Expert answers from
Forensic mental health services
- What are forensic mental health services?
- How are people referred to forensic mental health services?
- Liaison and diversion services
- Different types of forensic services
- Specialist staff
- Supporting families
- What happens when people are discharged from forensic mental health services?
Forensic mental health services are specialist services for people who have a mental health problem who have been arrested, who are on remand or who have been to court and found guilty of a crime. ‘Forensic’ means ‘pertaining to the law’.
These services are an alternative to prison for people who have a mental health problem and offer specialist treatment and care. They are ‘secure’ units, which means that people who are referred there are not free to come and go. Most people are detained in secure forensic services under mental health legislation.
The time spent in forensic units depends on an individual’s recovery and progress towards rehabilitation. Professionals who work in forensic mental health services take decisions about length of stay in collaboration with the professionals who will be responsible for an individual's support and care following discharge. If someone has been found guilty of a violent offence, or has been considered to be dangerous, the Ministry of Justice and Parole Board are involved in decisions about discharge.
Not everyone who has a mental health problem and comes into contact with the police or the courts will be referred to forensic services. Many people who have offended do get sent to prison. However, the government recognises that prisons do not offer the best treatment and care to people who have mental health problems, and is introducing services and training to make sure people are ‘diverted’ from the criminal justice system to forensic services as early as possible (see Liaison and diversion services below).
People with mental health problems can be transferred to forensic health services at the time of arrest, during court proceedings, or when they are in prison. They may be referred while they are on remand and waiting trial. A referral is usually made following an assessment of an individual’s needs, or a psychiatric report.
Under Section 37 of the Mental Health Act, a court can rule that someone convicted of an offence should be detained in hospital to receive treatment instead of being sent to prison. If the courts are concerned that an individual poses a risk to others, Section 41 allows a restriction order to be added to the Section 37. The Ministry of Justice closely monitors patients who are under restriction orders. They cannot be transferred to another hospital, or given leave, for example, or released without consent from the Ministry of Justice.
Section 47 of the Mental Health Act is used to transfer a convicted prisoner to hospital for treatment and Section 48 is used to transfer a prisoner on remand to forensic mental health services.
Research has shown that prison is not the right place for people who have a severe mental illness. Being put in prison can make their mental health problem worse and increase the risk of self-harm and suicide.
This government supports (and previous governments have supported) a policy of ‘diversion’. The aim of diversion is to make sure someone who has a mental health problem who has committed a crime has access to specialist assessment and treatment before they even get to court or have to spend time in custody – either after arrest, or on remand.
Lord Bradley’s Review of people with mental health problems or learning disabilities in the criminal justice system (2009) recommended that all police stations and courts should have access to ‘liaison and diversion services’ to make sure people who have a mental health problem or learning disability who have offended are ‘diverted’ from the criminal justice system to more appropriate health services.
The aims of liaison and diversion services are:
• to help make sure people are assessed properly;
• to make sure that people who have a mental health problem can be referred to forensic services if they are arrested and charged rather than spending time in custody on remand;
• to provide information to courts about people’s mental health problems;
• to make sure people who are arrested but not charged are referred to mental health services.
Liaison and diversion services do exist but the sort of service varies and they are not yet available everywhere.
The government has committed to setting up liaison and diversion services in all courts and policy custody suites across England by 2014. The 'Offender Health Collaborative', led by the charity Nacro and including the Centre for Mental Health and the NHS Confederation's Mental Health Network, is helping to determine the best way of running and developing a national liaison and diversion service.
There are three levels of security within forensic units – high, medium and low.
There are three high secure hospitals – Ashworth, Broadmoor and Rampton. People referred to one of these hospitals are detained under mental health legislation because they are thought to pose a ‘grave and immediate danger to the public.’ Each of these hospitals is part of an NHS trust.
Medium secure hospitals/units are for people who are detained under mental health legislation and pose a serious danger to the public. They are run by either the NHS or by private healthcare organisations. There are special women-only medium secure forensic units.
Most people transferred from court or prison are initially sent to medium or high secure units.
Low secure units are run by either the NHS or by private healthcare organisations. People who have already spent some time in a medium secure unit may be transferred onto a low secure unit before they are discharged back into the community. Sometimes, people who have never been involved with the criminal justice are admitted to one of these units when they are detained under the Mental Health Act as an involuntary patient.
Staff who work in forensic mental health services have special training that helps them offer appropriate treatment and support to people who have a mental health problem who have committed an offence. The treatment they offer focuses on an individual’s offending behaviour as well as their mental health problem. Specialist staff – including psychologists, psychiatrists, nurses, occupational therapists and social workers – work towards reducing the risk of re-offending, rehabilitation and recovery.
Staff who work in forensic services are trained in security and risk assessment, but they are first and foremost mental health professionals.
Family members of people with mental health problems who have committed an offence may feel ashamed and stigmatised. The mental health professionals responsible for your relative’s treatment and care should be available to answer questions and offer family members support, or there may be a support group for family members available at individual units.
However, forensic services vary in the support they offer to family members.
A research project surveyed 68 medium and low secure forensic units in England and Wales and asked them about what sort of services they offered to family members. The survey asked about visiting arrangements for families and children, for example. Support was available in 63 per cent of the units, and three of them employed dedicated carer support workers. 40 per cent said they were planning to introduce support services for family members. The majority had visitors’ rooms and all but one unit had a policy governing visiting time for children. Just over a quarter had a carers’ support group, and just over a quarter offered family therapy for carers and families.
Most of the units were accessible by public transport. Nevertheless, people are often admitted to forensic services that are far from home and family members may have to travel long distances to see a relative.
There is advice for family members of people who are spending time in forensic units in a leaflet produced by the Partners in Care campaign (run by the Royal College of Psychiatrists and the [then] Princess Royal Trust for Carers [now part of Carers Trust]). This recommends regular contact with the specialist team responsible for your relative’s care. It also recommends finding out about visiting arrangements because they will vary between different forensic units. Visitors may have to book in advance and show identification, and there will be security checks.
You can get a copy of this leaflet by visiting the Royal College of Psychiatrists’ website.
The mental health professionals responsible for people’s care and treatment within the forensic mental health service will liaise with community-based mental health teams who will be responsible for supporting an individual when they are discharged. Some areas have specialist community-based forensic mental health teams that can offer support.
Many people who have been discharged from forensic mental health services will be eligible for free aftercare services under Section 117 of the Mental Health Act. This could include accommodation.
When people leave forensic services, it may be difficult at first to adjust to an independent life, particularly if someone has been on a secure unit for some years.
A package of support to meet each person's individual needs should be discussed and arranged before an individual leaves forensic services. Family members should be should be consulted when plans are being made to discharge their relative from the care of a forensic unit.
This page was last updated 17 April 2013
Links on this page last checked: 31 July 2014
Next links check due: December 2014
Other useful websites
Royal College of Psychiatrists: Quality Network for Forensic Mental Health Services