Underlying patterns of practice in a regional forensic psychiatric service

Using a sample of 306 consecutive referrals, the interactions were investigated between factors relating to patients, referral agencies, assessments and courts. Both the variations in referral rates of diagnoses and the psychiatric histories indicated that the service was being used largely for second opinions on the mentally ill, but for those with neurotic disorder or exacerbations of personality disorder it was more akin to a general psychiatric service. Those thought to pose a sexual risk to adults were particularly likely to have histories of violence, but the opposite was true for those considered a sexual risk to children. Reports initiated by the court are more likely to contain a treatment recommendation and are also more likely to be implemented than those in defence reports. Both the likelihood of a treatment recommendation and its acceptance by the court increased with the severity of diagnosis, with psychiatrist and court reaching full concordance in cases of mental illness. As many as 20 per cent of those seen in prison had mental illness and this was nearly seven times the out-patient rate. Forensic outpatient work was found to be independent of the provision of secure care. These and other findings are examined to help explore the nature of the service.