The future

The organization of forensic psychiatry services is evolving and developing in many parts of the world influenced by changing approaches to mental health legislation, increased research activity into risk assessment and the nature and management of violent behaviour, and in response to the changes occurring in psychiatric practice generally. The management of personality disorder, particularly asocial (or dissocial) personality disorder, is the subject of enhanced research activity that could substantially affect future strategies in service development. Linked to this is a similar widespread concern to improve strategies for understanding and managing the problems of sexual offending, particularly when associated with dangerous behaviour. But in this field of psychiatry, political attitudes and culture, national social policy, and concern for civil rights will result in substantially different responses to research findings and recommendations between one country and another.

The observations that follow are for the most part about the United Kingdom, but similar concerns are being addressed in other countries. Mental health law

At the time of writing, 16 years after the existing Mental Health Act was introduced in England and Wales, mental health law is again under review by a group appointed by the Secretary of State for Health (Chairman, Professor Genevra Richardson). A review is timely. Since 1983 psychiatric care has been increasingly provided in the community, human rights legislation established by the European Convention on Human Rights and the decisions of judicial reviews in the English courts have influenced attitudes to the care of psychiatric patients, and human rights legislation has recently been introduced in the United Kingdom. Mental health law may need to change to reflect these changes.

Proposals for legislative change with reference to forensic psychiatry have emanated from a number of sources, including the Butler Report, (15> the Department of Health and Home Office review of health and social services for mentally disordered offenders and others requiring similar services, (16) the report of the Working Group on Psychopathic Disorder/20' the report of the Working Group on High Security and Related Psychiatric Provision, (12) and the Report of the Committee of

Inquiry into the Personality Disorder Unit at Ashworth Special Hospital. (!3,)

Existing mental health law is principally concerned with the grounds for the detention, care and treatment, and discharge of psychiatric patients in hospital. Some believe that legislation to control care in the community should be incorporated in a new Act.

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Break Free From Passive Aggression

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