The history of secure psychiatric provision in the UK is rooted in the thirteenth century at Bethlem Royal Hospital in London. However, it appears to be largely a containment philosophy grounded in the protection of the public with little, if any, treatment expectations. With the early development of psychiatry, with principles underpinning forms of intervention, albeit frequently bizarre and harmful, we can note libertarian approaches across Europe and the United States throughout the eighteenth and nineteenth centuries. All these psychiatric institutions had attendants or assistants operating in the form of carers, and these can be considered the precursors to modern-day nurses. However, forensic psychiatry appears to have emerged through the focus of the criminal act itself as a form of clinical condition (Mason & Mercer, 1998).

Michel Foucault (1978, page 1) claimed that forensic psychiatry was primarily “a pathology of the monstrous,” which erupted onto the legal scene between 1799 and 1830. During this time he claims that European courts of law, judges, jurors, and legal teams began to listen to psychiatric testimony. Not that psychiatrists had not previously given opinion in courts, but that before this period their testimony was not viewed as a mitigation for the offender’s behavior; if the person was deemed insane, then the psychiatric perspective was interesting, but the person was usually convicted anyway and often executed. However, Foucault argued that the creation of the clinical condition of homicidal monomania during this period allowed the psychiatrists to convince courts across Europe that they had a specialist knowledge of this condition, that they could treat it through hospitalization in their psychiatric facilities of the time, and the “patients” would be detained indefinitely. Foucault outlined several cases in which this occurred, and all were serious, bizarre, and strange. For example, in one case a servant girl called on a neighbor of her employers and asked if she could look after their daughter for a short time. The neighbor reluctantly agreed, and when the neighbor returned for their child, the servant girl had killed the daughter, decapitated her, and thrown her head out of the window. Thus, for Foucault, forensic psychiatry was born out of a pathology of the monstrous.

Michel Foucault’s interpretation of these historical beginnings is open to debate. However, a glance at any history of forensic psychiatry will attest to the “great event” that leads to changes in the legal framework, legal thinking, new laws, and psychiatric provision. In the UK in 1800, James Hadfield, a former soldier who had received head wounds, shot at King George III. At his trial, his counsel successfully argued that Hadfield was suffering from a paranoid delusion, which led to a verdict of not guilty. Although Hadfield was remanded to prison, the criminal law had no legal powers over him and the government of the day quickly passed the 1800 Act for the Safe Custody of Insane Persons Charged with Offences. This allowed the confinement of an insane person until “His Majesty’s Pleasure Be Known,” and although no new secure psychiatric provisions were built, these individuals were usually placed in Bethlem. This pivotal legislation was a major turning point for the treatment of offenders with mental health problems. However, the situation did not really change until Daniel McNaughtan shot and killed Edward Drummond, the private secretary to Prime Minister Sir Robert Peel, who was the intended target. At his trial in 1843, it was accepted that McNaughtan suffered from persecutory delusions, and the judge directed a verdict of not guilty by reason of insanity. Queen Victoria was outraged and claimed “insane he may have been but guilty he most assuredly was,” as she herself had seen him fire the shot. This led to the establishment of a number of rules, later known as the McNaughtan rules, which involved establishing the fact that at the time of the offense the person was deemed insane or that he did not know that what he was doing was wrong.

The first asylum in Britain was established at Dundrum, near Dublin in Ireland, in 1856, and this was followed by Broadmoor, near London, in 1863. Further state asylums followed, with Rampton, near Nottingham, opening in 1912 to care for dangerous mental defectives (the Mental Deficiency Act 1913). Moss Side, near Liverpool, also for mental defectives, was opened in 1919 but had several other functions over the years until 1948, when all three state asylums came under the Ministry of Health. Park Lane Hospital, adjacent to Moss Side, was opened in 1984 but was amalgamated with Moss Side to form Ashworth Hospital. These form the High Security Psychiatric Services for the UK. Scotland has just the one state hospital, Carstairs (Blackburn, 1993).

In the United States as far back as the eighteenth century, courts were concerned about a person being able to make a well-informed plea and establishing a defense. In the Frith case of 1790, the court stated:

At the turn of the nineteenth century, the circuit court judge hearing a famous case involving an assault on Andrew Jackson, remarked that if a mad man is placed on trial, the judge may use discretion, discharging the jury, and sending him to jail to be tried after the recovery of his understanding. In 1899, the Sixth Circuit court held that “It is not due process of law to subject an insane person to trial upon an indictment involving liberty of life” (Youtsey v. United States, 1899). By the turn of the twentieth century, a test for competency was developing. The ruling in United States v. Chisholm (1901) alluded to the cognitive powers and communication capabilities of the defendant. Sixty years later, such capacity and skills were specifically stated in a Supreme Court ruling (Dusky v. United States, 1960). American law elevated the competency rule into a constitutional principle.

However, the term forensic psychiatric nursing did not feature in the High Security Psychiatric Services until the development of the regional secure units in the UK. These medium secure psychiatric units owe their inception to the Report of the Committee on Mentally Abnormal Offenders (Her Majesty’s Stationary Office [HMSO], 1975), although it is fair to say that the idea was first debated in the mid-1960s (Snowden, 1990). Government money sparked the creation of these much smaller medium secure units, and there are more than 50 such facilities spread geographically across the UK. Alongside this, but someway behind, is the establishment of a third tier of secure psychiatric provision in the UK, and these are known as low secure psychiatric units. Other developments include the expansion of mental health units in prisons as well as community provision with outreach services. Therefore, the gamut of forensic psychiatric services from prisons and the three security levels of high, medium, and low through to community services is established with forensic psychiatric nurses featuring in all these facilities. It is with these developments that the term forensic psychiatric nursing first emerged throughout the 1980s. In the United States and Canada, the services are similar (with exceptions as outlined later) and the high security psychiatric services are usually referred to as state hospitals, which may be a part of an overall correctional facility.

At the time of writing there appears to be two general systems for secure forensic psychiatric care: (1) services that are made up only of healthcare professionals (i.e., psychiatrists, psychologists, nurses, and occupational therapists who undertake all roles pertinent to the function of the hospital, unit, or service including the security functions [as in the UK]) and (2) services that are made up of healthcare personnel and separate security staff who are responsible only for the security issues (as in the United States). There are advantages and disadvantages in both systems. For example, one advantage of the UK system is that security is seen as the responsibility of all staff and they are trained to undertake these roles. One advantage of the U.S. system is that the healthcare staff can focus on health-related issues only and do not obfuscate the therapeutic relationship with the security function.

There are many theories of both mental disorder and criminal behavior, and Mason and Mercer (1999) have offered a timeline of how the fusion of these theories forms the basis of contemporary forensic psychiatric nursing. They draw on psychiatric thinkers such as Szsaz, Jones, Scheff, and Laing and locate their philosophy with developments in criminology, and they consider sociological theorists such as Cloward, Goffman, Becker, Lemert, and Foucault. This fusion locates the central tenet of forensic psychiatric nursing as a psychosocial undertaking. Social scientists are continuing to attempt to make sense of the increase in both crime and mental disorder through various frameworks, and Box 36-1 describes seven major schools of thought as outlined by Ohlin and Farrington (1991).