Mothers who kill their own children are unusual women whose offences often elicit fear, horror and condemnation in others. Psychiatrists may be asked to assess such women to explore the relationship between the offence and maternal mental illness, and the potential risk to other children. In this chapter, I discuss some available data on mothers who kill, in terms of criminal justice statistics, and review accounts of motives for such killings. I briefly discuss the legal processes that mother who kill must face, and the role of the psychiatrist. I then discuss some recent research about the role of maternal attachment security in relation to attitudes towards children and the transition to motherhood and the potential for psychological disorder that arise during that transition. I also comment on social factors, such as the role of partners and fathers. I conclude with some discussion about the management of cases where mental illness is a risk factor for filicide, and the associated child protection issues that may arise in such cases.

Personality disorder (PD) is a complex condition, which has been the subject of both debate and research. However, maternal PD has only been the focus of research in the last two decades. In this chapter I discuss that research in the context of what is known generally about PD, as a disorder with a predictable presentation of signs and symptoms; an aetiology, and indications for effective treatment. There has been more research on maternal PD in the last 15 years, which shows that mothers with PD may struggle to care for their children, especially in the postnatal period, and their mental health may also deteriorate during pregnancy. In this chapter I describe the issues described above and discuss how clinicians approach the management of mothers with PD. I place special emphasis on the impact of maternal PD on mother-child relationships and attachment, and the implications for child health.

‘Forensic psychotherapy’ is a shorthand term for the treatment of offenders with psychodynamic psychotherapy. Over the last decade, a range of psychological therapies for offenders have been developed, often based on improved therapies for personality disorder. The author discusses what distinguishes forensic psychotherapy from other psychological therapies offered to offenders; and which offenders might benefit most from psychodynamically focussed therapy. The author describes how psychological treatments broadly fit within the risk needs responsivity construct and the matched stepped care system. Matched stepped care and an appropriate governance framework ensure services deliver evidence-based practices, targeting underlying needs. Clear treatment pathways exist, low- to high-intensity interventions are provided with good fidelity and the right people skills are in place to deliver these interventions. The requirement to step up in intensity and expertise level of treatment is based on a clinical formulation and risk. Having the right service in the right place at the right time delivered by the right professional is critical to reducing risk among people who are violent.

This chapter discusses how issues of spirituality present in forensic psychiatric practice, and especially in the treatment of offenders with mental health disorders. The context of the work of forensic psychiatric services is described. Then three domains of forensic psychiatric practice (the medico-legal, secure psychiatric care and existential forensic psychiatry) are explored, and the ways in which issues of spirituality arise are considered. The chapter concludes with some comments about the importance of the forensic psychiatrist keeping an open mind that can change, in order that his or her patients may experience change. The work draws on the author’s experience of forensic and prison services in England and Wales; prisoners are referred to mainly as ‘he’ because the majority of both offenders and prisoners are male.

This chapter will be divided into two parts. The first on suicide will look at the current epidemiology of suicide, the psychodynamic understanding of the pathway to a death of this nature and the effect the suicide of a patient can have on the clinician and teams working with them. The second part will describe the psychodynamic understanding of homicide. The suicide section is written by Dr Rachel Gibbons and the homicide section by Dr Gwen Adshead.