The Community Mental Health Team and the mentally disordered offender

There is a long-standing policy of diversion of mentally disordered offenders (MDOs) from the criminal justice system to care by mental health services. Care of the MDO presents specific challenges to the non-forensic practitioner. These include the need to understand the workings of the criminal justice system and the specific legal issues presented by an offender, the salience of risk, and its management in the mind of the courts and novel additional ethical dilemmas that arise. The importance of substance misuse as a factor in offending behaviour is emphasized, and its implications are explored. In addition, the MDO may present with clinical problems that are unfamiliar. Key principles of management are set out. These include developing a clear understanding of the patient and their world, excellent communication between all those involved, and rapid intervention when there is cause for concern. Staff working with an MDO require adequate supervision and support.