The simple answer to the challenge presented by the issues in forensic psychiatry covered in this book is that fundamental changes are required in the thinking around mental health and mental health problems, together with a remodelling of the criminal justice system vis-à-vis mental health: changes designed to counteract racism and ensure that the systems concerned take account of cultural difference. This task is not something that this chapter can even begin to attempt, but some avenues along which progress may be achieved are worth considering. However, any changes, to be effective, must be backed by those in authority through clear policies and their effectiveness being continuously monitored until the changes themselves become institutionalised. The bare bones of a policy to promote ‘racial equality’ is given in Box 15.1. The rest of this chapter will consider specific areas in which changes can be made-assessing dangerousness, psychiatric assessment and diagnosis, black staff and ‘white institutions’, black identity and separate services, resistance strategies and mental health, service structure, training, research, combating racism, political/ legal changes, forensic psychotherapy, and medication.