Forensic psychiatry services

The future model for the organization of forensic psychiatry services is likely to be based upon an expansion of regional facilities with some increase in medium-secure beds linked to long-term medium-secure facilities, as suggested above. Although a gradual transfer of high-security units to new regional high-security facilities of 200 to 250 beds has been recommended and many support a regional grouping of all forensic services, there are many obstacles to such a move. There is resistance from the Special Hospitals themselves who argue that it will be difficult to replicate the strengths claimed for these hospitals in terms of resources, opportunities for patient care, research, and security. Conversely, there is a legacy of highly critical and damning reports. It requires political courage and Treasury support to initiate major changes and there will always be local planning problems and resistance to new secure units near to local populations. Although many of the other recent proposals have received approval, the government has ruled out the possibility of closure of any of the Special Hospitals.

Regional developments should include separate facilities for forensic adolescent psychiatry as are already being developed in Newcastle and Birmingham, and special units for the assessment and treatment of offender patients with developmental handicaps and forensic problems which are also established in these centres.

Organization of forensic services in this way in the future should facilitate the movement of patients between one secure facility and another (including prison facilities) and ultimately into the community with multidisciplinary support and management from the same team. Continuity of care in this way is an important safeguard to identify signs of clinical change at an early stage and to provide protection for the public.

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