Crime and Punishment (Scotland) Act 1997: a survey of psychiatrists' viewsconcerning the Scottish 'hybrid order'

The Crime and Punishment (Scotland) Act 1997 introduced the hospital direct ion, Scotland's 'hybrid order'; so called because it allows the courts simu ltaneously to send a mentally disordered offender to hospital and to impose a prison sentence, to be completed after hospital discharge. Similar legis lation has been introduced in England and Wales for offenders with psychopa thic disorder, but the Scottish legislation applies to all legal categories of mental disorder. There was opposition to the introduction of the hospit al direction from psychiatrists in Scotland. In this survey psychiatrists e ngaged in forensic work in Scotland were identified (N = 51). Respondents ( n = 41) completed a decision-making exercise based on fictional case-Vignet tes, designed to elicit their attitudes towards hospital directions. The ma jority of respondents favoured the introduction of a hospital direction (n = 29). It was felt to be useful in cases where personality disorder coexist ed with mental illness which was brief, drug-induced or not related to offe nding. It was not felt to be useful in cases of antisocial personality diso rder alone. However, there mere concerns about the working of the new legis lation: whether it would be used appropriately by courts and whether psychi atrists should recommend a disposal that includes imprisonment.