The invitation to contribute a chapter to this volume has been a welcome, but somewhat intimidating, opportunity to review the opinions I had expressed almost two decades ago (Halstead, 1996). At that time I was a newly appointed consultant psychiatrist at St Andrew's Hospital, Northampton, for a 15-bed locked ward for patients with what may now be termed disorders of intellectual development (DID). I was an enthusiast for compulsory treatment under the Mental Health Act 1983 (MHA), using a rich therapeutic milieu, such was available at St Andrew's Hospital at that time. I had boundless therapeutic optimism. In the era of the Reed report (Department of Health & Home Office, 1992) and a relatively enlightened Department of Health, the message was very clearly to provide liberal and scientific treatment for offenders with mental disorders (and others with similar needs), in secure hospital settings, diverting them from prison and from the criminal justice system in general.
In the mid-1990s I certainly did not anticipate the massive increase in the provision of secure beds for people with DID, within the independent and charitable sectors, which would occur from approximately 1997, led by companies such as Care Principles (of which I was medical director between 2001 and 2007), Partnerships in Care, St Andrew's Healthcare, Castlebeck, The Huntercombe Group, Priory Group and several smaller providers.
I now work as an independent consultant psychiatrist and the vast majority of my work involves, in one way or another, the defence of patients’ rights within the context of the criminal justice system, the MHA and the Mental Capacity Act 2005 (MCA). This is therefore something of a ‘gamekeeper turned poacher’ story. I ask for the reader's indulgence, but I think I should be open, from the outset, concerning the perspective from which I am writing.
The Royal College of Psychiatrists has recently published an excellent review of forensic DID services, Forensic Care Pathways for Adults with Intellectual Disability Involved with the Criminal Justice System (Royal College of Psychiatrists, 2014), which is available on the internet and which I would strongly recommend.