Accessibility Page Navigation
Style sheets must be enabled to view this page as it was intended.
The Royal College of Psychiatrists Improving the lives of people with mental illness

Partners in Care

 

 

Forensic Psychiatric Services

working in partnership with psychiatrists and carers

Introduction

This leaflet is written for:

  • carers who provide help and support, without pay, to a relative, partner or friend, who is being assessed or treated by forensic psychiatric services;
  • psychiatrists and other members of forensic psychiatric teams who provide care and treatment for people within these services.

It suggests ways of improving communication that allow mutual respect and a working partnership to develop from the first contact with forensic psychiatric services.

For the carer

About forensic psychiatric services

Forensic psychiatric services specialise in the assessment and treatment of people with mental disorders undergoing legal or court proceedings, or who have offended.

However, people with mental disorders, who have never been involved with the criminal justice system, might also be treated in forensic psychiatric services, if they cannot be safely managed elsewhere. Treatable mental disorders include mental illness, personality disorders and learning disabilities.

The NHS provides forensic psychiatric services in healthcare and penal settings, including secure psychiatric hospitals, the courts, prisons and young offenders’ institutions. Private forensic healthcare mainly provides long-stay services.

Forensic psychiatric units have different levels of security ranging from low or medium to high secure hospitals. Most patients are detained under mental health legislation, which differs in each jurisdiction of the United Kingdom and Ireland.

Psychiatric services for offenders or those accused of offending

People with mental disorders do not necessarily have to stay in the legal or judicial system. They can be transferred to the healthcare system, at the time of arrest, during court proceedings or during prison sentence.

Referral to psychiatric services can be made by a GP, other doctors, mental health professionals, police, legal professionals, courts and prison staff.

A psychiatrist and/or members of a mental health team will usually make an assessment and recommendations. They may use mental health legislation as part of the process.

Lawyers and others can commission a psychiatric report, which is paid for by the person or organisation requesting it. Psychiatric reports can only be prepared with the consent of the person concerned who must be aware that it could be given to others, including the court. Psychiatric reports usually contain an opinion and recommendations, which can affect the outcome of the legal or court processes and future psychiatric care.

Forensic psychiatric services are more likely to become involved if:

  • mental health or legal issues are complex
  • the offence was serious and warrants a custodial sentence
  • the person might need admission to a secure psychiatric hospital
  • expertise is required in the care of mentally disordered offenders

Information about the options and mental health legislation can be obtained from voluntary sector organisations (see Further Help).

Carers issues

At any stage, carers can alert the police, the courts, lawyers and health professionals to concerns about someone’s mental health, care and treatment. This is important when the person is vulnerable, affected by a mental disorder, presents a risk to themselves or others, or where there are concerns about the administration of medication. Carers may wish to keep in touch with healthcare and legal professionals and give their contact details.

Carers of people involved with legal or court proceedings share similar concerns with other carers, but can have additional ones:

  • they or other family members may have been victims of the offender
  • the nature or severity of the offence may have upset the carer
  • carers can be stigmatised by the offence and have to move home
  • the carer may be excluded from the legal process
  • the person may not wish the carer to be involved with their healthcare
  • forensic services are often regional and can be far away from the carer’s home.      

As a carer, you may feel:

  • ashamed or guilty about the offence or the challenging behaviour
  • confused about the medical and legal systems
  • worried about the long-term outcome for the person
  • worried about financial matters and how you will get help
  • worried about the effect on you and the rest of the family
  • worried about the circumstances in the hospital or prison.

Tips for Carers

In partnership with your doctor and members of the forensic service team

Forming a positive relationship with all the staff and doctors involved in the care of a patient is important if the condition is long-term. Good communication between the psychiatrist, members of the forensic service team, the patient and the carer are important, but take time and effort.

The specialists you are likely to come across are: psychiatrists, psychologists, psychotherapists, psychiatric nurses, social workers and occupational therapists.

Questions to ask the doctor

Check box  

 What is the diagnosis?

Check box

 

   Can you explain it in terms that I can understand?

Check box

 

   Do you have any written material on this disorder? If not, who does?
Check box  

 Are there any treatments?

Check box

 

  Where can I get information about medication and the possible side-effects?

Check box

 

   How long will it take for the medication to work?

Check box

 

  Will there be opportunities for the patient to exercise, have education and work?

Check box

 

   Can they have therapy to reduce the risk of re-offending?

Check box

 

   Who will look after the patient’s physical health?

Check box

 

   Are there any plans for assessment by other professionals or services?

Check box

 

   How long will it be before they can leave secure facilities?

Check box

 

   Are they still involved in the criminal justice system?

Check box

 

   Will they need to go back to court?

Check box

 

   Will they remain in hospital or could they be transferred back to prison?

Check box

 

  Will they have to stay in this hospital or could they be moved to a hospital closer to home?

Check box

 

   How do I arrange to visit?

Check box

 

   Can I attend reviews of clinical care?

Check box

 

   How can I find out about the offence?

Check box

 

   Are there any organisations or community services that can help me?

Check box

 

   Which health service worker is my main contact for guidance and advice?

Check box

 

  How often should I come and see you? Can we have family or support therapy?

Check box

 

   This person has children – how do I arrange for them to visit?

Remember to arrange your next appointment before you leave. Regular well prepared visits to the doctor or other members of the forensic psychiatric services team will help get the best care.

Advice to help you to prepare for your visits

Find out about visiting arrangements and book in advance. You may have to be registered and show photo-identification on arrival. There are restrictions on the items you can bring into secure areas, (e.g. a mobile phone). Allow plenty of time for the security procedures, as you may be searched.

During your visit:

If you do not understand something, ask questions. Do not be afraid to speak up. It may be helpful to take notes and check that there are no misunderstandings.

For follow-up visits

Review the information from your last visit and write down any questions or concerns you have had since then. This will help you to concentrate on the things that matter most. Your concerns may include questions about:

  • changes in symptoms
  • side-effects of medication
  • general health of the patient
  • your own health
  • additional help needed

Further tips for carers when dealing with doctors and other members of the forensic service team

Doctors and healthcare professionals may be reluctant to discuss a person’s diagnosis or treatment with the carer. There is a duty of confidentiality between the doctor and the patient. If the person is too ill to understand what is happening, doctors might involve the carer in discussions and decisions. (See our leaflet ‘Carers and confidentiality in mental health’').

If the doctor is unwilling to involve you as the carer, you can

  • ask the person if you can stay with them at some or for part of their interview
  • talk with other carers as they may have some helpful suggestions
  • talk to other members of the forensic service team
  • contact carers’ organisations in the voluntary sector or the social worker
  • ask if there is a carers’ support group for the forensic service.

Don’t forget to take care of yourself and make time for you. It is important that you talk about your worries and don’t struggle alone. Try to keep in touch with friends. If you live in England, you may be entitled to a carer’s assessment to identify your needs. This can be arranged through your doctor or a member of the mental health team. They should also be able to refer you to a local carers’ support organisation.

For the professional

As a professional working with people in forensic psychiatric services, we hope that the following is a helpful guide to good practice.

    When making an assessment, do you?
Check box  

See the person with the mental disorder and the carer separately, as well as together

Check box

 

 

 Collect collateral information

    Do you allow yourself enough time to?
Check box  

 Obtain and read the background information

Check box

 

 

 Take a comprehensive history

Check box

 

 

 Leave time for questions and discussion

Check box

 

 

 Explain how you arrived at the diagnosis

Check box

 

 

 Talk about the prognosis

    In the management of the mental illness or disability, do you?
Check box  

 Discuss possible treatments

Check box

 

 

 Talk about the possible side-effects of medication

Check box

 

 

 Spend time asking about the carer’s health – physical and emotional

Check box

 

 

 Discuss how to meet the needs of both carer and the patient

 Points to remember

  • Everyone needs some respite
  • Make it clear that you will be happy to talk to other members of the family
  • Refer everyone that you see to a relevant mental health or carers’ organisation
  • Make it clear that someone will always be available
  • Give an out-of-hours telephone number
  • Make sure that there is a named professional person whom the family can contact at any time
  • When you write your letter to the GP or other professionals, consider sending a copy to the patient and the carer
  • Try to talk to other professionals on the telephone, as well as writing
  • Make sure that the patient and carer have adequate information about the care and treatment

 

Further help

MIND

Mindinfoline: 0300 123 3393. Publishes a guide to mental health and the courts.

Rethink Mental Illness

National Advice Service: 0300 5000 927. Publishes information and advice on offenders with mental illness.

The Law Society

Publishes information on finding a legal representative.


Carers' Trust

Carers Trust is a new charity which was formed by the merger of The Princess Royal Trust for Carers and Crossroads Care in April 2012. Carers Trust works to improve support, services and recognition for anyone living with the challenges of caring, unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. With our Network Partners, we aim to ensure that information, advice and practical support are available to all carers across the UK. 

This leaflet was produced as part of the Partners in Care campaign, a joint initiative between the Royal College of Psychiatrists and The Princess Royal Trust for Carers.

One of the aims of the Partners in Care campaign was to show that if all those involved in the care of people with mental health problems or learning disabilities can work together, a trusting partnership can be developed between carers, patients and professionals which will be of benefit to all.

Original authors: Dr Irene Cormac and Dr Mike Launer

Carer input: The Princess Royal Trust for Carers

Editor: Dr Philip Timms, chair, Royal College of Psychiatrists' Public Education Editorial Board.


© January 2014 Review date: January 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from the permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.
 

RCPsych logo

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552. 
 

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 


Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

feedback form feedback form

Please answer the following questions and press 'submit' to send your answers OR E-mail your responses to dhart@rcpsych.ac.uk

On each line, click on the mark which most closely reflects how you feel about the statement in the left hand column.

Your answers will help us to make this leaflet more useful - please try to rate every item.

 

This leaflet is:

Strongly agree

Agree

Neutral

Disagree

Strongly Disagree

  Strongly Agree Strongly Agree Agree Neutral Disagree Strongly Disagree Strongly Disagree
Readable
           
Useful
           
Respectful, does not talk down
           
Well designed
           

Did you look at this leaflet because you are a (maximum of 2 categories please):

Age group (please tick correct box)

 

Login
Make a Donation