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Forensic mental health services in high income countries are typically high cost and low volume, providing care to people with mental illness, personality disorders, learning disability and autism deemed to pose a risk to others. Research into how forensic mental health services work as a whole system is limited. Such research is urgently needed to guide policy makers and ensure that services operate effectively.

Aims and MethodTo examine the activity of the East Sussex Court Assessment and Diversion Scheme and to investigate its diagnostic formulations, recommendations and the short-term outcome of individuals referred, using a retrospective analysis of data collected over 3 years during the everyday clinical duties of scheme members.ResultsDiversion was recommended for 858 individuals from a total of 1830 referrals. Most were referred to community services, but 131 were admitted to hospital, the majority under compulsion. The number of individuals admitted to secure hospitals has increased, and delays in admitting them have lengthened. The ethnic minority population was over-represented in referrals.Clinical ImplicationsCourt liaison and diversion in East Sussex successfully directs defendants with mental disorders to appropriate resources, both general and specialist, in-patient and community. The expansion of in-patient secure services needs to continue to accommodate increased demand. Reasons why ethnic minorities are over-represented in referrals require further study.

Morbid jealousy is encountered in general, old age and forensic psychiatry, and clinicians in each specialty should be familiar with its recognition and management. As well as clinical matters, the issue of risk to the patient and others is prominent in the consideration of morbid jealousy. Hospitalisation is sometimes required, the use of compulsory admission is not infrequent and treatment in secure settings is occasionally warranted. This review addresses the nature of morbid jealousy, its psychopathology, diagnostic issues, associations, risks and management.

Research demonstrates a high incidence of offence-related trauma in mentally disordered offenders convicted of violent and sexual offences. The adaptive information processing (AIP) model offers a theoretical framework for understanding the hypothesised relationship between offence-related trauma and reoffending. Evidence suggests that for a sub-population of offenders presenting with offence-related trauma: (1) therapy may retraumatise them, and (2) unresolved trauma severely blocks the positive benefits of talking therapies. Thus, it is postulated that traumatised violent and sexual offenders may be released into the community when they are still at risk of reoffending. A single case study is presented, which describes the application of eye movement desensitisation and reprocessing (EMDR) for a sexual offender presenting with offence-related trauma, whose offences occurred in the context of serious mental disorder. The identification of offence-related trauma and subsequent resolution of trauma symptomatology are discussed in regard to effective offender rehabilitation. Furthermore, the idiosyncratic nature of offence-related trauma and the application of the standard EMDR protocol for a single traumatic event are considered.

The sharp rise in unemployment levels to the late seventies reaching a benchmark of three million in 1982 has made unemployment the major socio-political and economic issue of the decade. Also,the forecast that levels of unemployment will remain high for some time has resulted in a change of emphasis in the debate about the effects of redundancy and loss of work. Discussion in recent years of unemployment and the unemployed has mainly concentrated on demographic and labour market predictions,ignoring with a few notable exception (Jahoda et al.1933, Hill et al.1973, Townsend 1979) unemployment in its wider social context. Recently, however, the increasing concern with the social context has been apparent in the debates of academies and policy markers.