11 Forensic psychiatry11.3 Practising psychiatry in a secure setting
11.3.5 Community management of mentally disordered offenders
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Written by Resident Doctor Committee · Published
Aftercare
Section 117 aftercare is free and follows detention under sections 3, 37, 45A, 47 or 48 of the Mental Health Act 1983.
Restriction orders and conditional discharge
A restriction order (section 41) puts decisions on leave, transfer and discharge in the hands of the Justice Secretary.
This oversight continues after conditional discharge, so the patient stays liable to recall.
Decision | Who makes it |
|---|---|
Conditional or absolute discharge | Justice Secretary (section 42) or tribunal (section 73) |
Varying conditions | Justice Secretary |
Recall (section 42(3)) | Justice Secretary alone |
Clinical and social supervisors report within four weeks, then every three months. They advise on recall but cannot recall the patient themselves.
After recall, the case must be referred to the tribunal within one month.
Absolute discharge ends liability to recall.
Conditional discharge does not authorise forced medication in the community. A treatment condition does not give permission to inject someone who refuses.
Supervised discharge under the Mental Health Act 2025 allows conditions that deprive a patient of liberty in England and Wales from 18 February 2026. MM (2018) had ruled such conditions out.
Compulsory community supervision
Compulsory community supervision after discharge includes supervised discharge, conditional discharge and involuntary outpatient commitment.
Its benefit is concentrated in people with non-affective psychosis, and only when orders are sustained and paired with frequent service contact.
The OCTET trial compared longer supervision under a community treatment order (CTO) with section 17 leave and found no fall in 12-month readmission.
CTOs cannot be used while section 41 restrictions apply.
Treating sexual offenders
Structured cognitive-behavioural programmes have the best controlled evidence of any talking treatment for reducing sexual reoffending.
Hormonal treatment works by lowering androgens.
Multi-agency public protection arrangements
Health services must cooperate with multi-agency public protection arrangements (MAPPA). Categories describe who is eligible, and levels describe how intensively they are managed.
Tier | Covers |
|---|---|
Category 1 | Registered sexual offenders |
Category 2 | Violent and other sexual offenders, including specified hospital order cases |
Category 3 | Other dangerous offenders who need multi-agency management |
Category 4 | Terrorist or terrorist-risk offenders |
Level 1 | Single-agency management |
Level 2 | Active multi-agency management |
Level 3 | Senior involvement and extra resources |
Victims may make representations about discharge conditions but cannot veto discharge.