Forensic mental health

What is forensic mental health?#

The word “forensic” means related to, or associated with, legal issues. Forensic mental health services provide assessment and treatment for people with a mental illness who have offended, who are at risk of offending, or who have been found not guilty of an offense on the grounds of mental impairment.

People in the criminal justice system have significantly higher rates of mental illness than people in the wider community. They are also more likely to be held in custody, to be sentenced to imprisonment, or to become a victim of crime. Young men are over-represented in the prison population and so are more likely to be referred to forensic mental health specialists or services.

People may be referred for assessment by the police, courts, prisons, other health or mental health services, or justice agencies. Treatment may be provided in the community, in hospital or in prison.

Why a mental state assessment may be needed#

The mental state of a person who has offended, is alleged to have offended, or is at risk of offending may need to be assessed for several reasons, including:

• their current need for mental health treatment
• whether they are fit to enter a plea in court
• their state of mind at the time of the offense
• whether they can be managed safely within mainstream mental health services

Mental illness#

Mental illness is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardized criteria. “Mental illness” is an umbrella term covering many different conditions that affect the mind.

Around one in five people will experience some form of mental illness, mild, moderate or severe, at some time in their lives. Even when people have the same illness, the impact and effect on each person is different.

Some of the main groups of mental illness are:

• mood disorders, such as depression or bipolar disorder
• anxiety disorders
• personality disorders
• psychotic disorders, such as schizophrenia
• eating disorders
• trauma-related disorders, such as post-traumatic stress disorder
• substance use disorders

When forensic mental health clinicians become involved#

Forensic mental health clinicians may become involved when:

• offenders or alleged offenders are referred by courts or other agencies for assessment
• people living in the community who have a serious mental illness have offended or are at high risk of offending
• people in custody need inpatient treatment or require assessment or treatment of a mental illness
• people are accused of crimes but are considered unfit to plead because of mental impairment
• people are found not guilty of crimes because of mental impairment
• people cannot be managed safely within mainstream mental health services

Referrals can come from a range of sources, including the police, courts, prisons, community corrections, and other justice and mental health services.

Treatment and support#

Forensic mental health services provide recovery-focused treatment with the goal of successful rehabilitation and a safer community. Care is delivered by a multidisciplinary team across hospitals, prisons, youth justice settings and the community.

Treatments and interventions may include:

• Medication. Antidepressants are among the most commonly prescribed medicines and can also be used for anxiety. Mood stabilisers are used for bipolar disorder, and antipsychotic medicines are used for schizophrenia and other forms of psychosis.
• Psychological therapy. Many different types of psychological intervention can be provided one-on-one or in a group.
• Offense-related programs.
• Drug and alcohol related programs.
• Psychosocial interventions.
• Recovery-focused rehabilitation.
• Family and carer support.

A range of public and private services support people with forensic mental health needs, including specialist adult and youth forensic services, and private forensic psychologists and psychiatrists who offer treatment and counseling.

Key points#

• Forensic mental health sits at the intersection of mental illness and the law, providing assessment and treatment for people who have offended, are at risk of offending, or were found not guilty due to mental impairment.
• People in the criminal justice system have higher rates of mental illness and may be referred by police, courts, prisons or other services.
• Care is recovery-focused and delivered by a multidisciplinary team across hospital, prison and community settings.
• Treatments can include medication, psychological therapy, and offense-related, drug and alcohol, and family support programs.

Where to get help#