Table 3.

Example qualitative feedback from Delphi consultations on proposed forensic mental health service definitions.

Service type	Summary definition of service (from Stage 1 reference group meetings)	Feedback received (during survey Round 1)	New service attribute proposed (during survey Round 2)	Consensus reached in survey (agreement)?^	Result of Stage 3 reference group consultation
Court Liaison Service	This service aims to provide mental health advice, assessments, diversion and referral for people who have been charged with an offense. Key attributes include: Delivered in lower courts, police custody and prison settings Services provide or facilitate specialised advice to the court regarding the impact of a person’s mental health or intellectual capacity on their offending behaviour and ability to take part in legal proceedings	‘ specialist psychological assessments for fitness and cognitive status ’ ‘ Provision of mental state assessments is important in the diversion program. Ensuring defendants receive treatment asap. ’	Court Liaison Services should be responsible for providing specialist psychological assessments to determine fitness and cognitive status.	No (55%)	Do not include as key attribute Reference group advised this attribute fits better within the function of the Community Forensic Mental Health Service.
Community Forensic Outreach Service	This service aims to provide clinical assessment, structured risk assessment, liaison, support, advice and risk management planning support for people who are in the care of mainstream mental health services or in contact with other agencies and who are engaging in (or at risk of engaging in) risky behaviours. Key attributes include: Services are delivered to mainstream mental health services and/or other referring stakeholders at the interface of mental health and the criminal justice system This service is typically a function of Community Forensic Mental Health Services	‘ case management of high risk clients should be an integral part of the model of care ’ ‘ manage a case load of those patients identified as high risk and beyond the expertise of mainstream services ’ ‘ Dedicated case management of a small number of high risk offenders […] on specific forensic orders may not be suitable for mainstream community [mental health services]. ’	Community Forensic Outreach Services case manage a cohort of high-risk patients whose needs are beyond the expertise of mainstream mental health services.	No (75%)	Do not include as key attribute Reference group advised this statement does not reflect the intention of this core service, which was designed with a consultation liaison function. These services provide assessment and specialist advice to mainstream services. Case management is provided by Community Forensic Mental Health Services.
Acute Forensic Assessment Unit	This service aims to provide short to medium-term inpatient assessment and treatment planning services for people in custody who are experiencing severe episodes of mental illness complicated by alleged or proven offending. Key attributes include: Clinical focus on decreasing acuity to a level that the individual can be treated in another environment (such as outpatient care by prison mental health services) Provided in a setting which balances consumer welfare and community safety	‘ Could have more of a trauma aware focus ’ ‘ Trauma informed practice needs to be specified within the service attributes. ’	The Acute Forensic Assessment Unit provides trauma-informed practice.	Yes (100%)	Include as key attribute Reference group advised this attribute should be included in all bed-based service definitions.
Non Acute Forensic Unit	This service aims to provide long term treatment and rehabilitation in a safe, structured environment for individuals with severe mental illness associated with significant violent or other serious offending behaviour. Key attributes include: Located within high security forensic hospitals Programs build and test an individual’s ability to manage their treatment needs as well as relationships, occupational capacity and activities of daily living within the safety of a secure perimeter Average length of stay would be at least 12 months (may be impacted by legal circumstances depending on the jurisdiction)	‘ Dislike the model suggesting it has to be a prolonged stay (i.e. 12 months +) ’	The average length of stay within a Non Acute Forensic Unit is dependent on legal circumstances and jurisdictional differences, but would generally be at least 12 months.	Yes (86%)	Do not include as key attribute Reference group advised this attribute should not be included as it was very similar to a statement in the originally drafted service definition and the phrasing of the first statement was preferred.
Non-Acute Forensic Rehabilitation Unit	This service aims to provide long term rehabilitation and treatment for people with severe mental illness associated with significant violent or other serious offending behaviour. Key attributes include: Located in a low secure environment and in a setting that faciliates access to clinical support services Offers rehabilitaiton programs aimed at maximising individual functioning and minimising likelihood of repeat ofending related to recurrent mental illness	‘ There is no mention of the role of NGO support in these facilities and the model of interactions with health and these services in this setting. ’	Support provided by Non-Government Organisations (NGOs) is a key aspect of Non Acute Forensic Community Rehabilitation Units.	Yes (88%)	Include as key attribute
Prison Mental Health Service	This service aims to provide mental health services to people in prison. Key attributes include: Facilitates access to mental health care in general prison environments Provides reception screening for presence of mental illness; early identification of mental illness; assessment, treatment and care; and transfer of consumers to hospital if necessary	‘ 7 days per week and extended hours required ’ ‘ prison MH can be responsible for crisis assessment for prisoners at risk of suicide and self harm. So need to be available extended hours and weekends to work with Corrections to put in safety planning ’	Prison Mental Health Services should be available 7 days per week, operating on an extended hours schedule.	No (67%)	Include as key attribute with minor amendment: Edit text to specify workforce can be ‘on site or on call.’

^Proportion of respondents who agreed or strongly agreed that the new service attribute should be included in the service definition.