Abstract
This is an excellent book which presents information in a concise manner, yet covers a broad territory and provides wide-ranging references. The book maintains that an empirical foundation for the treatment provided to mentally disordered offenders is necessary, and once established, will lead to greater enthusiasm in those who provide such treatment, and greater confidence in those who fund forensic psychiatric programs. The special needs and vulnerabilities of this population are emphasised, as is the relative dearth of research into treatment provided in secure environments. The book conveys respect and sensitivity towards this often forgotten and marginalised group.
The book is organised into 10 chapters. Chapter 1 provides an overview and gives a framework in which the effectiveness of interventions can be assessed. The authors recognise the limitations imposed on management by the setting, the system in which the setting operates and the particular ethical issues which arise within forensic services. Chapters 2–6 each examine the management of particular categories of mentally ill offenders: those with brain damage, personality disorder, psychopathy, schizophrenia, and major affective disorders. Each provides a concise summary of the area, recent diagnostic classification and critically assesses treatment options. Chapters 7 and 8 provide greater detail on pharmacological treatment in psychotic offenders and personality disordered offenders. There is some repetition of the available strategies, although each chapter is self-sufficient as the emphasis is on the research carried out in particular groups, highlighting those that have been shown to be effective and their limitations. Chapter 9 deals with community-based programs, an increasingly relevant area of forensic psychiatric practice. The concluding chapter comments on a number of areas in which reliable studies are lacking, such as the mentally disabled offender, female offenders and interventions to reduce the confounding effects of drug and alcohol abuse. Strategies to evaluate and implement treatments based on empirical findings are discussed. Importantly, there is also a plea to include consideration of broader aetiological factors, such as housing and family environment, in the assessment and management of mentally ill offenders.
This book deals with commonly encountered issues and makes no attempt to be all-inclusive. Particular groups that may be represented among mentally ill offenders, such as children and adolescents, or those who commit sexual offences are not included. Many of the studies cited relate to research carried out on patients in the non-forensic system, which can be usefully transposed to forensic settings. This book is highly recommended, not only to those who work in forensic services, but also to those who work in general adult psychiatry where the challenges posed by aggressive behaviour and comorbid personality disorder are common.