Managing offenders with psychiatric disorders in general psychiatric services 

It has been shown that the prevalence of mental illness among those in the criminal justice system is significantly greater than that found in the general community. As presented in Chapter 11.4, for example, the per capita rate of psychotic illness in prisons is approximately 10 times greater than that found in the general community. Tragically, relatively few services exist that provide continuity of mental health care between gaols and the community. This produces a situation where individuals whose mental illness may have been identified and treated in gaol find themselves without services in the community. Typically, only when in crisis do they find their way into general psychiatric services either in community settings or in hospital. This situation has produced considerable stress on already taxed mental health services. Given the prevalence of offence histories among psychiatric patients, it is important for mental health professionals to be aware of the unique issues—and myths—that accompany patients with offence histories. At the outset it is important to emphasize that the duty of mental health services is to address mental health issues. That ought to be the focus of mental health services. As this chapter makes clear, though, for some patients, there is a relationship between the mental illness and offending and by addressing the mental illness, the risk of re-offending might well be reduced. Moreover, many of the ancillary issues that lead to relapse and destability in psychiatric patients also may lead to offending. Addressing these issues will both help provide long-term stability for patients and will help reduce their risk of offending. As a result, there is a need for general mental health services to acquire expertize to identify and manage patients with offending histories. This chapter will provide information about the relative risk of offending among psychiatric patients and the relationship (or lack thereof) of inpatient aggression and community-based violence and offending. A framework will be provided for assessing and treating patients with offending histories and issues using a typology of mentally ill offenders. The role of forensic mental health services in bolstering general psychiatric services, and in sometimes providing primary care for mentally ill offenders, will also be discussed.