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Forensic psychiatry is mainly practised
in:
Hospitals / secure
units
Most forensic psychiatry inpatient units are secure. There
are four levels of security:
- low secure
- medium secure
- enhanced medium secure
- high secure
Low secure services
There are many forensic low secure services around the
country. They are usually provided alongside general
psychiatry services. There is no comprehensive database
of forensic low secure psychiatric services. Each
health provider supplies their own information on their
website or publications.
Medium secure services
These are tertiary services, usually covering one or more
counties. Most have between around 30 to 120 inpatient
beds. There is no comprehensive database of medium secure
psychiatric services.
Enhanced medium secure
These are medium secure tertiary services with higher
levels of relational support and procedural security.
High Secure Services
These are tertiary services. There are three high
secure hospitals for England and Wales plus one for Scotland
(Carstairs Hospital).
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Prisons
Psychiatric care for in prisons is usually provided by a
mix of general adult psychiatry and forensic psychiatry
services.
The
community
Low secure forensic psychiatry services usually manage numerous
patients in the community.
Medium secure forensic psychiatric services tend to run either
‘parallel’ or ‘integrated’ community services.
In the parallel model, the medium secure
service follows up most of their discharged patients - so
these services usually have quite high community
caseloads.
In the integrated model, patients discharged
from the medium secure unit return to their home general psychiatry
service for community follow-up.
Note - patients who are discharged from medium secure units
either move to a low secure or open unit from where they are
followed up by low secure or general psychiatry services. Some
patients are discharged from medium secure units directly into the
community.
Patients are rarely discharged directly into the community from
high secure hospitals.
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