Mohan Rajesh, Slade Mike, Fahy Tom A
Section of Forensic Mental Health, Institute of Psychiatry, P.O. Box 25, London SE5 8AF, United Kingdom.
Psychiatr Serv. 2004 Nov;55(11):1294-8. doi: 10.1176/appi.ps.55.11.1294.
Community forensic mental health teams are a new service within the widening range of specialized community mental health services. The characteristics of these novel services are poorly defined. Two commonly described service models in the United Kingdom are the integrated model (forensic specialists working within community mental health teams) and the parallel model (forensic specialists working on a separate specialist team). The study reported here aimed to establish clear definitions of these service models.
A literature review and a focus group of ten service professionals were conducted to identify candidate characteristics of services in community forensic mental health teams. A total of 31 characteristics were identified and used to prepare the first-round questionnaire for the two rounds of a modified Delphi consultation, which is an expert opinion and consensus method, with a multidisciplinary panel of 32 mental health professionals experienced in community forensic work.
Twenty-nine staff (91 percent) completed the two rounds of consultation. Thirteen service characteristics differentiated the integrated and parallel models. Key characteristics of parallel teams included having their own team base, separate referral meetings, a specialist management line, specialist supervision, protected funding, forensic psychology, good links with criminal justice systems, and capped caseloads. Integrated teams were distinguished by their close links with community mental health services and acceptance of more referrals from primary care.
Integrated and parallel models of community forensic mental health teams differ on many service characteristics. Defining these characteristics will help in researching the pros and cons of each model in the treatment and risk management of mentally ill offenders in the community.
社区法医精神卫生团队是不断扩大的专业社区精神卫生服务范围内的一项新服务。这些新型服务的特点界定不清。英国通常描述的两种服务模式是整合模式（法医专家在社区精神卫生团队中工作）和平行模式（法医专家在单独的专业团队中工作）。本文报告的研究旨在明确这些服务模式的定义。
进行了文献综述，并组织了一个由十名服务专业人员组成的焦点小组，以确定社区法医精神卫生团队服务的候选特征。共确定了31个特征，并用于为两轮改良德尔菲咨询编制第一轮问卷，这是一种专家意见和共识方法，由32名在社区法医工作方面经验丰富的多学科精神卫生专业人员组成小组。
29名工作人员（91%）完成了两轮咨询。13个服务特征区分了整合模式和平行模式。平行团队的关键特征包括拥有自己的团队基地、单独的转诊会议、专门的管理线路、专门的监督、专项资金、法医心理学、与刑事司法系统的良好联系以及限定的工作量。整合团队的特点是与社区精神卫生服务紧密相连，并接受更多来自初级保健机构的转诊。
社区法医精神卫生团队的整合模式和平行模式在许多服务特征上存在差异。明确这些特征将有助于研究每种模式在社区中对精神病罪犯的治疗和风险管理中的优缺点。
