Forensic Psychiatric
Services
working in partnership
with psychiatrists and carers
- Survey: as a carer of someone with a
mental health problem, we would be interested on learning how to
improve the information we provide for carers. Please take 5
minutes to complete this survey.
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.
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?
 |
|
See the person with the mental
disorder and the carer separately, as well as together
|
|
|
Collect collateral information |
Do you allow yourself
enough time to?
In the management of the
mental illness or disability, do you?
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: 0845 766 0163; Legal advice service:
0845 225 9393.
Publishes a guide to mental health and the
courts.
Rethink
National Advice Service: 020 8840 3188 or 0845 456
0455
Publishes information and advice on offenders with
mental illness.
The Institute of Mental Health Act
Practitioners
Provides useful guidance and information on the
Mental Health Acts.
The Law Society
General Enquiries tel: 020 7242 1222
Publishes information on finding alegal representative.
The Princess Royal Trust for
Carers
Email: support@carers.org
Provides information, support and advice to
carers.
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.
© July 2010. Review date: July 2012.
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
Head of
Publications. The College does not allow reposting of
its leaflets on other sites, but allows them to be linked to
directly.
For a catalogue of public education materials or copies of our
leaflets contact:
Leaflets Department
The Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351
ext. 6259
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.
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.
Did you look at this leaflet because you are a (maximum of 2 categories
please):
Age group (please tick correct box)