Crime and Punishment (Scotland) Act 1997: A survey of psychiatrists' views concerning the Scottish 'hybrid order'

The Crime and Punishment (Scotland) Act 1997 introduced the hospital direction, Scotland's 'hybrid order'; so called because it allows the courts simultaneously to send a mentally disordered offender to hospital and to impose a prison sentence, to be completed after hospital discharge. Similar legislation has been introduced in England and Wales for offenders with psychopathic disorder, but the Scottish legislation applies to all legal categories of mental disorder. There was opposition to the introduction of the hospital direction from psychiatrists in Scotland. In this survey psychiatrists engaged in forensic work in Scotland were identified (N = 51). Respondents (n = 41) completed a decision-making exercise based on fictional case-vignettes, designed to elicit their attitudes towards hospital directions. The majority of respondents favoured the introduction of a hospital direction (n = 29). It was felt to be useful in cases where personality disorder coexisted with mental illness which was brief, drug-induced or not related to offending. It was not felt to be useful in cases of antisocial personality disorder alone. However, there were concerns about the working of the new legislation: whether it would be used appropriately by courts and whether psychiatrists should recommend a disposal that includes imprisonment.