Assessment and Management of Specific Populations

Abstract

The focus of this chapter is patient populations within clinical forensic psychiatry that present with specific challenges. It is divided in two parts. In the first part the authors discuss ethical issues in the assessment and treatment of forensic psychiatry transgender populations.

Since the single biggest risk factor for violence is being male and the vast majority of the prison population in the UK are male, it is no surprise that forensic psychiatry is a field in which the primary focus is on male service users. More recently, the needs of female service users within secure services have become better considered. However, it remains the case that provision for women in the forensic psychiatry services is a poor relation to what is available for men.

The division of the wards (and prisons) to male and female has raised the issue of how best to treat people identifying as transgender. Drs Baker and Ratnam are discussing in this chapter practical and ethical issues arising from treating transgender persons, and they provide their valuable experience of treating women transgender patients in their female forensic psychiatry ward.

In the second part of this chapter, the focus is offenders with intellectual disabilities. Dr Wooster discusses six important ethical issues that arise when working with people with intellectual disabilities, particularly in the context of forensic healthcare. The first of them involves the ability to learn, which affects the rehabilitation progress through the criminal justice and/or healthcare system, followed by the ability to understand sexual consent and sexual relationships. The third ethical issue that will be discussed is safeguarding, followed by discussion on use of medications and consent. Subsequently, Dr Wooster focuses on issues around the integration of offenders with intellectual disabilities within forensic psychiatry services and concludes with issues concerning the use of advance directives to guide their care and enhance preservation of autonomy.