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The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.

Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.

An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.

There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

There are limited risk assessment tools validated for use with the internet child abuse material (I/CAM) offender cohort. Developed through a multi-stage process, the purpose of this paper is to present the “Estimated Risk for Internet Child Sexual Offending” (ERICSO), a new tool for I/CAM offender assessment, including demographic, collection, nature of engagement and social domains, plus a structured professional judgement section. Validation studies remain ongoing.

This paper presents a case series analysis of six Australian men, including two Aboriginal men, convicted of I/CAM offences to pilot proposed ERICSO domains and commence validation against the short self-esteem scale, University of California Los Angles loneliness scale, internet sex screening test and the sexual violence risk-20 V2.

Participants of all ages generally reported histories of mental health diagnosis and/or treatment and substance abuse. Two participants reported prior sexual offending, one for I/CAM offences. Participants expressed sexual preferences for female child victims and were convicted of possessing thousands of I/CAM files. Two participants reported accessing I/CAM for over six and 10 years, respectively, before detection by law enforcement.

Preliminary implications indicate ERICSO higher scores are consistent with I/CAM offenders having more online sexual behaviour diversity and more areas of risk/treatment need. For example, participants with problematic self-esteem and loneliness in our data set have higher ERICSO scores. Social connectedness may be a relevant factor though definitive conclusions cannot be drawn from the small sample size.

The ERICSO presents novel assessment of factors in considering treatment targets in addressing both illegal I/CAM and problematic legal sexual behaviours.

This study aims to investigate outcomes of multisystemic therapy (MST) using the Youth Level of Service/Case Management Inventory (YLS/CMI) – part I.

This study, using a pre-post design, included a sample of 2,123 Norwegian youths (mean age = 14.7, SD = 1.34). The MST team supervisors assessed the YLS/CMI risk factors in addition to five behavioral treatment goals (Lives at home, Attends school/work, No violence/threats, Law-abiding and Drug-free) before and after treatment. In addition, data included responses from parent interviews six months post treatment.

Significant correlations were found between the total and dynamic YLS/CMI change scores and the additive index of behavioral treatment goals. In addition, the YLS/CMI change scores predicted the five treatment goals at the termination of treatment and at six-month follow-up.

The results indicate that the YLS/CMI is a valuable assessment tool for predicting the achievement of MST behavioral goals in adolescents with serious problem behavior.

This study provides an evaluation of the YLS/CMI in a Norwegian context and adds support for continued use of the YLS/CMI in MST.

This paper provides new insights about the YLS/CMI inventory as a tool for examining treatment change in MST. Results show that the YLS/CMI captures relevant risk factors in the youths’ environment.

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Lengthy and complex routes to specialist care may negatively affect clinical profiles of trauma survivors accessing mental health services. The purpose of this study was to describe the characteristics and referral pathways of a cohort of clients accepted by a specialist trauma service in England; and investigate the associations between referral pathways and clients’ clinical profiles, namely, pre-treatment levels of post-traumatic stress, depression, anxiety, stress and post-traumatic growth.

Data on 117 consecutive, accepted referrals were extracted from clients’ clinical records. Information on demographics, trauma histories, clinical presentations and referral pathways was synthesised through summary statistics. Correlational analyses were conducted to test associations with pre-treatment scores.

Clients accessing the service were highly complex and mostly experienced prolonged, interpersonal trauma. Pathways to the service varied, but 50% of the sample had at least four “steps” in their referral histories and seven previous clinical contacts. The average time between trauma and specialist referral was 16.34 years. The number of referral steps positively, significatively and moderately correlated with anxiety and stress at pre-treatment.

Limitations include issues around collecting past referral information, the small sample size for clients with available pre-treatment data and the lack of post-treatment scores.

This evaluation provides an informative overview of the characteristics and referral pathways of clients accessing a specialist trauma service. It also offers preliminary insights on the relationship between clients’ routes into the service and their clinical profiles. Practice, commissioning and research implications are discussed.

This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.

This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.

Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.

This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms.

Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L).

Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs).

Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered.

To the best of the authors’ knowledge, this is the first study to respond to the UK’s National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people’s treatment uptake, response rates and treatment completion rates (NICE, 2021).

The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review.

Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study.

The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice.

Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible.

This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA.

Some individuals with autism may engage in violent behaviour. Research into autism specific factors (ASFs) that may contribute to violence is limited. The purpose of this paper is to explore the feasibility of use of an ASF framework which was developed to inform risk formulation and treatment needs.

Retrospective identification and evaluation of ASFs in offenders with autism (N = 13) at childhood, time of index offence and in current risk behaviours. The ASFs described in the framework were repetitive behaviours and circumscribed interests; poor social understanding and empathy; sensitivity to sensory stimulation; and disruption to rigid behavioural routines or difficulties coping with change.

There was evidence for all four ASFs being consistently present in childhood, contributing to violent behaviour at the index offence and current risk behaviours in at least one case. Poor social understanding and empathy was often present at both childhood and index offence in all cases. Of the seven cases with offence paralleling behaviour, five had at least one ASF present at each timepoint.

This proof-of-concept study provides initial support that ASFs play a role in offending behaviour of individuals with autism. Clinicians working in specialist and generic forensic services, with an in-depth knowledge of autism, could use the ASF framework to enhance risk assessments and facilitate more targeted treatment planning for offenders with autism in specialist and general forensic services.

To the best of the authors’ knowledge, this study is the first to test the application of the ASF framework in an autistic offending population.