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One of the challenging facets of mental health care can be that of trying to deal with a patient's level of insight. Problems that seem apparent to assessing practitioners are sometimes not regarded in the same way by the patient. Measuring a concept like insight is not easy. The Behavioural Status Index (BSI) breaks insight into components and measurable criteria. Such a measurement instrument provides opportunities for detailed analysis of function, opportunity for very specific interventions, further detailed assessment and measurement of progress. This paper begins with a theoretical introduction to the concept of insight and a description of the BSI. Data analysis then follows for the BSI insight subscale. Data were collected, using a repeated measures method from a sample of 503 individual patients in two high‐security mental health hospitals. Results are reported for the central tendency and spread of items; the differences between the Mental Health Act 1983 classifications of mental illness, psychopathic disorder and learning disabilities, patient‐ward dependency level and gender; and the relationship between items, within the subscale. The relationship between items suggests two distinct groupings of acceptive (the ability to recognise and differentiate inner feelings of tension or anger) and cognitional (conscious awareness of inner states) behaviours.

A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues.

A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire.

Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning.

Studies using cross-section can only provide information at fixed points in time.

The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility.

This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.

The nature and problems of forensic nursing research are presented and discussed. The background to and current state of forensic nursing research are described. Some differences between the nature of forensic psychiatric, psychological and forensic nursing research are identified. Forensic psychiatric research deals primarily with drug treatments and psychological research deals with specific therapies often referred to as ‘talking therapies’, whereas forensic psychiatric nursing research deals with care of the patient and all that entails, such as physical, psychological, emotional, spiritual and social care. Issues identified include the power gradient and forensic nurses' position on that gradient, the application of Lee's typology of research as threat and Mason's (2003) discussion of the typology in the forensic context. The article concludes with some discussion of the strategic direction required for further development.

The level of service provision for people suffering from a mental disorder is an area of debate that has always presented clinicians with numerous difficult decisions. The decision‐making process is perhaps at its most contentious with reference to the type and degree of risk individuals may present, either to themselves or to the general public.

Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, specialised private hospitals, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. Rarely is the term defined in the general literature and as a concept it is multifaceted. Concept analysis is a method for exploring and evaluating the meaning of words. It gives precise definitions, both theoretical and operational, for use in theory, clinical practice and research. A concept analysis provides a logical basis for defining terms and helps us to refine and define a concept that derives from practice, research and theory. This paper uses the strategy of concept analysis to explore the term ‘forensic nursing’ and finds a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and to define it more clearly. Forensic nursing is found to derive from forensic practice. A proposed definition of forensic nursing is given.

This paper aims to report on the development of a psychometric measure of insight, The Risk Insight Scale. This measure is intended to assess the insight and understanding of individuals with intellectual disabilities (ID) who engage in offending and/or risky behaviour. The measure assesses insight in two domains: insight into offending and/or risky behaviours and insight into the need for treatment for offending and/or risky behaviours.

Forty secure inpatients with ID were assessed using the measure. Preliminary data are presented on inter-rater and test–retest reliability, internal consistency and validity.

The data demonstrate that the new tool has good internal consistency, good inter-rater reliability and good test–retest reliability.

The psychometric measure must be completed by someone who is familiar with the patient. More data is needed to validate the measure at this stage. Further discussion is provided regarding insight as a construct and its role in risk assessment.

The psychometric measure is both of potential benefit in clinical settings with regard to informing risk assessment and case management and may also serve as an effective tool in intervention outcome evaluation and academic research trials.

The generation of new tool to support and enhance risk assessment, specifically in supplementing assessment of insight in individuals with ID with offending and/or risky behaviour.