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In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues.

A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions.

Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order.

While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.

This article is a humorous attempt to chronicle the progress of a fictitious course — in this case an assessment course, but many of the gaffes which we record are common to all kinds of courses and conferences. We have tried to include as many as possible of the avoidable errors which can be committed; we have footnoted some of the more obvious and common errors. The reader may find some that have slipped our net. As a rough distinction, there are four kinds of error illustrated here: administrative errors, errors in planning and design, errors arising from lack of interpersonal skills, and misalignments in the organisational climate. Some conference or course designs may be more robust than others in the degree to which they are affected aby these different kinds of error; an assessment course is probably more susceptible than most to most of them — which is why we chose it. The account is of course purely fictitious. We rather hope that this article will help to ensure that it stays that way. Any resemblance to persons living or dead should probably be a matter for regret.

Self‐reported quality of life (QOL) was examined in a cohort of detained psychiatric in‐patients. Two patient groups, categorised as high and low on the Lehman Quality of Life Interview (QOLI) in terms of their ‘satisfaction with life in general’, were compared. A model of satisfaction with life derived from a logistic regression analysis contained three measures: (high) QOLI satisfaction rating for living situation, (low) suicidality and (high) motivation and energy. The practical implications of these findings are discussed in terms of assessment, symptom relief and environmental change.

The purpose of this paper is to assess the effectiveness of a gender-specific group treatment programme for personality disordered (PD) women in a medium secure psychiatric setting.

In all, 56 consecutive admissions with a primary diagnosis of personality disorder (mostly borderline type) and co-morbidity were assessed according to their participation in, and benefit from, a core set of five manualised group treatments that focused on social and interpersonal deficits, instability of mood and problematic substance use. A single cohort pre-test post-test comparison design was used with evaluation based on global change over an amalgam of self-report group specific outcome measures.

In all, 70 per cent of patients attended three or more core groups, with attendance for each group ranging from 85 to 53 per cent. Between 65 and 77 per cent of patients showed a significant improvement on pre-group psychometrics. Patients who achieved a significant positive change in one group tended to do so in others. In all, 85 per cent of patients who completed two or more groups had overall positive direction of change scores. Those who benefited from treatment engaged more quickly, were more likely to have been admitted from hospital, to have previously engaged in therapy and to score lower on measures of impulsivity and personality pathology.

In a clinically representative study the absence of a control group limits the extent to which observed changes can be attributed to described interventions.

Findings reflect the importance of providing a broad clinical approach to changing cognitive behavioural functioning with PD patients in secure settings. They also highlight the need to improve ways of engaging patients at an earlier stage of hospital stay and of increasing the acceptability and uptake of relevant group treatments. Further evidence-informed service developments are needed to meet these challenges.

The study adds to a small literature on the clinical impact of a gender-specific group treatment programme for PD women in secure settings.

Despite widespread work on the process of safeguarding vulnerable adults, there is a relative absence of research in secure psychiatric settings where reliance is placed on external community safeguarding teams. This study analyses safeguarding incidents over a three‐year period in a medium secure psychiatric setting for women. It focuses on incident type, the characteristics of victims and perpetrators and safeguarding processes, including protection strategies. The action implications of the findings are discussed with reference to the unique feature of the patient population and setting and the extant research literature.

The nutrition and eating habits of women in a secure psychiatric service were surveyed using in vivo participation, observation and self‐report procedures. It was predicted that high levels of obesity were partly related to unhealthy eating preferences, over‐consumption of food and environmental factors that supported an unhealthy lifestyle. The results indicated an obesogenic environment in which patients made unhealthy food choices to supplement meals. Post‐survey initiatives have led to increased satisfaction with a healthier and more palatable diet and proactive attempts to help patients engage with a therapeutic and healthier lifestyle to address obesity. The importance of environmental change, education and motivational strategies to engage patients is highlighted.

In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness and men with learning disability in a secure care pathway. Total and individual HoNOS‐secure item ratings made by multi‐disciplinary teams across the course of a period of admission (mean 15 months) for 180 men were examined. There was significant positive change on the clinical and risk‐related scales of HoNOS‐secure for patients in the learning disability care pathway (N = 48) between initial and final ratings. In the mental health care pathway (N = 132 patients) an apparent lack of change masked a more complex picture, where initial decline in HoNOS‐secure ratings was succeeded by significant improvement. Results suggest that it is challenging to measure clinical and risk‐related medium‐term clinical outcomes objectively for these patients, particularly in relation to core issues of treatment of mental disorder, and reduction of both problem behaviour and risk to others. However, it is important that practitioners continue to strive to demonstrate the benefits of care and treatment through appropriate outcomes measures.

Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric) militate against effective treatment. Despite this, few studies have reported on the use of population‐appropriate treatment approaches. This pilot study reports the results of group and individual treatments involving combination nicotine replacement therapy (NRT), motivational enhancement therapy (MET) and cognitive behavioural treatment. The importance of selecting patients with some skills in emotional regulation is highlighted, along with ways of reducing institutional obstacles to change and maximising environmental support for quit attempts.

The purpose of this paper is to describe the architectural design considerations and effects of moving patients from an adapted Victorian medium secure unit to a purpose built facility.

Patients and staff views of the old and new unit environments were compared in terms of homeliness, architectural features, ward atmosphere (WAS) and patient satisfaction.

The new unit was rated as more homely. The change of environment did not increase risk behaviours and was associated with a reduction in symptomatology.

Limitations of the study include the small‐sample size and choice of measure of WAS. More research is needed into the constituents of “planned” environments where the physical environment is the primary intervention.

These include the need for close collaboration among architects, clinicians and patients in order to maximise the therapeutic benefit of the built environment.

This paper contributes to a small literature that “bridges” architectural, psychiatric and environmental domains.

Lifestyle change to improve physical health is a significant challenge in secure psychiatric hospitals for women. In addition to factors that contribute to an obesogenic environments body image, self-care, self-esteem, and motivational problems compound efforts to increase physical activity and to lose weight. The paper aims to discuss these issues.

Two elements of a comprehensive programme to improve physical health and mental wellbeing are discussed. The first describes the development of a unique role of self-care and body image therapists and an evaluation of the effects of treatment. The second describes initiatives to assess the environmental and therapeutic milieu contingencies that impact on physical activity and to increase engagement in exercise through motivational strategies.

Research within the current settings has resulted in a validation of the role of the self-care and body image therapist. Other evaluations have described the environmental contingencies that impact on physical activity along with strategies to increase exercise participation.

While much has to be learnt about how to translate awareness of the value of a healthy lifestyle for women into positive behaviour change the programme described represents part of a comprehensive and long term attempt to evaluate and improve the physical wellbeing of women in secure care.