Introduction

This chapter briefly reviews treatment in forensic psychiatry. The focus is on rehabilitation, long-term community care, services for juvenile offenders, mental health services for prisoners, and treatment based on regional forensic units. This focus betrays a particular set of priorities. There is an emphasis on therapy and rehabilitation rather than control and containment, and on extending adequate mental health services to prisoners. There is also an emphasis on the forensic inpatient treatment occurring in regional secure units not the massive high security hospitals which continue to oppress our services, and more importantly our patients. The focus also extends to services provided for young mentally disordered offenders which aim at preventing them from growing up into older mentally disordered offenders. In conclusion, there is a hope that in the future if risk assessments function as they should in facilitating a remedial therapeutics of risk management then prevention may become a central mission for forensic mental health professionals.

There is, however, what might be termed a preliminary issue of whether forensic mental health professionals can, at least in their forensic roles, properly engage in treatment. There are real questions, particularly in the United States, about forensic psychiatrists having any therapeutic role, particularly when they also provide expert opinion to the courts on the same individuals. For our American colleagues, this question develops into an ethical dilemma.

The current definition of forensic psychiatry adopted by the American Board of Forensic Psychiatry and the American Academy of Psychiatry and the Law begins as follows: 'Forensic psychiatry is a subspecialty of psychiatry in which scientific and clinical expertise is applied to legal issues in legal contexts embracing civil, criminal, correctional, or legislative matters'.(1) In similar vein, Pollack(2) argues that forensic psychiatry is limited to the application of psychiatry to evaluations for legal purposes. From this perspective forensic psychiatric treatment is an oxymoron, or at best is to be annexed as a footnote to therapeutic jurisprudence. Though some traditional medical concern for the client being assessed, over and above the needs of the lawyers, is on occasion urged others like Appelbaum (34) would discard the clinician's role in favour of that of 'a forensicist' who abandons any therapeutic involvement. There are signs of change, however, with an increasing interest and attention in North America to correctional psychiatry organized around providing services to prisoners, and in the wider aspects of treating offenders with mental disorders in various contexts.(56)

Forensic psychiatrists in the United Kingdom, Scandinavia, Canada, and much of Europe and Australasia would, in contrast with those in the United States, regard the treatment of mentally disordered offenders (or even potential offenders) as a primary function. ^a89 and l0.) In some European jurisdictions, for example in Sweden, the forensic services and the associated forensic mental health professionals are sharply divided between assessment functions and treatment functions. Perhaps only in forensic psychiatry would a divorce be countenanced between those who assess and prognosticate and those who treat and manage.

This chapter, by its very inclusion, declares a partiality for forensic psychiatry as a specialty within the traditional bounds of medicine, a specialty which does not disdain the therapeutic.

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