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This study is an attempt to identify and examine patients with index offences (IOs) relating to homicide or attempted homicide within a particular high-security hospital. This audit aims to provide a better understanding of these patient groups in order to promote and tailor the psychotherapeutic groups that exist for these patient cohorts. It is our view that shorter stays could be linked to higher reoffending rates, highlighting the need to further treat these patients the first time as a matter of public safety. These findings support the principle: do it once, and do it well.