The role of a community forensic mental health team

Drs Turner and Salter show a positive enthusiasm for the follow-up of certain community patients with a previous forensic background by generic mental health teams (Psychiatric Bulletin, September 2005, 29, 352). They call into question the role played by forensic community teams. Referring to Dr Dowsett's report entitled ‘Measurement of risk by a community forensic mental health team’ (Psychiatric Bulletin, January 2005, 29, 9-12) they state that there are a number of patients who‘… are often easier to manage than many non-forensic patients…’.

Having worked in both community general adult teams and forensic settings, my experience is that general teams are relatively wary and reluctant to engage with patients who have been labelled as ‘forensic’. I have observed this in areas where there are highly developed medium secure services and those with none. I have certainly observed that the handover of ‘ forensic’ patients in general adult teams is often a prolonged and protracted affair, not accounted for by natural delays resulting from the sharing of information and risk assessment. There is a delay over and above the normal handover process.

The reasons for this may be a perception that ‘forensic’ patients should remain so for the rest of their lives, a fear of violence or of the responsibility for caring for an offender with mental health problems, or a perceived lack of skills.

I would argue that community forensic teams are the ideal solution to caring for those in the transition from medium security to the community. These services are patchy, with some areas being better served than others.

Drs Turner and Salter state that ‘… use of the HCR-20 [Historical/Clinical Risk - 20] is not especially difficult…’. This may be true, but I doubt busy general teams would have time to administer it. I also do not agree with Dr Pyott (Psychiatric Bulletin, September 2005, 29, 352) that tools such as the HCR should be used to decide which teams or services should follow-up patients, i.e. generic v. forensic. This is oversimplistic and I think there is some validity in allowing a certain fluidity to remain between general and forensic services. The HCR-20 is no replacement for good clinical skills and interview techniques and should never be used in isolation.

Finally, community forensic teams have a role in supporting services and colleagues in prison psychiatry. I am currently working for a psychiatric inreach team in a prison, and have on four recent occasions enlisted the support and help of local community forensic services. They have helped coordinate responses from appropriate teams, and generally provided support, liaison and advice to our service. We have struggled to obtain similar support from general adult services.