Survey of community forensic psychiatry services in England and Wales

Abstract

Background: Forensic psychiatry is one of the last specialist mental health services to develop a community orientation. In the UK community forensic mental health services have begun to develop, but little is known about how widespread these services are and which therapeutic models and organisational structures are used. Aims: To establish the number of community forensic teams in England and Wales and to describe their composition, workload and service model. Method: We identified all community forensic services in England and Wales. A postal questionnaire was sent to each team leader to obtain details of service provision. Information was requested on catchment area, location, staffing, caseload and referrals. Information was obtained on therapies offered (e.g. anger management) and on links with other agencies (e.g. bail hostels). We also gathered information on risk assessment tools, referral procedures and access criteria for the services. Results: Thirty seven services were identified; 26 (70%) responded to the survey. The majority of services covered a mixed urban/rural area and were based in regional secure units. Most (80%) services operated parallel to generic community mental health teams. Caseloads varied from 50 to 150 patients; individual caseloads from 6 to 24. All services offered risk assessment and case management, half offered anger management and cognitive behaviour therapy. Few services offered treatment for personality disorder, sex offenders or substance misuse. Conclusions: The survey demonstrates the variability in community forensic services across England and Wales. Most services provide comprehensive risk assessment but not specialized therapies to reduce offending behaviour. The survey highlights the need for service models to be evaluated in order to inform future service development.