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It is Sunday morning at 7.00 am. I receive a call from a patient's independent expert psychiatrist informing me that the prosecution will drop the charges and my patient will walk free from court the following morning. The expert informs me that the co-defendant has tipped off Scotland Yard that there are bigger fish to fry. In simple terms this means my patient will be released directly from the court, without any future clinical planning on Monday morning. In the absence of any follow-up, the likelihood of his relapse and thereby his risk of harm to others in the community, escalates manifold.
The whole of Sunday was spent enquiring and notifying the local forensic secure units of his discharge. None were willing to accept the responsibility of monitoring the patient in the community. The following day as the case collapsed, fortunately the patient, unprecedently, agreed to remain in hospital as an informal patient, in a locked forensic psychiatric ward, until a community team agreed to follow him up locally. Finally, a week later, he was discharged directly into the community from a locked forensic psychiatric ward.
The case outlined above is an example of a start of a week which outlines key aspects of risk assessment and security. It also highlights that even the weekends can be filled with the twists and turns of managing dangerous and high-profile offenders with mental health problems.
The job of a forensic psychiatrist involves two key areas of practice: understanding the risk and security on one hand; and having a comprehensive knowledge of law, crime, and their interphase with mental health on the other. However, underneath these two intrinsically related fields, lie care and compassion for a group of marginalised, disenfranchised, troubled, and disintegrated patients. These are individuals who are excluded and alienated from society, not only because they are mentally disordered, but also because they are violent offenders coming largely from impoverished ba