Community forensic psychiatry

Abstract

Recent developments in mental health care have seen services move from their institutional settings into the community. Along with a range of specialist and non-specialist mental health services that have evolved, community forensic mental health teams (CFMHTs) have been established in many parts of the UK. While the evidence base for cost-effectiveness and better efficacy of specialist teams over generic teams is still being questioned, two main models of community forensic services have evolved: the ‘integrated’ model where specialists work as part of the community mental health teams, and the ‘parallel’ model, where they work as a separate service alongside community mental health teams. These teams offer risk assessments and advice for sector teams, case manage patients, offer court liaison and diversion schemes and are involved with Multi-Agency Public Protection Arrangements (MAPPA). As specialists they have smaller case-load sizes, which enables them to work more effectively with patients with complex problems. They perform risk assessments with a combination of clinical and actuarial components. The staff also deliver a range of treatments to reduce the risk of violence from mentally disordered offenders. Forensic clinicians in the community have an ethical dilemma of offering empathic and patient-centeed care in an intrinsically coercive environment, and have a duty to protect the public from violence from mentally ill patients. Research into health care delivery systems and interventions to reduce violence are needed in community forensic mental health.