Abstract:SummaryWith the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface … Show more
“…The optimum approach is one involving collaboration between general and forensic psychiatry. In our second article in this issue (Khosla 2014), we discuss this collaboration in the present day.…”
SummaryMental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved overtime.Learning Objectives•Have an understanding of the evolution of general and forensic psychiatry in the UK over the past 200 years.•Comprehend the similarities and differences between general and forensic psychiatry.•Be aware of some of the roots of conflict between general and forensic psychiatry.
“…The optimum approach is one involving collaboration between general and forensic psychiatry. In our second article in this issue (Khosla 2014), we discuss this collaboration in the present day.…”
SummaryMental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved overtime.Learning Objectives•Have an understanding of the evolution of general and forensic psychiatry in the UK over the past 200 years.•Comprehend the similarities and differences between general and forensic psychiatry.•Be aware of some of the roots of conflict between general and forensic psychiatry.
“…In a completely parallel system, patients discharged from forensic services would never return to general psychiatric services but always be managed in the community by forensic services. 22 This is very rarely the case in practice and to see the models as mutually exclusive is probably erroneous.…”
Section: Structure Of Community Forensic Servicesmentioning
Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.
“…In the remainder of this section I will explore a number of recommendations (Box 3) for managing the interface between intellectual disability and adult mental health services made by the Royal College of Psychiatrists (2020) and various professionals. Khosla et al (2014) point to referrals made by general adult to forensic psychiatrists for advice on risk and management as a model of cooperation to resolve interface difficulties between general adult and forensic psychiatry. This model could also be applied at the interface between general adult and intellectual disability psychiatry.…”
Section: How Best Can We Improve the Interface?mentioning
confidence: 99%
“…In the remainder of this section I will explore a number of recommendations (Box 3) for managing the interface between intellectual disability and adult mental health services made by the Royal College of Psychiatrists (2020) and various professionals. Possible arrangements to the manage interface between intellectual disability and adult mental health servicesReferrals from adult services for advice on intellectual disability-related problemsJoint-working protocolsJoint multidisciplinary interface meetingsDeveloping a needs-based modelSetting up virtual cross-service teamsTraining and education in intellectual disability for mainstream staff (Hall 2006; Royal College of Psychiatrists 2020)…”
Section: How Best Can We Improve the Interface?mentioning
confidence: 99%
“…Referrals from adult services for advice on intellectual disability-related problemsJoint-working protocolsJoint multidisciplinary interface meetingsDeveloping a needs-based modelSetting up virtual cross-service teamsTraining and education in intellectual disability for mainstream staff (Hall 2006; Royal College of Psychiatrists 2020)…”
Section: How Best Can We Improve the Interface?mentioning
SUMMARY
People with intellectual disability can have a range of common mental health difficulties that sit at the interface of two psychiatry subspecialties: intellectual disability and general adult psychiatry. Clinical presentations, comorbidities and complexities can affect the setting of boundaries between the two disciplines. This article touches on current concepts, drives for inclusion of people with intellectual disability in mainstream psychiatry services and some of the difficulties at the interface. It focuses on potential solutions for managing this interface between the two subspecialties.
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