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Abstract
Certain independent inquiries, the failure to implement the care programme approach, the new mental health strategy, the recent National Service Framework for Mental Health (Department of Health (DaH), 1999), and the Fallon Inquiry into the Personality Disorder Unit at Ashworth Special Hospital have all raised many questions about psychiatric care which remain unanswered The issue of organizing and developing forensic services can be regarded as a key element if safer services are to be a reality. This article offers a model for forensic mental health services which Is derived from policy statements, the published strategy, research, and discussion papers.
The agenda for delivering the new mental health strategy as articulated in Modernising Mental Health Services (Department of Health (DoH), 1998) is long and will require great effort to achieve. Delivery of the strategy is especially important if we are to secure services which win back the confidence of the public, satisfy our political masters and ensure safe, sound, and supportive provision. The task is demanding to say the least as we strive to achieve the delivery of the new strategy in the context of services which have failed to meet the challenge of care in the community for the most severely ill (Baldwin, 1993; McFadyen and Farrington, 1996; Torrey, 1997; Crail, 1998), where staff do not necessarily have appropriate core skills, knowledge and attitudes (Sainsbury Centre for Mental Health, 1997), and where acute inpatient care can be said to be poor (Sainsbury Centre for Mental Health, 1998).
The challenge will be to radically re-engineer existing services, notably community mental health teams and acute 24-hour care, while keeping professionals with their often conflicting likes and dislikes motivated - this is the essence of strategic management (Falkner and Johnson, 1992). It has been argued that to achieve positive change within existing mental health services the very efficacy of these services must be challenged (McFadyen and Farrington, 1998). Nowhere is this more apt than within forensic mental health services these present a particular challenge.
NEW COMMISSIONING ARRANGEMENTS
Within the modernizing NHS, commissioning of medium and high secure psychiatric care will become the responsibility of a lead commissioner for each region, working with a 'reference' group drawn from all health authorities working to a regional office...