Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients needs.