Establishing Standards of Care for Forensic Mental Health: An International Delphi Consensus-building Study
Date
Authors
Leclair, Marichelle
Imbeault, Arianne
McKenna, Brian
Nicholls, Tonia
Crocker, Anne
Thomson, Lindsay
Supervisor
Item type
Journal Article
Degree name
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Journal ISSN
Volume Title
Publisher
Frontiers Media SA
Abstract
OBJECTIVES: The present study aimed to establish a consensus on a definition of forensic mental health systems and services, and to identify principles and components of forensic mental health systems. METHODS: A Delphi consensus-building process was employed among 23 experts in forensic mental health, defined by lived experience of forensic mental health services, professional, clinical or management practice in forensic settings, or academic research in the field. Items were rated on a 9-point Likert scale, with consensus defined as ≥75% of panelists rating an item between 7 and 9. Across three Delphi rounds, items were revised, merged, or added based on participant feedback. Data were collected anonymously using LimeSurvey, with reminders sent to maximize participation, followed by a structured consensus meeting to resolve remaining areas of disagreement. RESULTS: The final consensus statement comprises three components: (1) a definition of forensic mental health services; (2) a general statement including 12 guiding principles; and (3) 43 core components organized across 10 thematic domains addressing models of care, pathways and processes, programs and activities, physical health, service user and peer involvement, evaluation and improvement, service integration, safe environments, restrictive practices, and other system-level considerations. While all items achieved consensus at the consensus meeting, areas of sustained discussion related to the integration of cultural expertise, the inclusion of a lived experience workforce, and the distinction between descriptive and aspirational elements of forensic mental health services. CONCLUSIONS: This international consensus statement provides a structured framework for understanding forensic mental health systems. By articulating shared principles and core components while allowing flexibility across jurisdictions, the framework offers a foundation to support service development and evaluation across diverse jurisdictions.Description
Keywords
Delphi, consensus statement, forensic mental health services, service organization, standards of care, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Clinical Research, Mental Health, Health Services, 8.1 Organisation and delivery of services, Mental health, 3 Good Health and Well Being, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1701 Psychology, 3202 Clinical sciences
Source
Front Psychiatry, ISSN: 1664-0640 (Print); 1664-0640 (Online), Frontiers Media SA, 17, 1802511-. doi: 10.3389/fpsyt.2026.1802511
Rights statement
© 2026 Leclair, Imbeault, McKenna, Nicholls, Crocker and Thomson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.