In any society a small proportion of people with mental disorder present with behaviour that transgresses norms and violates the rights of others. Concurrently, the same people are often vulnerable themselves – to violence, to abuse or exploitation by others – or at risk of neglect or selfharm. High rates of mortality are well documented. Long conceptualised as a ‘forensic’ population, they interface between mental health and criminal justice systems, and require containment for a time in secure services to manage risk. In recent years a growing realisation has been that both protection of the public and the personal recovery of these patients must be championed by progressive, specialist clinicians. The label ‘forensic’ is an insufficient descriptor of this group of services which provide care and treatment for mentally disordered offenders, but also for a range of individuals who have not been diverted from the criminal justice system. Many clinicians who work in secure services do not self-identify as ‘forensic’ practitioners. This book provides an overview of the clinical populations, professions, assessment and treatment approaches used in a wide range of specialist secure services. It does so with the intent of providing the broadest possible perspective and so we have opted to title our book the Handbook of Secure Care.

The aim of secure services has shifted over time from primarily containment to active programmes of therapy and rehabilitation within care pathways, which aim for less restrictive placements through levels of security, leading to open and community care and reintegration into wider society. Concurrently, services have grown, with an increase in the past decade in the number of secure mental health beds in many countries. In the 21st century this expanding sector has seen new super-specialisms (i.e. subspecialties) whose more bespoke skills reflect the needs of diverse niche groups. This diversity is expressed across diagnostic boundaries, from mental illness and intellectual disability to autism, brain injury and degenerative disorders. Distinct secure care pathways have evolved for men, women, adolescents and the elderly. Dedicated facilities also now exist for younger adults and the pre-lingually deaf.