Older adult patients subject to restriction orders in England and Wales: A cross-sectional survey

Abstract

A cross-sectional survey of patients aged 60 years and older subject to restriction orders in England and Wales identified a total of 282 patients, 6.5% of the total number of restricted patients of all ages. Serious and violent offending continued into older adult years among these highly selected and atypical patients. Patients born outside the UK were over-represented and accounted for 24% of patients in our study. A sample of 37 patients who committed index offences when aged 60 years and older was compared with a sample of 245 patients committing the index offences when younger than 60. The two groups were similar in terms of index offences and presence of past psychiatric history. Patients in the older group at index offence were significantly less likely to have had any previous convictions. Functional mental illnesses predominated in both groups; patients in the older group at index offence were significantly more likely to be diagnosed with delusional disorder, depressive illness, or dementia, while patients in the younger group at index offence were more likely to be diagnosed with personality disorders. In the former group, 75% of patients showed no evidence of cognitive impairment at assessment in hospital. Of the patients from both groups detained in conditions of high and medium security, 43% were awaiting transfer to conditions of lesser security. Whether current service provision can meet the complex care needs of older adult mentally disordered offenders, or whether improved integration of existing services or the development of specialist services will be necessary, requires further investigation and research.