Introduction

Psychiatric intensive care is at the interface with forensic psychiatric services because they share a common clinical problem – violence. This is the behavioural disability which characterises the majority of patients within the forensic psychiatric service. Knowing how to evaluate violence, and quantify the risk of future violence, is the essence of risk assessment. Knowing when to refer a particular patient to forensic psychiatric services is an important part of effective risk management. Understanding what services are offered by forensic psychiatry is a necessary precondition to using that service effectively.

The aim of this chapter is to provide guidelines to those working outside forensic psychiatry on what is and what is not available within that service. The assessment of dangerousness is discussed elsewhere, but dangerousness in terms of risk to others is pivotal to an evaluation of a patient's need for secure care. It is therefore vital to know whether that patient warrants referral to forensic psychiatric services.

It is unrealistic, given existing resources, to imagine that forensic psychiatric services could, or should, manage all those patients who are violent. But knowing which patient should be managed in a more secure setting, whether that be intensive care or the local medium secure unit, is our current concern. However, there are no absolute rules or fixed access criteria; local services vary and are in a state of flux, developing new services for old problems. Many facilities at one time provided within the old asylums are being re-invented and re-named.