or ongoing mental health issues. We wondered whether such units were equipped to be able to deliver care for older individuals with increasing physical comorbidities or those who develop certain organic conditions such as dementia. Another issue that needs consideration is the use of risk assessment tools such as Historical Clinical Risk Management 20 (HCR-20) in the older age group in forensic units that are generally used for working-age individuals. It is our view that the current psychological treatment programmes such as the sexual offending treatment programme will need modifications for this client group.

We feel that the complex needs of elderly mentally disordered offenders appear to fall within the domains of geriatric psychiatry services and forensic psychiatry services, but they may not be met by either service alone. Consideration should be given to setting up specialist tertiary forensic geriatric psychiatry. There has been some initiative in the independent sector in this matter.

References

1 Connolly, M. Futurology and mental health services: are we ready for the demographic transition? Psychiatrist 2012; 36: 161–4.Google Scholar
2 Fazel, S, Hope, T, O'Donnell, I, Jacoby, R. Hidden psychiatric morbidity in elderly prisoners. Br J Psychiatry 2001; 179: 535–9.CrossRefGoogle ScholarPubMed
3 Home Office. Prison Statistics England and Wales 2002. Home Office, 2003.Google Scholar
4 Needham-Bennett, H, Parrott, J, MacDonald, AJD. Psychiatric disorder and policing the elderly offender. Crim Behav Ment Health 1996; 6: 241–52.CrossRefGoogle Scholar
5 Taylor, PJ, Parrott, JM. Elderly offenders. A study of age-related factors among custodially remanded prisoners. Br J Psychiatry 1988; 152: 340–6.Google Scholar
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