The role of forensic psychiatry in mental health systems in Europe.

BACKGROUND: Forensic psychiatry at first glance seems to differ from one country to another due to different historical developments, different legal systems and different mental health systems. In spite of that, forensic psychiatry has several goals shared across countries, principally: assurance of treatment for severely mentally ill people who become delinquent; giving evidence to courts in cases when the offender's mental responsibility is in question; working effectively at the interface of the law and psychiatry, and, in so doing, working well with other clinical and non-clinical professionals in the field; preventing relapse of offenders with mental disorder. In order to achieve these goals, special knowledge and skills must be developed, especially in assessment and management of violence and sexual deviance and of the risk of these behaviours, incorporating techniques developed in neighbouring disciplines. One of the greatest challenges in the development of forensic psychiatry lies in its relationship with general psychiatry. It is arguable that the specialization of psychiatry into sub-specialties has lead to loss of some skills in general psychiatry and to a 'forensification' of people who would previously have been treated as general psychiatry patients. AIMS: In partnership, however, general and forensic psychiatrists could potentially achieve more than either group on its own: they could better prevent people with mental illness from becoming offenders; prevent people with mental illness from becoming victims of crime; intervene in the vicious circle from victim to perpetrator; assess young people at risk for antisocial behaviour and protect them from becoming criminals. Clinical research on these topics is just beginning and this article argues for a close integration of forensic psychiatry into the wider mental health system and for a more intensive exchange of knowledge and skills from forensic psychiatry to general psychiatry and vice versa.