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.