The State Hospital Survey: A description of psychiatric patients in conditions of special security in Scotland

The State Hospital, Carstairs, is the maximum security psychiatric facility for Scotland and Northern Ireland. This study describes the cohort of patients there (N = 241) between 1992 and 1994. Case-notes were examined to ascertain demographic details and information on psychiatric, medical, drug, forensic, family and personal histories. Diagnoses were made by application of the St Louis criteria. Standardized interviews were held with each patient and the responsible medical officer. Patients were on average 34 years old and had spent 9 years in psychiatric hospitals. There were 169 (70.1%) who had a principal diagnosis of schizophrenia. Approximately half were admitted following an offence and over 80% had a history of criminal activity. Physical health problems were present in more than 50% of patients. Adverse childhood events of diverse kinds were frequently reported. Psychotic symptoms continued to occur in many patients despite extensive treatment. More than half were said not to require the full security of the State Hospital. It was concluded that these patients represent a severely ill and relatively young population, and are likely to require substantial care in the future. A range of secure facilities needs to be developed in Scotland so that patients are held in the minimum appropriate degree or security.