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This paper sets current proposals for reform of mental health legislation in the context of historical development of care for mentally disordered offenders and those who require similar services. The authors reflect on the fact that the National Service Framework and the various documents related to reform of the Mental Health Act 1983, seem to do little to address the area of the treatment of people suffering from psychiatric disorders who fall foul of the criminal justice system and bring little that is new to the field of forensic practice. They suggest that the ‘safety first’ approach seems still to be paramount.

Provision of comprehensive diversion services for the mentally disordered who come into conflict with the law offers benefits for patients and all those involved in the process, including the police, crown prosecution service and other agencies. It gives access to the most appropriate disposal for this vulnerable group. This case study of a man who had multiple contacts with the diversion services in Birmingham illustrates the particular difficulties associated with diversion from custody for mentally disordered individuals, particularly where there are multiple problem areas. Examination of the case suggests that in spite of inter‐agency commitment to the philosophy of diversion, in some instances a period spent in custody is unavoidable.