Delphi Consensus on Forensic Mental Health Systems and Services

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Frontiers in Medicine Published April 19, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider this Delphi consensus framework to guide forensic mental health service development and evaluation.

This publication is an international Delphi consensus guideline involving 23 experts in forensic mental health, including those with lived experience, clinical practice, and academic research. The panel engaged in a structured Delphi process to develop a shared understanding of forensic mental health systems and services.

The authors synthesized consensus into a final statement comprising three elements: a definition of forensic mental health services, a general statement including 12 guiding principles, and 43 core components organized across 10 thematic domains. Consensus was defined as ≥75% of the 23 panelists rating an item between 7 and 9 on the rating scale.

The guideline does not report primary outcomes, effect sizes, p-values, confidence intervals, or adverse events, as this was a consensus-building exercise rather than an intervention study. The authors did not identify specific limitations within the process.

The document provides a structured framework for understanding forensic mental health systems, offering a foundation to support service development and evaluation across diverse jurisdictions. It should be interpreted as a consensus-based resource, not as evidence of clinical outcomes or patient-level effects.

Study Details

Study typeGuideline

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

ObjectivesThe 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.MethodsA 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.ResultsThe 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.ConclusionsThis 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.