Modern forensic psychiatry services

General psychiatry services in the United Kingdom and in many other developed countries are provided largely in the community with support from small open psychiatric inpatient units and treatment centres. The capacity of small general psychiatry units to manage threatening, dangerous, or violent behaviour arising from severe mental disturbances is inevitably limited as security is often minimal or absent. Partly as a consequence of this, and also because the approach to the care of difficult and unpredictable behaviour differs in nature and degree, alternative services have developed. Another major factor has been the recognition in some countries that prison populations have a high level of morbidity and the existing services have been inadequate to provide an alternative to the basic care provided in prisons. As a result prisons have to cope with large numbers of individuals with some degree of mental disturbance.

Forensic psychiatry services incorporate two important ingredients: security and treatment. The purpose of the units that together comprise a service is to provide a range of treatment, management, and rehabilitation at different levels of security depending upon the needs of a particular group and prevailing mental health legislation. The priority that such an approach receives varies from one country to another depending upon the strength of the national economy, the budget for the provision of mental health services, and social policy about the importance to be given to the provision of specialized services for offenders. In developing countries the provision of specialized services for mentally disordered offenders is a luxury beyond the scope of limited resources and seriously mentally ill sentenced prisoners are dealt with in prisons, and sometimes mental hospitals, if they are recognized as justifying any special treatment.

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