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Why we visited

The overall purpose of forensic mental health services is to co-ordinate care and support for the benefit of the individual while ensuring public safety.The key to achieving this is good multi-disciplinary working.

Services need to have regard to quality of care and proper attention to the needs of the individual and provide care that promotes recovery and enhances their chance of an independent life. Where possible the emphasis should be on providing care in the community rather than institutional settings in accordance with the principle of least restriction of freedom.

Working within the principles of mental health law will lead to a patient-centred service, which delivers care at the lowest appropriate level of security, as close to the patient's home as their medical condition and personal circumstances allow.  That said, we are aware that,

(a) the geography of Scotland is such that for some individuals from rural communities the appropriate specialist treatment has to be provided at a distance from their homes; and

(b) treatment considerations must be viewed in tandem with the need to protect the public.

Over the past five years, there have been significant developments in services for people receiving care in forensic mental health services.There are well developed plans to reduce bed numbers at the State Hospital and additional medium secure services have been developed, with the opening of Rowanbank in Glasgow adding to the existing medium secure facilities at the Orchard Clinic, Edinburgh.The Care Programme Approach has been revised and Multi Agency Public Protection Arrangements (MAPPA) are well established across Scotland. In addition, a Forensic Network was established in September 2003. The Network is multi-agency, with strong links with Scottish Prison Service, social work services, police and criminal justice agencies, the Scottish Government and carers amongst others.

Many individuals whose admission to hospital has been through the criminal justice system, or who are subject to civil powers but who have had contact with the criminal justice service, have found themselves in forensic services largely on the basis of risk. The Commission is particularly interested to see how the principles are being applied to this group of service users.

Of the 68 individuals we interviewed, 51 had appeared in court for offending behaviour and 43 of these had spent some time in prison. In addition, 34 had formal contact with a mental health or learning disability service before admission. For 10 of the people interviewed there had been no previous contact with mental health services.

For people in low and medium secure services we would expect greater emphasis to be placed on risk assessment. We were particularly interested to see how this affected the principle of least restriction and how it then impacts on individual assessed need. Care and treatment needs should be related to the individual's mental disorder and associated assessment of risk. There should be no discrimination because of offending behaviour.

We made a considered decision not to include services provided at the State Hospital. The State Hospital is Scotland's only high security hospital and provides services for both offenders with mental health problems, as well as those who have not been through the criminal justice system, but who need care under conditions of special security.

Because everyone at the State Hospital is subject to formal measures the Commission visits on at least six occasions each year. As the only provider of its type, we would not have had other services to compare it with.

Instead we have concentrated on these low and medium secure facilities across the country which provide, in some circumstances, step down facilities for people moving on from the State Hospital.Most people who use medium and low security services, however, have never required the services provided by the State Hospital.