Bridging Realms: at the interphase between Forensic, General Adult, and Rehab Psychiatry

Excerpts from my experience in Low Secure Forensic Unit as a General Adult Psychiatry Higher Trainee

During my 12-month ST6 placement in General Adult Psychiatry, I was assigned to a low secure Forensic Psychiatry unit. Despite my initial unfamiliarity with forensic psychiatry, the experience proved to be both inspiring and remarkably rewarding.

One of the initial impressions I grappled with was the heightened sense of security within the unit.

The locked doors, restricted movements, and constant awareness of potential risks created an atmosphere quite distinct from the open wards I had previously encountered. It was a stark reminder of the delicate balance between providing therapeutic interventions and ensuring the safety of both patients and staff. This environment forced me to sharpen my risk assessment skills and taught me the importance of keen observation.

Interacting, on a daily basis, with service users with a significant forensic history challenged my preconceived notions, fostering a greater sense of empathy and open-mindedness. Recognising the interplay of mental illness, past trauma, and sociocultural factors became crucial in tailoring treatment plans, requiring patience and a willingness to acknowledge the complexities of their backgrounds, current presentation and forensic risk.

Exploring the challenges of recovery and rehabilitation in the forensic setting revealed nuances comparable, if not more intricate, than those in a general adult setup. Dual diagnoses, reluctance to engage in treatment, and societal stigma added layers of complexity. Overcoming these challenges became integral to the rehabilitation process, emphasising the role of social inclusion and the obstacles posed by legal complexities and administrative hurdles.

Despite these challenges, moments of profound connection and growth were prevalent. Witnessing patients overcome obstacles and rebuild their lives underscored the transformative potential of psychiatric care. The multidisciplinary team in the low secure forensic unit played a pivotal role in shaping my understanding of collaborative care and co-production, emphasising the importance of teamwork in Psychiatry as a whole.

The emphasis on rehabilitation and risk management in forensic psychiatry prompted, for me, a reconsideration of traditional notions of ‘recovery’ in psychiatric treatment. I was fascinated how ‘progress’ was routinely measured not only in symptom reduction but also in the individual's ability to reintegrate into society safely, highlighting the broader societal implications of mental health care and the role psychiatrists play in public safety.

I hope to inspire more General Adult Trainees to consider choosing placements in Low Secure Forensic Units during the course of their higher training. This experience encouraged me to gain insights not only into Forensic Psychiatry and the intricate interplay between Mental Health Services and the Criminal Justice System but also to explore the nuanced aspects of Recovery and Rehabilitation. 

Additionally, it offered the opportunity to examine the challenges faced, particularly but not entirely exclusive to this service user group and gain experience and skills that can be readily transferrable to other clinical settings and subspecialties within the wider realms of Psychiatry.