The NHS in Scotland is often held up as setting an example the rest of the UK would do well to follow. But in its services for mentally disordered offenders, Scotland is lagging well behind.
'Services have been organised badly and poorly co-ordinated. There has been no national strategy and no separate funding for services, except for the high-security State Hospital at Carstairs, ' says Derek Chiswick, consultant forensic psychiatrist at Edinburgh Healthcare trust.
'Mentally disordered offenders have been seen as a burden on the general psychiatric services and there has been an excessive and inappropriate use of beds at the State Hospital, ' he told a conference of the Mental Welfare Commission for Scotland and the Scottish Development Centre for Mental Health Services last week.
'We also have our own 'trolley scandals', which are well hidden and receive no media coverage - people have long waits in prison for hospital admission and also wait a long time for a psychiatric assessment of their future needs.'
England has had a ringfenced budget to provide services for mentally disordered offenders since 1975 and, from the same time, has had a number of regional secure units, Dr Chiswick said. Scotland has not benefited from either of these initiatives. And there are few community services available for mentally disordered offenders north of the border, while those that do exist 'are not properly resourced and are a low priority'.
Nor are there beds in the independent sector 'which fulfils a large role in providing services for mentally disordered offenders in England and Wales'.
The situation is worsening, with more pressure being put on the State Hospital, said Lindsay Thomson, senior lecturer in forensic psychiatry at Edinburgh University. 'The number of patients in high security has increased from 200 in 1993 to 261 today.' And there was a major problem with people who have a serious mental illness and misuse substances, said Dr Thomson. 'In Scotland 50 per cent of patients with schizophrenia have substance misuse disorder.' This increased the likelihood of violence and offending.
Scotland was crying out for a range of services, she concluded.
Cue Scottish health minister Sam Galbraith, bearing the fruit of last year's consultation exercise on health, social work and related services for mentally disordered offenders.
Mr Galbraith told delegates that the government had recognised that more needed to be done and provided - and on a joint agency basis. He duly unveiled a new national strategy which aims 'to address the lack of co-ordination that has too often attached to the care and custody pathway followed by mentally disordered offenders'.
The strategy recognises that local forensic services are needed so that mentally disordered offenders are given safe and appropriate care, reasonably close to their homes, he said.
'But we are not looking for a scaled down version of other models, with medium-secure units like fortresses.
Rather we are looking for a solution based on expert risk assessment, flexible response and public safety.'
Before any changes to provision, there would be a national needs assessment. 'Once we know what is needed and where it is needed we will invest in both care and more secure accommodation tailored to the needs of this group, ' he promised.
Dr Jim Dyer, director of the Mental Welfare Commission for Scotland, was 'encouraged' by the new strategy.
But a 'grand plan' was no use without money, and the strategy was not forthcoming about resources. 'It seems as if it does not quite grasp the magnitude of the issue, ' said Dr Dyer.
Sandy McCall Smith, professor of medical law at Edinburgh University, closed the conference by suggesting that the way society responded to mentally disordered offenders was indicative of its moral state.
Arguing for treating mentally disordered offenders in a more humane way, he said: 'We should resist the punitive philosophy. We imprison too many people who are damaged and too many who cannot be blamed for what they have done.'