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 [[organisations/reach-out-provider-collaborative|Reach Out]] in the West Midlands, the [[organisations/north-london-forensic-collaborative|North London Forensic Collaborative]], the [[organisations/south-west-provider-collaborative|South West Provider Collaborative]], and the [[organisations/east-england-provider-collaborative|East of England Specialist Mental Health Provider 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 [[Diversion Schemes for Mentally Disordered Offenders|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] 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] Further detail on governance, policies, and services is on the [[organisations/bsmhft|BSMHFT page]].
Significant developments in policy and service organisation have occurred since 2025. The Mental Health Act 2025 has passed into law and its reforms are being phased in over the coming decade, beginning with provisions affecting restricted patients that came into force in February 2026.[^c9] The government allocated £75 million in 2025/26 to support integrated care boards and NHS-led Provider Collaboratives in reducing out-of-area forensic and inpatient placements.[^c10] The Department of Health and Social Care launched a call for evidence in May 2026 to inform a new cross-government mental health strategy for England, structured around the three shifts of the 10 Year Health Plan. NHS England published a national service specification for community forensic child and young people mental health services (FCAMHS) in May 2024, defining the service model and referral criteria for tier 4 community forensic CAMHS across England. The West Midlands is simultaneously expanding community forensic provision through the Reach Out collaborative, including a £30 million tender for 45 secure beds.
Provider collaboratives have demonstrated significant results. The North London Forensic Collaborative was highlighted by NHS Providers as a national example of best practice, achieving a 60% reduction in out-of-area placements and a 12% reduction in inpatient bed use.[^c14] The South West Provider Collaborative increased the proportion of adults treated for secure mental health needs within their region from under 50% in 2016 to over 90%.[^c15] The East of England Specialist Mental Health Provider Collaborative was established in July 2021 to commission specialised services across six NHS trusts.[^c16]
Despite these advances, the Care Quality Commission has reported that the forensic inpatient system is under stress due to capacity, leading to delays in patient transfers and discharge, and has urged investment in community forensic services and case management.[^c13]
NHS England allocated £30 million for six pilot projects based on the [[Trieste Model]] of community mental health care, of which BSMHFT's Golden Hillock Neighbourhood Mental Health Centre in East Birmingham is one.[^c12] The pilot serves one of the 10% most deprived wards in England, where 90% of the population are from Black, Asian and minority ethnic backgrounds.[^c11] If successful, the model is intended to become the standard of community mental health care across England.
A significant strand of forensic mental health research in Birmingham has focused on the Diversion at the Point of Arrest (DAPA) scheme, introduced in South Birmingham in 1992.[^c3] Over a four-year period, the scheme recorded nearly 500 contacts, with community psychiatric nurses providing round-the-clock assessment in police stations.[^c4] This work has been cited in subsequent academic literature as an exemplar of police station diversion.
[[Forensic Community Psychiatric Services and Nursing|Forensic community mental health nurses]] play a pivotal role in statutory community aftercare for mentally disordered offenders, and research from Birmingham contributed to the evidence base for this model of care.[^c2]