Forensic Mental Health Services and Diversion
Forensic mental health services in England and Wales provide care for mentally disordered offenders across hospital, community, and criminal justice settings. These services are among the specialised services commissioned by NHS England, with increasing delegation of commissioning responsibility to NHS-Led Provider Collaboratives such as Reach Out in the West Midlands, the North London Forensic Collaborative, the South West Provider Collaborative, the East of England Specialist Mental Health Provider Collaborative, the Kent, Surrey and Sussex Adult Secure Services Provider Collaborative, and the IMPACT East Midlands collaborative.[^c6] This wiki documents the development of such services in and around Birmingham, including the work of nurse researcher [[Stuart Wix]], the governance of [[Birmingham and Solihull Mental Health NHS Foundation Trust]] (BSMHFT), and the evidence base for diverting mentally disordered offenders from the criminal justice system into treatment.
The number of people accessing NHS-funded secondary mental health services in England increased by 24% between 2019/20 and 2022/24, reflecting growing demand across the system.[^c7] A 2026 mapping study of community forensic mental health services in England found substantial variation in service structure, referral routes, and psychological interventions, with 59% of the 32 identified services linked to secure hospitals and 41% operating as standalone teams.[^c27] Birmingham and Solihull Mental Health NHS Foundation Trust is one of the largest mental health trusts in the West Midlands, providing services across Birmingham and Solihull.[^c1]
Significant developments in policy and service organisation have occurred since 2025. The [[policy/mental-health-act-2025-reforms|Mental Health Act 2025 reforms]] received Royal Assent on 18 December 2025, with the first provisions affecting restricted patients and supervised discharge coming into force on 18 February 2026.[^c9] In April 2026, sections 51 and 52 extended Human Rights Act obligations to private care providers and mandated a review of CQC notification requirements for children. The Act introduces a statutory 28-day limit for transferring severely mentally unwell prisoners to hospital, due by the end of 2027, though workforce shortages including 11.2% vacant consultant forensic psychiatrist posts raise implementation concerns.[^c17][^c18] The government allocated £75 million in 2025/26 to reduce out-of-area placements.[^c10] The Department of Health and Social Care launched a call for evidence in May 2026 to inform a new cross-government [[policy/mental-health-strategy-call-for-evidence-2026|mental health strategy]], structured around the three shifts of the 10 Year Health Plan, which closed on 10 July 2026 with the strategy expected in autumn 2026. The [[policy/fcamhs-service-specification|FCAMHS service specification]] for children and young people was refreshed in 2025 with strengthened provisions for neurodiversity and health inequalities.
Provider collaboratives have demonstrated significant results. The North London Forensic Collaborative was highlighted as a national example of best practice, achieving a 60% reduction in out-of-area placements and a 12% reduction in inpatient bed use, while the South West Provider Collaborative increased regional treatment rates from under 50% to over 90%.[^c14][^c15] Despite these advances, the Care Quality Commission has reported that the forensic inpatient system is under stress due to capacity, leading to delays in transfers and discharge.[^c13] The [[inquiries/lampard-inquiry|Lampard Inquiry]], the first public inquiry in the UK specifically focused on mental health care, continued its investigation into more than 2,000 deaths under Essex NHS mental health services between 2000 and 2023, with its final report now expected by mid-2028 after significant delays caused by late disclosure of evidence from core participants.[^c24]
NHS England allocated £30 million for six pilot projects based on the [[research/trieste-model|Trieste Model]] of community mental health care, of which BSMHFT's [[organisations/golden-hillock-nmhc|Golden Hillock Neighbourhood Mental Health Centre]] in East Birmingham is one.[^c12] The centre serves one of the 10% most deprived wards in England, where 90% of the population are from Black, Asian and minority ethnic backgrounds, and had supported more than 1,000 adults by May 2026.[^c11] The Health and Social Care Committee described early evidence from the pilots as "nothing short of miraculous" and recommended extension, but the Government had not committed to continuation by mid-2026, creating funding uncertainty for the six centres.[^c25][^c26] The Royal College of Psychiatrists' Quality Network for Forensic Mental Health Services published its sixth edition standards for medium and low secure services in April 2025, and the [[research/qnfmhs-standards|QNFMHS]] accreditation programme continued to expand.