79% were men, 52% of whom had never been in an intimate relationship. Forty-three percent had an Axis I diagnosis: 30% had delusional disorders, 10% had schizophrenia, 1% had bipolar disorder, 1% had major depression, and 0.5% percent had an anxiety disorder. Fifty-one percent had a primary diagnosis of personality disorder; most were in the cluster B category.

Harmon and others examined 48 individuals charged with harassment and referred for forensic psychiatric evaluation (10). Of these individuals, 38 had psychotic disorders, with delusional disorder being the most frequent diagnosis. The authors point out that the criminal justice system has difficulty in dealing with this type of patient. Criminal penalties are seldom severe, with the incarceration option rarely used. This study found that restraining orders were frequently ignored, with 22 of 48 (46%) being violated.

In the present study, we examined the behaviour of psychiatric patients prior to admission, as documented in the clinical file, to determine whether they had engaged in criminal harassment as defined in the Criminal Code of Canada (Note 1) and if so, to determine whether they were charged with that, or any other, offence.

In view of a reported association between substance abuse and stalking (11), we also wanted to determine whether substance misuse was associated with this behaviour in our patients.

Method

This study was a retrospective casenote review of all patients on the acute and forensic units at a provincial psychiatric hospital on a single day chosen at random. Data gathered from the patients’ charts included primary diagnosis, history of alcohol or drug abuse, history of violence or overt threats, and incidents wherein the patient had harassed another person or persons, according to criminal code criteria. Based on the file

information, the first author then made a clinical judgement whether substance abuse had been a factor directly relating to the present admission. Data was entered into an Epi Info databas (12) and analyzed using chi-square.

Results

A total of 106 charts were examined (39 female, and 67 male patients). There were 49 forensic patients and 57 acute-program patients.

Eight patients were found to have harassed another person or persons; 6 were forensic patients, and 2 were acute-program patients. Both of the acute-program patients, and 2 of the 6 forensic patients, were women. Although criminal charges preceded the patients’ admissions in 6 of the 8 cases, only 1 was charged under section 264 (4).

The primary diagnoses for harassers were paranoid schizophrenia,  bipolar disorder, and schizoaffective disorder. The types of harassment and diagnoses are shown in Table 1, with repeated communication and threatening conduct being present in most cases (6 of 8).

Of 106 patients, 49% (n = 52) had a history of alcohol abuse, and 36% (n = 38) had a history of drug abuse. There was considerable overlap of drug and alcohol abuse in these patients, with 34% (n = 36) having a history of both. Forensic patients were significantly more likely to be identified as having a history of alcohol abuse (35 of 49, or 71.4%, compared with 17 of 57, or 29.8%; P < 0.05). Forensic patients were also significantly more likely to have a history of drug abuse (27 of 49, or 55.1%, compared with 11 of 57, or 19.3%; P < 0.05).

In forensic cases, alcohol abuse was identified as being directly related to the index offence for only 4 patients (11%). Drug abuse was identified as playing a role in only 1 case. Of the 8 patients who had harassed, 5 had a history of alcohol abuse, and 3 of these also had a history of drug abuse. Alcohol was directly related to admission for only 1 harasser.