Comparison of outcomes following after-care from forensic and general adult psychiatric services

Background Forensic psychiatry services are expanding in England and Wales but require support from general services for patient after-care. Aims To compare outcomes following community after-care from forensic or general adult psychiatry services. Method An observational comparison was made of case management following discharge from medium security in seven pre-reorganisation health regions of England and Wales, by forensic services (n=409) and general adult services (n=652). Criminal convictions, hospital readmissions and deaths were compared over a mean follow-up period of 6.2 years, adjusting for difference in case mix. Results Forensic services did not supervise more high-risk patients in the community. Neither service was superior in outcome. More patients managed by general services died from natural causes. Conclusions Neither service was superior on measures of subsequent offending or hospitalisation. Specialist forensic after-care conveyed no added benefit. Case management may have been the same in both services. Declaration of interest J.W.C. developed a specialist service evaluated in this study.