Abstract

This case report describes an individual convicted of a violent offence whose complex mental health difficulties appear to be a reason for excluding him from services. During the individual’s admission to a specialised service for personality disorder, a range of structured and semi-structured assessments identified an array of psychological difficulties. Clinical formulation was informed by a contemporary evidence-based typology and suggested that his violence was characterised by anxiety and vengeful/ruminative anger. The fact that the individual’s needs were multiple – including autism, personality disorder, dyslexia and a rare neuropsychological profile – paradoxically appeared to be a reason for mental health services not to intervene, so that he continues to languish in prison. As forensic services in the future are likely to be required to provide for an increasingly difficult clientele, this case highlights not only potential deficiencies in current forensic mental health provision, but the challenges that services are likely to face in the future.