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This study aims to explore whether female psychiatric homicide offenders form a distinct group when compared to women who have committed other types of serious violent offences.

A range of background and psychological characteristics for 13 homicide and 13 non‐homicide offenders, matched by date of birth, were compared. In addition, change in psychological and behavioural presentation after 12 months stay at a registered charity trust hospital in England was considered.

The findings indicate that the two groups were broadly similar, although the non‐homicide violent offenders had somewhat more troubled backgrounds. The two groups responded similarly to treatment, although the homicide offenders displayed significantly fewer aggressive risk behaviours whilst in care.

It is concluded that the two groups present with similar needs, with indications of greater treatment need for polynomial substance misuse for the non‐homicide group.

This is the first study to compare directly these two specific groups of violent female offenders, considering both static background variables, and behaviour whilst in security.

The aim of this paper is to investigate reasons for treatment non‐attendance for dual diagnosis women in secure psychiatric settings.

A semi structured interview was used to investigate patients' reasons for session non attendance on the day of non participation across four wards. Reasons for non attendance were grouped using the mulifactorial offender readiness model (MORM) categories of affective, volitional, behavioural, cognitive and external. Assignment of responses to categories was undertaken by a two person team and inter rater reliability was assessed.

Patients' rates of attendance varied by ward and level of security (low vs medium); and diagnosis. Systematic enquiry about the reasons for non attendance led to increased session attendance. Reasons for non attendance were cognitive reflecting negative evaluations of treatment and treatment outcomes. Psychological therapies and educational sessions were deemed the most important along with one‐to‐one clinician appointments.

Issues of treatment engagement and the timing of treatment interventions are major issues in the care of secure psychiatric patients, particularly those with a primary diagnosis of personality disorder. Findings highlight the importance of systematic enquiry about reasons for non attendance and suggest potential interventions designed to improve engagement.

The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.

The extant literature on CBT as applied to women in secure settings is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a women's medium secure service.

Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment.

There is comparatively little work on CBT group treatments for women in secure settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment developments.

The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care.

A range of interventions (environmental and motivational) designed to increase participation in physical activities were introduced on two secure wards for women. A pre-post design assessed frequency, duration and intensity of physical activity, attendance at physical activity sessions, exercise motivation, exercise-related mood, attitudes to exercise and health and biological indices. Measures collected over a three-month baseline period were repeated six months post-intervention.

Significant changes occurred in both attitudes to exercise and health, exercise motivation and exercise behaviour following change initiatives. With the exception of resting pulse rate and perceived exertion, the increased level of activity was not reflected in changes in body mass index, body fat or body muscle.

Management led, multi-disciplinary interventions to increase physical activity can have a positive impact on both lifestyle behaviours and physical health.

This study adds to a small literature on increasing physical activity in women in secure psychiatric settings where obstacles to change are formidable.

The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions.

Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas.

Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space.

Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes.

This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services.

The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI).

Electronic patient records were used to determine levels of obesity and weight change over a three-year period. BMI levels were related to status, medication and patient characteristics.

The incidence of obesity (34 per cent) in the sample (n=351) was higher than in the general population. One-third of patients were on medication for hyperlipidaemia and 10 per cent were diagnosed with type II diabetes. Patients on regular antipsychotic drugs and sodium valproate and who were less active had higher BMIs. Gender differences over a three-year period showed a tendency for women's weight to continue to increase which may be linked to lower levels of engagement in activities of moderate or vigorous intensity.

Previous surveys using secure psychiatric populations have been point in time reviews. The current study tracks changes over a three-year time period and related this to a range of interventions.

The purpose of this paper is to assess the antecedent behaviours and consequences of firesetting for women in a secure psychiatric setting along with treatment engagement factors. To explore predictions made about emotionally expressive subtype firesetters by the multi-trajectory theory of adult firesetting (M-TTAF).

In total, 75 individual firesetting episodes involving 25 female multiple firesetters were assessed using the St Andrew's Fire and Arson Risk Instrument. Assessments were made of treatment readiness, firesetting related self-efficacy, insight and barriers to change.

Findings support the relationship between recidivist firesetting and the psychological features of psychosis, personality disorder and substance misuse. The reported association of firesetting with suicidal thoughts, depression, interpersonal problems, anger/revenge motivation and lack of planning supports the view that behaviour is used to manage distressing life experience and as a “cry for help”. However, in a quarter of incidents there was an intention to harm others and evidence of premeditation in twelve percent. A small but significant minority lacked insight into their behaviour, were not ready for treatment and had low firesetting related self-efficacy. Predictions made by the M-TTAF about likely clinical features and motivators of emotionally expressive firesetters were largely supported.

The study highlights the importance of a detailed and specific risk assessment of firesetting that leads to identification of individual risk factors and an individualised treatment approach. This is of particular importance given the complex problems presented by women in secure settings and by the diversity of the conditions associated with fires set by each individual.

The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards.

Patients and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards.

The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment.

Treatment interventions need to optimise research findings that attest to the influence of the environment on the behaviour of patients with intellectual disabilities.

Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care.

The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care.

The paper uses a retrospective survey of routinely collected incident data from one 207‐bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability.

In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other‐directed aggression, 31.8 per cent self‐harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self‐harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway.

Incidents, especially those of lower severity, can be under‐reported in routine practice. Information about incident severity was limited.

Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility.

This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.