The Forensic Network is committed to supporting family and friends of patients within Forensic Mental Health and Learning Disabilities services. We have representatives from Support in Mind Scotland representing user and carers’ views on our Network Advisory Board and they have done since the Network was established in 2003. For more information on Support In Mind Scotland and their national Caring Connections service, please visit our useful resources page. Details on how to make a complaint about the service you, or someone you care about, has received are also listed on our Useful Resources page.
Content on this Page:
- - What is a Carer?
- - What are Forensic Mental Health Services
- - Levels of Security in Forensic Mental Health
- - When are people referred to Forensic Mental Health Services
- - Criminal Justice & Mental Health System
- - Pathways
- - Carer Coordinators
- - Carer Forum
What is a Carer?
When we use the word ‘carer’, we mean anyone who has any type of relationship with someone who has a mental health illness and who is currently receiving support from Forensic Mental Health Services, in either the community or in a secure hospital. If you are care about someone who has a mental health illness, whether you are a friend, sibling, neighbour, or family relative, then the information contained in this ‘carer’ section may be useful for you.
What are Forensic Mental Health Services?
Forensic Mental Health Services specialise in the assessment and treatment of people with a mental health illness who are or have previously undergone legal or court proceedings. Some other people are also located in forensic mental health services because they are deemed to be at a high risk of harming themselves or others. These services are often located within secure hospitals or wards, however they can also be community services.
Forensic mental health services offer specialty care and treatment rather than penal punishment and a large majority of people in forensic mental health services are detained under the Mental Health (Care and Treatment) (Scotland) Act 2015 and the Criminal Procedure (Scotland) Act 1995. In legal documents these people are often referred to as ‘Mentally Disordered Offenders’.
Staff who work in forensic mental health services have specialist training that helps them to offer appropriate support to people who need to engage with forensic mental health services. There is often a range of treatment on offer in these services and treatment will focus on the individual’s mental health illness and offending behaviour. All staff will work with the individual to reduce the risk of re-offending, to increase rehabilitation and recovery. There may be a range of specialists involved in an individual’s care, from psychiatrists, psychologists, nursing staff, occupational therapists, and social workers. The staff are primarily mental health professionals, but also contain training in risk management and security.
Levels of Security in Forensic Mental Health
In Scotland there is one high secure service located at the State Hospital in Carstairs and three medium secure services; the Orchard Clinic in NHS Lothian, Rowanbank in NHS Greater Glasgow & Clyde, and Rohallion in NHS Tayside. There are also several low secure and community services across Scotland. The level of secure service a person is accessing (high, medium, low, or community) is determined by the level of a risk a person is thought to pose, either to themselves or to the public. This is often determined by a risk assessment, which is conducted by clinicians, often in a multi-disciplinary team.
The high secure services in Scotland only accept males, however the medium, low and community services accept both male and females. Female high secure services for Scottish patients at the moment are located at Rampton Secure Hospital in England and The State Hospital high secure service for Scotland also provide a high secure service to Northern Ireland. There are also special forensic mental health services for people with learning disabilities. Many of the forensic mental health services are ran by NHS Health boards, however there are some privately ran forensic mental health services in Scotland too.
When are People referred to Forensic Mental Health Services?
People with a mental health illness can be transferred to forensic mental health services at the time of arrest, during court proceedings, when in remand awaiting trial, or after trail from prison. The Criminal procedure (Scotland) Act 1995 gives Scottish courts the power to ensure that a person receives care and treatment under The Mental Health (Care and Treatment) (Scotland) Act 2015 whilst they are involved in legal or court proceedings.
If Police, Prosecutors, Court Staff or Legal representatives are concerned about a person’s mental health, they will request a mental health assessment. This helps the court to decide whether treatment may be necessary and how best to deal with the case. If a person is found to have a mental health illness, there are several disposals available to court depending on the care and treatment that the person requires after assessment.
Criminal Justice & Mental Health System Pathways
Some Key Terms:
Assessment Order - An order imposed by a criminal court prior to trial or after conviction before sentencing which authorises hospital detention for up to 28 days, so that the patient's mental condition may be assessed. Medical treatment may be given in certain circumstances under this order.
Treatment Order - An order imposed by a criminal court which authorises hospital detention for mental disorder.
Compulsion Order - A final disposal imposed by a criminal court which authorises hospital detention or compulsory powers in the community for a period of 6 months and can be renewed for six months and then d then annually thereafter.
Interim Compulsion Order - An order imposed by a criminal court after conviction and before sentencing which authroises hospital detention for assessment and treatment for a period of 12 weeks to allow for assessment of the person's mental disorder or allow further evidence to be obtained. It can be renewed for up to 1 year.
Restriction Order – When added to a compulsion order it allows restrictions to be implied in order to limit the potential risk of serious harm to others while the individual progresses through rehabilitation. For this to be imposed it would be expected that there is a significant link between the mental disorder specified in the Compulsion Order and the offending behaviour or the future risk posed. A compulsion order with a restriction order (CORO) authorises the detention of a person in hospital.
Hospital Direction – This allows a person to receive the appropriate medical treatment in hospital and then be transferred to prison to complete any prison sentence that has been imposed. Time in hospital counts towards the overall time serviced in relation to the prison sentence.
Transfer for Treatment Direction – An order made by Scottish ministers that allows the transfer of a sentenced prisoner to hospital for treatment of a mental disorder.
Emergency Detention Certificate – This is a civil procedure authorising the removal of a person to hospital within 72 hours and the detention of that person in hospital for a further 72 hours. These are granted by a fully registered medical practitioner who has (where practical) sought the consent of a mental health officer.
Short-term Detention Certificate – This is a civil procedure that authorises a person to be transferred to hospital within 3 days of being granted and then the detention of that person in hospital for a period of up to 28 days. The certificate is granted by an approved medical practitioner with the consent of a mental health officer. This period can be extended through an ‘Extension Certificate’ for three working days.
Compulsory Treatment Order – An order granted by the Tribunal which authorises compulsory measures for a period of six months, can be renewed for 6 months and then for twelve months thereafter.
Named Person – Someone nominated by the individual being cared for to support them and protect their best interests. The named person is entitled to receive certain information about the person and to act on the behalf of the person in certain circumstances. Further information on named persons can be found on the Scottish Executive (2005) Mental Health Act Guide.
Advance Statements – A witnessed document that made when the patient is well and which sets out how they would prefer to be treated (or not treated) if they were to become ill in the future, The tribunal and any medical practitioner working with or treating the patient must give regard to the advance statement. If wishes in the advance statement are not followed for any reason then a medical practitioner must send a written record to the Mental Welfare Commission of why these wishes have not been followed. Further information on Advanced Statements may be found in the Mental Welfare Commission’s (2014) Best Practice Guide
Many of the forensic mental health services have a carer coordinator who is a specific member of staff that is responsible for looking after the needs of carers. This member of staff is a good person to ask for any information that you need in relation to the service and the carer and treatment of the person you support. The carer coordinator should also make you aware of any further support available to you in your local area or be able to direct you to the right people to obtain any information you require. For a list of the contact details for carer coordinators please see our carer contacts page.
As a Network we also support a professional carer coordinators group, which brings together professionals and third sector partners from across Scotland who are facilitating carer group and events for their services. The group is currently looking at the development of a carers strategy for Scotland. We hope that this will assist services in making sure they can support carers individual needs and have information about services available. For more information about this group and their ongoing work, please contact Nicol Shadbolt on 01555 842018 or email@example.com
The Network supports a national forum for Carers supporting people engaged with forensic mental health services, however this has become less active in recent years. It is hoped that this will be revived over the coming year and will meet to discuss the needs of carers nationally. If you wish to join the distribution list for this group or be made aware of ongoing developments in this forum, please contact Sharon Bruce on 01555 842018 or firstname.lastname@example.org
If you would like any further information on Criminal Justice Pathways and Mental Health, or if you feel we can be of help with any other relevant information, please do not hesitate to contact the Network Office and see our Useful Resources page.