Forensic Mental Health Services

Forensic mental health services specialise in the assessment and treatment of people who may be mentally ill and are in the criminal justice system. However, people who are not going through the criminal justice system can also be referred to forensic mental health services if their behaviour is very challenging and cannot be managed elsewhere.

What are forensic mental health services?

These services are intended to see that people with severe mental illness who enter the criminal justice system get the mental health and social care they need. If this means they need to be in hospital, they may be transferred to a secure hospital or an ordinary psychiatric hospital.

This is known as 'diversion' - transferring people with severe mental illness out of the criminal justice system and into health and social care services.

young woman in an office talking to the doctor Forensic mental health services work in the community, police stations, courts and prisons.

Forensic mental health services quite often refer to secure hospitals.

There are different levels of secure hospitals; low, medium and high security:

The majority of people who have committed a serious criminal offence which would normally lead to a prison sentence will be admitted to medium, or occasionally high, secure facilities.
Very few people are admitted directly from the courts to low secure hospitals.
Low secure hospitals are usually for patients who display particularly challenging behaviour and who may have complex needs that cannot be effectively managed in local mental health services.

In some cases people are transferred down the levels of security before being discharged into the community.

How are people referred to forensic mental health services?

People can be referred to forensic mental health services by one of four ways:

Transfer from the police station to hospital for assessment after having been removed to a place of safety or having been arrested.
Transfer from the courts to hospital under the Mental Health Act for assessment and/or treatment or as an alternative to prison.
Transferred from prison, either whilst on remand (awaiting trial and not sentenced) or when sentenced (having been found guilty).
From a general psychiatric hospital or community mental health services if their behaviour is particularly challenging and cannot be safely managed elsewhere.

The majority of people in forensic mental health services are in medium secure facilities and almost all patients have been transferred from prison.

What facilities and interventions are there in secure hospitals?

In each hospital, an individual‟s treatment is organised by a multidisciplinary team comprising psychiatric, nursing, social work, psychology, occupational therapy and security staff. Regular case conferences are held and reviews of detention carried out.

Each individual patient will have their own treatment plan, depending on their individual needs and why they 3855 Older and younger women seated talking, appointment, meeting were transferred to a secure hospital. Day to day activities can include:

programmes focusing on offending behaviour
one to one or group therapy
activities to improve independence and social skills
education courses
leisure activities

Each patient will have a Responsible Clinician (RC) who is responsible for their care and treatment whilst in hospital. An RC will usually be the patient's psychiatrist. If a patient or their carer or relatives have any concerns over their care and treatment, it is best to speak with or write to their RC.

How is a patient discharged from a secure hospital?

How a patient is discharged from hospital depends on how they were referred to hospital and what section of the Mental Health Act they have been detained under.

Generally speaking, patients may be able to get discharged from hospital by:

their Responsible Clinician (usually their psychiatrist)
the Mental Health Act Managers (sometimes referred to as Hospital Managers, who make sure hospitals are using the Mental Health Act properly)
the Tribunal (an independent judicial panel who reviews whether a person should remain under section).

However, if a patient has a restriction order (section 41 or 49 of the Bird in the sky in daylight Mental Health Act) added to their hospital order, so making the section a 37/41, 47/49 or 48/49, they can only be discharged by:

the Secretary of State for Justice at the Ministry of Justice.

Some patients in forensic mental health services are under civil sections e.g. sections 2 or 3 of the Mental Health Act. They have different discharge procedures:

the majority of civil sections allow the patient's nearest relative to apply for discharge
the patient can also be discharged by their Responsible Clinician, Mental Health Act Managers or Tribunal.