Forensic Mental Health Systems: Weaving the Threads Together

• Author: Alexander Simpson
• Pages: 657-671

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CHAPTER 30

Forensic Mental Health Systems:

Weaving the Threads Together

Alexander Simpson

I. INTRODUCTION

is chapter addresses issues that are relevant to many parts of this book. It describes the dierent areas

of forensic mental health practice, not as individual components, but as part of an overall system of care.

People with mental disorder who come before the criminal justice system need a range of clinical and

service responses. Further, a person traversing the forensic mental health system (FMHS) will encounter

a range of service functions: mental health workers working with the police, court assessment and pos-

sible diversion, tness evaluation, providing mental health care in prison, possible oen long-term foren-

sic hospitalization and community reintegration, and eventual return to general mental health care. is

is a complex journey, where the person will meet many people (mental health care sta, judges, review

boards, lawyers for defence and prosecution, police, and correctional sta to name but a few) and may

be distant or absent from family and community supports. is is a complex legal, clinical, and personal

journey. How does a FMHS try to bring coherence to this experience?

Forensic mental health systems are complex ones, because of the range of venues in which assess-

ment and care is delivered (in courts, prisons, hospitals, and in the community). FMHSs also address

the needs of people with a wide range of problems (people with mental illness, intellectual disability,

personality disorder, substance misuse, or some combination thereof).

Dierent jurisdictions approach FMHSs with dierent legislative and service delivery models, but all

must address similar aims and oen have similar challenges, viz:

• Who decides who is and who is not an FMHS patient, and on what criteria?

• Who is responsible for purchasing and providing the necessary components of an FMHS?

• If there are multiple providers, how do they work together?

• Who evaluates the dierent service elements?

• How does FMHS sta know if they are meeting the objectives of funders, politicians, and the public?

is chapter touches on these subjects. It attempts to provide an overview for the reader to think

about how FMHSs work, how we can determine if the system is functional, and what we can do to as-

sess forensic mental health needs. e chapter is primarily focused on adult persons with serious mental

illness and problems with oending, though issues of system design and assessing need apply equally

well to juvenile persons with oending problems and to correctional programs for problem behaviours.

II. A (VERY SHORT HISTORY

FMHSs have their origins in the late eighteenth and early nineteenth century when in Europe, North

America, and the new colonies of Australasia, psychiatric hospitals were established or were being

established with a brief, in part, to care for persons who were found not guilty of a criminal oence on

the grounds of insanity (Porter, 2001). e “medical men” who assisted courts to make such decisions