Independent Review into the Delivery of Forensic Mental Health Services: progress update report 2024

2 Theme One: Strategic Governance & Oversight

Recommendation 1. It is recommended that a new NHS Board should be created for forensic mental health services in Scotland.

The Government’s published response to this recommendation was to establish a short life working group (SLWG) to agree on an approach that would deliver increased support for planning, collaboration, and improvement of forensic mental health services. The intention was to fully test the proposal for a new Board against other options.

The SLWG undertook an options appraisal exercise which produced no clear preference between Barron's recommendation, that a NHS Forensic Board be established, and the two proposed alternatives. Overall, the outcome of the options appraisal process suggests that continuing the status quo (individual Health Boards and Networks) for the strategic governance and planning of forensic mental health services in Scotland was not supported. This report can be found on the Scottish Government website.

Forensic Mental Health Board for Scotland

The Scottish Government have considered the outputs of this options appraisal in the context of recent governance developments in Health and Social Care, including the creation of the NCS and the NHS Scotland Planning and Delivery Board and has now reached a desired way to move forward. The intention is to establish a “Forensic Mental Health Board for Scotland” with the aim of delivering a national approach to planning and governance of forensic mental health services. This Board may be created by utilising or amending existing legislation and functions of the Special Health Board that is the State Hospitals Board for Scotland.

Given the complexity of developing a single system, there are still a number of options that will need to be considered as a priority to identify a practical way to move forward. Work is required to determine exactly what functions the Board should have and how it would work with other Boards and the NCS. Therefore, the Scottish Government will work to establish a “Forensic Governance Advisory Group” to engage with stakeholders across the system to support the development of this new governance framework.

Members of the Advisory Group are now in post and further detail can be found on NHS Scotland Publications website under DL (2024) 18 and DL (2024) 26. The group will focus on developing a clear proposal for the board, identifying its core responsibilities, and considering interim solutions. It will engage widely with clinical professionals, stakeholders, and individuals with lived experience to ensure all voices are heard during this process.

Recommendation 2. The definition and purpose of ‘forensic mental health services’ should be reviewed by the Scottish Government at a multi-disciplinary, multi-agency level to help inform the establishment of the new Forensic Board.

The SLWG (as noted above) scope of work included looking at Recommendation 2, which aimed to review the definition of forensic mental health services. The group were mindful of the range of interpretations of the term "forensic mental health" and worked together to agree to the following as a working definition:

“Forensic mental health services provide person-centred, safe and effective assessment; care and treatment; for persons with severe and disabling mental health disorders* who pose a risk of harm to others; and who have come to the attention of the criminal justice system (or whose behaviour poses a risk of such contact); in conditions of therapeutic safety and security in hospital (high, medium or low), or in the community and in criminal justice custody.”

*as defined in the Mental Health (Care and Treatment) (Scotland) Act 2003, whether or not they are, or may be, managed under its provision.

The definition can now be found on the NHS Scotland - Publications website.