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.

Arson and other types of deliberate firesetting have major human and financial costs. People with mental disorder are disproportionately involved, and mental health and criminal justice practitioners are often required to assess, treat and manage this troubling group. The literature on juvenile firesetting is advanced relative to that on adult firesetting but around half of all deliberate fire-related damage is caused by adults, so it is surprising that professionals who want to learn more about adult firesetting have been so poorly served, with no specialist single-subject text until now. This volume aims to provide a fresh, focused look at firesetting, at its interface with mental health and mental disorder; and to bring together research evidence, theory and practitioner advice from multiple perspectives in one accessible volume.

Medico-legal interest in deliberate firesetting can be dated, at least in the United Kingdom, to 1829 when Jonathan Martin the York Minster arsonist was declared not guilty on the grounds of insanity (Balston, 1945). However, interest and research on the subject has been sporadic. Although this means that there are considerable opportunities for future research on the topic, it also means that the existing literature is limited. In the current volume we have taken a decision that individual chapter authors be allowed to develop their ideas using the whole of the available literature. This means that, inevitably, there is some repetition between chapters when referring to theories, definitions and so on. However, this approach has also facilitated a situation where individual chapters all stand on their own merits and without repeated reference to one another.

Terminology

Both firesetting and arson are commonly used terms in the literature. In brief, firesetting describes a particular behaviour (the deliberate setting of fires), while arson is a legal term that varies across jurisdictions in its precise meaning. Although we have preferred firesetting in our title, our approach in commissioning chapters has been to give authors the freedom to use their own preferred terminology, with the proviso that they specify and justify their own definitions.

The future

In the UK the number of deliberately set fires fell year on year from 2002 to 2007 (the most recent annual figure at the time of writing); and the frequency of fatalities and non-fatal casualties has also decreased in recent years (Department for Communities and Local Government, 2009).