Introduction

The long-term mentally ill have much in common with mentally disordered offenders. Apart from some direct overlap, both groups have similar long-term needs across a wide range of problem areas (psychiatric, psychological, social, occupational, etc) and these needs can only be met by co-operation between a number of different agencies (health, social services, housing, voluntary bodies, etc). Both groups may also spend periods of time away from normal society and therefore face problems of social re-integration and the transition between segregated and open settings. It is therefore instructive to examine issues concerned with the future pattern of provision for mentally abnormal offenders from the perspective of our experience with the long-term mentally ill.

In most countries the pattern of services for people with long-term mental illness has changed dramatically over the past 25 years. There has been a concerted effort to shift the location and organization of care away from large, remote, and old-fashioned mental hospitals towards smaller, more community-based mental health services. The extent to which this shift in the pattern of service provision has been successfully achieved varies greatly both within and between particular countries, but there is now fairly good evidence that if community services are properly planned and properly targeted on those in greatest need then it is possible to produce a pattern of community-based provision which benefits the majority of those with long-term psychiatric and social needs (Bachrach & Lamb, 1989; Thornicroft & Bebbington, 1989). From a policy point of view, the main lesson that has emerged from this process is that it is very much easier to set a goal which involves the elimination of a particular kind of institutional provision (the mental hospital) than it is to put an effective alternative in its place. The lack of effective alternatives to replace the mental hospital is partly due to lack of resources, but it is also partly attributable to a lack of agreement over what might constitute a comprehensive range of service provisions appropriate to a specific set of local conditions and priorities.

One element of service that most people would agree is crucial to the effective functioning of a community-based mental health service is a mechanism for co-ordinating and maintaining continuity of care.