Managing patients in the forensic system is pretty interesting. There are some who have been assessed in the corrections system to be mentally unwell (and may have been responsible for actions leading to the incarceration), or some who are in the system for diagnostic clarifications or more assertive management.

It can be frustrating to try and establish some form of rapport with patients who almost always feel that the system is trying to suppress or do injustice to them. Why should I be treated? I'm not mentally unwell...that familiar saying seems to start some of the conversations off. For me, the key is in reassuring them that you're advocating for their interest, and that generally helps a long way. And we are actually doing so, though sometimes we take away their autonomy to decision-making and consent, but generally this is done to assist and help them through recovering from an acute episode of mental unwellness.

Currently there is a young Sudanese gentleman who is in remand for upcoming charges of murder; he stabbed a GP to death in response to a conviction/delusion that the Australian healthcare system has failed to treat him for his physical health. He was diagnosed with Hepatitis C shortly after arriving from Egypt; and now has a complex delusional system about how the various specialists have refrained treatment from him due to certain prejudices/ discrimination. He still is very suspicious about the medical treating team, believing that previous investigation results were fabricated to make it seem like he did not require treatment for his Hepatitis. These ideas preoccupy him everyday, causing him sleep deprivation, high levels of anxiety, also believing that his liver is completely destroyed/damaged due to the delay in his treatment. Though he is on treatment to try to relieve his distress/preoccupation of these physical complaints (which we are also liaising with hepatologist and haematologist), it is just a long process of reassuring him that his current physical health is our priority too, but that he will not die from no treatment in the immediate sense. I feel that he's getting depressed from this perceived injustice and his stay in the hospital, the stigma of mental illness probably doesn't help his current state of mind. I'm trying to regularly see him to address his concerns, with an interpreter, in hope that he is able to perceive that we are truly trying to help him address both his anxiety as well as his physical health.