Information was collected about 100 successive admissions to a regional secure unit for people with a learning disability (mental handicap). Most of the patients were males under the age of 30, with a mild or borderline learning disability. A majority also had a psychiatric disorder. The most common offences committed were sexual, arson and assault. After discharge, most patients returned either to the community or to a mental handicap hospital. A comparison of the first cohort of 50 admissions with the second cohort of 50 admissions showed that the unit had changed its admission policy and had increasingly admitted those with a mild or moderate learning disability referred by the courts. In addition, the average length of stay had doubled, and the number of admissions each year had halved. This reflects a lack of local facilities which can provide intensive supervision.

AbstractThere is no consistent pattern of services in England for people with a learning disability who offend or have severe anti‐social behaviours (‘mental impairment’). In one English health region, the mental impairment service comprises two residential units on hospital sites. The first of these (Unit A) operates as a medium‐secure unit, assessing and treating patients referred by the courts. The second (Unit B) has a lower level of security, and provides long‐term treatment for people with a mental impairment domiciled in its hospital's catchment area. Almost all the patients in the two units had mild learning disabilities, and substantial minorities had psychiatric and/or neurological disorders. A higher proportion of patients at the unit with the lowest level of security had psychiatric disorders and disturbed behaviour. This anomaly results from the lack of local mental impairment services throughout the region, which makes it difficult to discharge patients from Unit A. It is recommended that priority be given to the development of local mental impairment services rather then new medium‐secure assessment units.

A survey of 107 families of children with Rett syndrome was conducted to further define the behavioural phenotype. There was a high prevalence of behavioural and emotional problems, including episodes of anxiety (76 per cent), low mood (70 per cent) and self-injurious behaviour (49 per cent). Although there was no significant difference across the age-ranges studied, there was a tendency towards a reduction in these problems with increasing age, suggesting that the behavioural phenotype in Rett syndrome varies with age. Epilepsy occurred in over half the children, but there was no clear association with behavioural and emotional problems. A number of families had established strategies for coping with their child's anxiety and mood changes.