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23 J. Forensic Psychiatry & Psych. 1 (2012)

handle is hein.journals/jnlofncpy23 and id is 1 raw text is: The Journal of Forensic Psychiatry & Psychology Routledge Vol. 23, No. 1, February 2012, 1-6 Taylor&FranciGroup Chinese forensic psychiatry and its wider implications Anya Topiwalaa, Xiaoping Wangb and Seena FazelC* aOxfordshire and Buckinghamshire Mental Health Foundation, NHS Trust, Oxford, UK; bMental Health Institute of Central South University, Changsha, China; University of Oxford, Warneford Hospital, Oxford, Oxford OX3 7JX, UK The current configuration of forensic mental health services in Europe and Australia, whereby mentally ill offenders are directed on treatment orders to secure psychiatric hospitals away from the criminal justice system, is being challenged by differing models such as those in the USA, where there are more than three times the number of persons with severe mental illness in prisons and jails than in all public and private hospitals (Torrey, 1995; Torrey et al., 2010). There are a limited number of forensic beds, all of which are maximum level security, which are predominately occupied by those ordered into them by the court. In contrast, secure hospital provision in Europe encompasses differing security levels from low to high, for assessment and treatment of offenders from court or prison. Within Europe, there are some differences in the amount of provision - for example, Germany has three to four times the number of forensic psychiatric inpatient numbers per head of population than England and Wales (Priebe, 2008). The article by Hu et al. (2010) in the pages of this journal describes forensic psychiatric services in a large region in mainland China and concludes that patients referred to and treated in secure hospitals are not dissimilar to those in Western Europe. In addition, it raises some important questions about the future direction of forensic psychiatric services in China, and in particular, whether China will follow a Western European model of large-scale deinstitutionalization of psychiatric patients from general hospitals, followed by what appears to have been a reinstitutionalization in prisons and secure hospitals. Major mental health reforms in many Western countries in the latter part of the 20th century led to deinstitutionalization in psychiatry, with a shift in emphasis to care in the community. However, over the last decade, a reinstitutionalization of psychiatric patients has partly reversed this trend (Priebe et al., 2005, 2008), which has occurred by increases in involuntary admissions and forensic beds (Keown, Mercer, & Scott, 2008; Priebe et al., 2008), *Corresponding author. Email: seena.fazel@psych.ox.ac.uk ISSN 1478-9949 print/ISSN 1478-9957 online © 2012 Taylor & Francis http://dx.doi.org/10.1080/14789949.2011.576261 http://www.tandfonline.com

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