Care of the Mentally Disordered Offender in the Community; 2nd Edition

Drs. Buchanan and Wootton have produced a multi-authored work that addresses key concerns on the complex topic of providing mental health services to mentally disordered offenders in the community setting. This well-organized book is an update to the first edition released in 2002. The care of offenders remains the subject of significant public and political attention with an emphasis on maintaining public safety. In the intervening 15 years, there has been an increasing emphasis on the responsibility for public mental health systems to address the needs of mentally disordered offenders. This emphasis has led to the development of evidence-based interventions to reduce the risk of re-offending, new programs for developing services, and significant policy changes to help professionals in their attempts to engage individuals to support recovery and maintain community tenure. Broad in scope, the book's content is relevant to residents/fellows as well as early career and seasoned forensic professionals.

The text is organized in three parts. Part One explores the social, clinical, and administrative contexts of this work, including perspectives from both the United Kingdom and the United States. Over the last four decades, assessment and treatment approaches in general have increasingly been infused with a risk-focused approach to patient care. The authors explore the impact of this focus on patient care, providers, and associated legal and policy implications. Given the current narrative in the media surrounding criminal justice reform, it is fitting that there is an examination in the text of the transformed role of psychiatrists in relation to the criminal justice system. In addition, the authors discuss crucial social justice concerns related to systems of social control, in particular, having energies immoderately focused toward ethnic minorities in both the United States and the United Kingdom. The authors highlight how an evolving emphasis on community safety and the legal defensibility of clinical decision-making have led to a movement from subjective evaluation to objective measures in risk assessment.

Part Two focuses on assessment, management, treatment, and recidivism reduction. The section starts with a description of recidivism reduction strategies using the risk-needs-responsivity paradigm followed by a consideration of treatment with medication and evidence-based psychotherapeutic interventions. Historically, psychiatrists and other mental health professionals have not enthusiastically incorporated the care of offenders into their portfolio of professional services with recidivism reduction as a treatment outcome, often citing a concern that personality disorders in this population are intractable. In their review of recidivism reduction and psychotherapeutic interventions developed over the last thirty years, the authors encourage optimism as these interventions can contribute to significant personal change and successful community tenure. This optimism contributes to a growing paradigm shift of inclusion and engagement with offenders in the development of modern psychiatric and mental health services. This second edition adds a chapter on the approach used in the United Kingdom to treat and manage personality-disordered offenders and sex offenders. Part 2 concludes with a description of the methods for violence risk assessment in the community setting and associated challenges.

Part Three examines the complex interface between services, agencies, and competing priorities. The authors address mandatory community treatment, transitioning mentally disordered offenders into general mental health care, navigating the service delivery landscape involving multiple agencies with potentially competing goals, and the interface between general and forensic psychiatric services. The authors describe how over the last thirty years, the reduction of psychiatric hospital services has led to the development of methods for mandatory psychiatric treatment in the community setting. The authors compare and contrast the varied approaches, including the use of court orders in the United States, clinician-initiated Community Treatment Orders in Australia, and the role of Mental Health Tribunals in the United Kingdom. In this section, each country's construct of mandated community treatment is presented by examining the local interventions, the prevalence of their use, and related evidence-based measures of their effectiveness. The reader is reminded that mandated care may often be involuntary, and the authors highlight ethics principles that underscore the need for collaboration between policy makers and health care providers in the development of new initiatives. The authors urge an approach to decision-making that is informed by data derived from well-designed and well-funded randomized and controlled studies.

This book will serve as a valuable resource for residents/fellows and early-career practitioners who are seeking to understand the complexities of and identify best practices for providing care to mentally ill offenders in the community. Highlights include Part One's “Forensic Psychiatry Unlocked,” which provides trainees in general, public, and forensic psychiatry a perspective on the prevalent and evolving field of forensic psychiatry. This includes a paradigm shift toward working with individuals to develop skills to achieve successful tenure in the community in the context of criminal justice involvement. Part One's “Psychiatry in the Courtroom” provides a description of the role of the psychiatrist as consultant to parties in a legal matter to address questions of insanity, risk assessment, recidivism reduction, and the effectiveness of community-based treatment. This includes how scientific information from the fields of genetics and neurobiology can assist judicial decision-making. Part Three, with its focus on navigating the “seismic zone” of professional and practical intersections common in the mental health–criminal justice interface, is particularly germane to the new practitioner.

• © 2018 American Academy of Psychiatry and the Law