Forensic psychiatry

Forensic psychiatry is a sub-speciality concerned with the assessment and treatment of mentally disordered offenders. A large part of the work of forensic psychiatrists is the assessment of people held at various stages of the criminal justice system, which is portrayed in Figure 1. They may also be asked to assess patients under the care of general psychiatric services who are thought to be at high risk of committing an offence. In some areas, there are community forensic psychiatry teams that work with psychiatric patients likely to commit criminal offences.

Fig. 1 Pathways through the criminal justice system.

Forensic psychiatrists also provide inpatient care in conditions of high, medium or low security. Until 1980, the main provision for forensic inpatient treatment in England and Wales was in three Special Hospitals which provided psychiatric care in conditions of high security. A series of scandals following revelations of security breaches and abuses emerged, and led to reform of the way inpatient care was delivered, and a move towards treating mentally disordered offenders in Regional Secure Units, which provide conditions of medium security. Patients are either admitted to these directly, or are transferred there from one of the High Secure Hospitals when they no longer require this level of security. Regional Secure Units have the advantage of keeping patients closer to their family and friends and, because they are much smaller than the High Secure Hospitals, have fewer of the problems associated with large institutions. They are also able to work more closely with the local psychiatric services in their region, which makes it safer and easier to transfer the care of patients who no longer require conditions of medium security.

A minority of patients in Regional Secure Units and Special Hospitals are referred directly from district psychiatric units rather than the criminal justice system. These are patients whose risk to themselves or others cannot safely be managed within their local psychiatric hospital.

Diversion of mentally disordered offenders

The need for forensic psychiatry is based on two important principles. The first is that if someone commits a crime because of a mental disorder, then treatment of the mental disorder is in the best interests of the individual and society. Table 1 summarises the common ways in which mental disorder leads to crime. Secondly, imprisonment usually exacerbates mental disorder and reduces the chance of rehabilitating the offender, and may result in unnecessary suffering. Therefore, it is often best for mentally disordered offenders to be dealt with by psychiatrists rather than remain within the criminal justice system. The process of getting them out of the criminal justice system is usually referred to as diversion of mentally disordered offenders.

Table 1 Crimes associated with certain mental disorders

Disorder	Offence	Reasons
Schizophrenia	Low rate of violence and homicide, but more likely than in general population	Secondary to delusions and hallucinations Frustration caused by negative symptoms More likely to be caught
	Acquisitive offences	Difficulty shopping and organising finances caused by negative symptoms Poverty due to social drift
Mania	Violence (usually minor), reckless driving, deception, inappropriate sexual behaviour	Disinhibition Impaired judgement Grandiosity
Depression	Homicide/infanticide, victims usually family members; often followed by suicide	As a result of guilt and hopelessness, may believe family need protecting or putting out of their misery When depression caused by dysfunctional relationship, tension and frustration may lead to violence and homicide
	Shoplifting	Poor concentration and memory Fear of being caught can lead to temporary alleviation of low mood
‘Cluster B’ personality disorders	Increased rate of violence, arson, sexual offences and acquisitive offences	Disregard for feelings of others < div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Mood stabilisers and ECT Old age psychiatry I Diagnosis and classification of schizophrenia Anxiety disorders – clinical presentation and aetiology Old age psychiatry II Personality disorders – introduction and classification Stay updated, free articles. Join our Telegram channel Tags: Psychiatry An Illustrated Colour Text Jul 12, 2016 \| Posted by admin in PSYCHIATRY \| Comments Off on Forensic psychiatry Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access