Race, restriction, risk and reconviction: findings from an England and Wales medium secure cohort

Over-representation of Black people in psychiatric hospital admissions is a long-standing issue; it is unknown whether this group is also at increased risk for discretionary restrictions that extend legal control after leaving hospital. Regression modelling explored associations between restriction order status, reoffending likelihood, index offence severity (violent/non-violent), psychosis, drug abuse and alcohol abuse. Models were generated for Black versus White medium secure patients discharged from all English and Welsh medium secure services during 1997/8. Black people were restricted more often than the White group. Restricted status was anchored on psychosis and violent index offence in the White group, but on psychosis and history of drug problems in the Black group; reconvictions were indistinguishable between the groups. Racial differences reflected the influence of stereotypes on medico-legal decision-making. These findings resonate with the recognised need for legislative reform and provide a template for identifying subtle (but important) forms of systemic racism.