The following comments were received for ‘Community Services for Mentally Disordered Offenders in Scotland’
I thought it was basically good, with appropriate reference to MHO, social worker and criminal justice social worker from my narrow perspective.
1.1 The only issues I would pick up are the references to MHO/Social Work and Criminal Justice SW participation in the FCMHTs. You do give an example in table 2 (page 15) of how 3 local authorities share part-time MHO/SW and CJSW presence in the team. However this is sometimes more complicated to achieve. In the wide spread demography of the North of Scotland 3 local authorities and 2 island authorities share a low secure forensic unit and service. There is evidence that the partnership does not work well for the Island Authorities (who do have very low levels of use). The complications of purchasing off Island forensic services are immense and amplify the problems encountered in the purchase of off-island general psychiatric hospital care. It is difficult to justify developing localised CJ, MHO and AMP expertise on island. This is echoed in the Western Isles, which has complicated relationships with 3 or 4 mainland hospitals and in other remote places such as Argyll and Bute. There is also evidence that elsewhere in some of the smaller authorities, the sharing of MHO/SW services to dedicated forensic services has been problematic for the partner local authorities. This is not to denigrate your preference for the FCMHT model. It is just to say that your thinking on how the essential social work parts of it can be brought in is very Health Board oriented and does not reflect the complexities of local authorities having to (and sometimes struggling to) fit into plans made by and for larger health partners. Some more thought should be given to this and it may be of benefit to engage with some of the remote and island authorities to capture and reflect their needs.
1.2 My other issue is of lesser significance. The term Forensic is one oriented to psychiatry and does not fully capture the range of needs so well discussed in the report. You also use the term MDO in relation to the target group of service users. It is a wider and more accurate term and shifting from Forensic CMHT to MDO CMHT would be advantageous in reflecting the shift in focus of need. Admittedly the term "Mentally Disordered Offenders' Community Mental Health Team" is a little unwieldy, but perhaps some alternative could be sought.
1.3 Concluding sentence at the moment 22 of 48 patients on CD are supervised by general, LD or old age psychiatrists and the remaining 26 by forensic consultants.
1.4 Need to highlight the scale of change from the current practice.
1.5 Forensic Community Psychiatric Nurses, you may need to think about linkages with other services to get local indepth knowledge.
1.6 Social Work, This was written before the new Act and should really list and specify all the roles and responsibilities of designated MHOs and supervisory responsibilities under MoP.
1.7 Social Work, it is also necessary to have SW/MHOs but they may be based outwith the team working closely strengthening their links with the community and family from where the person comes. Some areas do not have enough cases to work in the way you describe. Aberdeenshire works well with the Grampian forensic service with no dedicated in team workers. This may be too prescriptive.
1.8 Forensic Occupational Therapy, these are often social work tasks as well.
1.9 Support Workers, again with the right support and guidance they can come from elsewhere.
1.10 Enhanced Care Programme Approach, not all areas use enhanced and given the new CPA guidance this whole section may need reworking.
1.11 Core Recommendations, 1. subject to numbers, rurality etc.
1.12 Core Recommendations, 4. not enhanced