Community forensic psychiatry

Community forensic mental health teams (CFMHTs) have evolved as part of the widening spectrum of community-based mental health services, to manage those people with mental illness who pose a risk of violence to others. These services are relatively new and the evidence base for their effectiveness is yet to be convincingly established. Two service models have been described – the integrated model where the forensic specialists work within the community mental health team, and the parallel model, where they work as a separate team, alongside generic services. CFMHT staff accept referrals from other mental health services and criminal justice services (CJS), working as a link between mental health and CJS. They offer risk assessments, advise on managing risk, accept patients for forensic case management, offer specialist treatments to reduce risk of violence and advise on appropriate placements in secure conditions. They manage the risk of violence in those with severe mental illness and patients with personality disorders and sexual offenders. The development of community treatment orders (CTOs) and public protection issues are likely to dominate discussions of managing patients who have a risk of violence. There is a need for evaluation of the cost-effectiveness of these services, as well as ensuring high levels of specialist skills and competence through training to offer interventions to reduce risk.