Looking in from the outside, what would the ordinary person expect of forensic mental health services? I suggest that there are three questions he or she would ask: (a) Are there public health measures that can be introduced to prevent those with mental disorder going on to commit crimes? (b) Can we identify in advance the individual who is likely to go on and commit a violent act because of his or her mental health difficulties, and prevent that or limit damage? (c) If a seriously harmful act has already been committed, what interventions might prevent a repetition? All of these questions are about prevention of an untoward event in the future and anticipate knowledge. How secure can we be that current forensic mental health practitioners can make adequately evidenced responses? I fear that examination of current literature would indicate that they and their academic colleagues would fall short of these expectations. Reasons for this are undoubtedly numerous. The issues are complex, with the interplay of many variables from the vagaries of human nature through varying presentations of disorders, still often classified rather than diagnosed, to widely differing environments which, further, may suddenly change in a critical way. The impact of a serious offence can be so catastrophic that officialdom often decides that “something must be done.” Yet, without a good evidence base, such decision‐making is often ineffective and wasteful of resources. The limited evidence base has not been helped by the virtual extinction of an academic forensic psychiatry infrastructure and funding within British universities and the National Health Service. This does not bode well for the future.

中文翻译：

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从外部看：不能替代严格的评估

从外部看，普通人对法医精神卫生服务有何期待？我建议他或她会问三个问题：（a）是否可以采取公共卫生措施以防止精神错乱者继续犯罪？（b）我们能否预先确定由于其心理健康困难而可能继续进行暴力行为的个人，并防止这种情况发生或限制损害？（c）如果已经采取了严重有害的行为，那么哪些干预措施可能会阻止重复发生？所有这些问题都与预防将来发生的意外事件有关，并期望获得知识。当前的法医精神卫生从业人员能够做出充分有根据的回应，我们有多安全？我担心对当前文献的检查会表明他们和他们的学术同事将达不到这些期望。无疑有许多原因。问题是复杂的，人类变量不断变化，疾病表现仍常常被分类而不是被诊断，再到千差万别的环境（可能会突然以关键方式突然变化）中，许多变量之间的相互作用相互影响。严重犯罪的后果可能是灾难性的，以至于官僚机构常常决定“必须做某事”。但是，如果没有良好的证据基础，这种决策通常是无效的，浪费资源。有限的证据基础并没有因为学术法医精神病学基础设施的实质性灭绝以及英国大学和国家卫生局内部的资金而有所帮助。这对未来来说不是好兆头。