Introduction

Abstract

Forensic psychiatry is a subspecialty of psychiatry that operates at the interface between law and psychiatry. It is concerned with patients who have committed an often serious offence and may be detained in highly restrictive secure settings. Unlike in other areas of medicine, patients with mental disorders, and even more so those who have committed serious offences, are treated not only in order to improve their own mental health and facilitate recovery but also for the protection of the public from harm from the patient. This dual role can cause tensions and dilemmas for the practitioner who has potentially incompatible duties to the patient, third parties and the wider community [1–3]. The balance between these duties may change over time and depends on the social and political context of the practitioner. Several authors have argued that currently, i.e. at the beginning of the twenty-first century, the pendulum has swung, maybe too far, to risk aversive approaches, potentially leading to restrictive practices and increasing lengths of stay (LoS) in forensic-psychiatric settings [4].