The Bridgewater 100: an analysis of admissions to a hospital for the criminally insane.

One hundred admissions to a hospital for the criminally insane are reviewed. Within this sample 20% were referrals from psychiatric hospitals and 30% were transferred from prison. The remainder were referred from the courts for evaluations. In 44 cases this was for an evaluation of competency to stand trial and in 6 cases the referrals were for evaluation prior to sentencing. An analysis of the subgroups and individual cases indicates that mentally ill patients are often referred to facilities for the criminally insane because the appropriate wards do not exist within the mental health system. This exposes them to a criminal population and results in negative social labelling. A large proportion of those referred from prisons have consciously manipulated their transfer in order to do "soft time". This also confers on them future advantage by virtue of being labelled more mental than criminal. The majority of those referred for competency evaluations could easily have been assessed in a non-inpatient setting. In these cases the referral appeared to be a covent request for treatment or a legal maneuver. Methods for solving these problems are briefly discussed.