Reports reveal an increase in the number of individuals with serious mental illness in jails, prisons and forensic hospitals. Despite the wide-ranging and devastating consequences of this 'criminalization' of mental illness, there remains a lack of information on the subject as well as on the provision of care for these patients. This important new book fills a gap in the literature by examining topics such as: the history and policy factors related to criminalization; original research on forensic populations; pharmacological and psychological treatment strategies; and principles and guidelines for diversion out of the criminal justice system.
Community Forensic Psychiatric Services in England and Wales
Richard Latham and Hannah Kate Williams
This paper is intended to provide a summary and commentary on the extent of community services for mentally disordered offenders in England and Wales. Our focus on England and Wales is because the different countries of the United Kingdom have devolved legislative and administrative powers so that this paper would – by necessity if a United Kingdom paper – be three times as long so as to include Scottish and Northern Irish law, practice, and policy; Wales is considered alongside England as the two countries are sufficiently similar. We have interpreted “community services” broadly and have included descriptions of court liaison and diversion services, and multiagency risk management services. In other words, we have described, in some form, all of the services that are in place to manage mentally disordered offenders after they have been released from prison, discharged from hospital, or diverted from either form of custody to the community.
As in all jurisdictions, the issue of mentally disordered offenders is on the agenda of “justice” and “health,” both in political terms and for professionals providing services. Where we refer to forensic community mental health teams, we are describing health services; almost exclusively NHS services. Court and probation services are part of the justice system. The more recent direction of travel has been towards jointly funded services – broadly speaking by the NHS and the National Offender Management Service (NOMS) – and the sharing of responsibility. This is particularly the case with children and young people and with adults with personality disorder.
Multidisciplinary community mental health teams are the backbone of general community psychiatry in England and Wales. Community psychiatry had its origins as early as the 1920s, but the large institutions dominated until much later in the century. More specialized community mental health teams1 have fallen in and out of fashion over the last 20 years, sometimes driven by research evidence.2 Assertive outreach teams have all but disappeared whilst early intervention in psychosis and crisis teams have shown more longevity. Specialist community forensic mental health teams are relatively young and underevaluated but are at the center of the services we have described below.