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UK best practice guidelines for the treatment for people with schizophrenia recommend the use of psychoeducational approaches. The purpose of this paper is to describe the introduction of psychoeducational groups for people with an intellectual disability and co-morbid mental illness within forensic settings.

“Staying Well”, a psychoeducational programme for people with an intellectual disability and co-morbid mental illness was based in part on a group programme from Ashworth Hospital, but adapted and developed to be suitable for people with intellectual disability. Input from a very experienced speech and language therapist was of great importance. Five groups with a total of 20 participants (15 different individuals) with mild to moderate intellectual disability and co-morbid mental illness were run over a two-year period. At the end of each group, an individualised “Staying Well Plan” was devised, to reduce the risk of future relapses.

The group was very positively welcomed in the two pilot hospitals, by participants and members of the clinical teams. The key measure of the success of the programme is that the “Staying Well Plans” developed for the individuals are still in place two years after the completion of the first groups.

The authors believe that this approach is of benefit to both the participants and their carers, stimulating positive engagement, open discussion about mental illness and reinforcing strategies for “Staying Well”.

This paper shows how a psychoeducational approach to severe mental illness in individuals with an intellectual disability is both possible and well received.

The purpose of this paper is to describe a feasibility study into the development and pilot of a psychoeducational group for people with intellectual disability and co-morbid mental disorder (including mental illness and personality disorder) within forensic settings.

“Mind Matters”, a psychoeducational programme for people with an intellectual disability and co-morbid mental disorders is a group based programme in a medium secure hospital, adapted and developed to be suitable for people with intellectual disability therapist multidisciplinary approach was key to its development. An open group on a 16-bedded ward for individuals with mild to moderate intellectual disability and co-morbid mental illness was delivered over a six-week period.

The group was positively received in pilot by participants and members of the clinical teams. Attendance and engagement of participants were key measures of the success of the programme. In addition to the apparent increased social skills and motivation to engage with future psychological intervention.

The authors believe that this approach benefitted both the group members and staff on ward, reinforcing strategies for maintaining positive mental health. It also stimulated engagement, discussion about mental disorders including mental illness, personality disorder and intellectual disabilities.

This paper shows how a psychoeducational approach to mental disorder and mental health in individuals with an intellectual disability is possible, beneficial and well received.

The purpose of this paper is to inform the development of an evidence-based and effective rehabilitation programme to address substance use disorders in a population of patients with severe mental illness and mental disorders detained in a secure forensic psychiatric facility. A clinical review identified a high prevalence of substance use disorders in the patient population at a secure forensic facility in Sydney, Australia with only a limited number of patients being assessed and offered interventions for substance use problems.

A literature review was undertaken specifically looking at articles between 2009 and 2017 that considered models of care or approaches to substance use rehabilitation in patients with co-morbid psychiatric disorders. Articles were considered based on their relevance to the purpose and the environment of a secure forensic facility.

The literature review emphasised the need for a cohesive model of care integrating substance use rehabilitation with mental health care. Comprehensive assessment and individualised approaches that incorporated patient choice and stages of change were considered essential components to any dual diagnosis rehabilitation programme.

The literature regarding rehabilitation approaches for those with severe mental illness and co-morbid substance use disorders was reasonably consistent with the models of care used in relation to criminal offenders and mental illness generally. Integrated and individualised rehabilitation approaches for dual diagnosis patients could play a significant role in forensic settings.

Limited robust evidence for substance use rehabilitation has been published. The authors consider the existing evidence base and the underlying theory behind substance use rehabilitation to propose a model for rehabilitation in secure forensic settings. This is the first known review of substance use rehabilitation involving mentally ill offenders with dual diagnoses in secure forensic settings. This paper is the original work of the authors.

There is ongoing discussion around how to structure psychiatric services to meet the needs of people with intellectual disability and co‐morbid mental illness and several different models have been suggested. With research evidence lacking, there is a lack of consensus as to the best model of service provision. This paper aims to review the current knowledge in this area and discuss the salient issues.

This is a review article summarising the current debate. Evidence from original research is presented and combined with opinion from clinical experience.

The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co‐morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach.

This article will be of benefit to clinicians working in the field of intellectual disability and mental illness, and to managers and commissioners with responsibility for providing services. It will also be useful for those new to the discipline to gain an overview of the current issues and debate within service planning for this population.

There are few studies of quality but all indications are that mental illness is a common problem in people with autism spectrum disorders (ASD) of all ability levels. Anxiety and mood disorder are common as well as paranoia, but there are problems assessing the phenomenology of illness in people with ASD. Schizophrenia does not appear to be more common in people with ASD. Suggestions are made for assessment and treatment of co‐morbid mental illnesses.

This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.

All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.

Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).

The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.

Children and young people with an intellectual disability (referred to in this article as young people) have a higher incidence of mental illness and challenging behaviour than individuals without cognitive impairment. Inpatient assessment and treatment in a learning disability‐specific provision rather than mainstream inpatient child and adolescent mental health services (CAMHS) is most beneficial for those young people who experience a more severe intellectual disability or whose presenting complaint is challenging behaviour not associated with a co‐morbid mental illness. Assessment and treatment of this complex group of young people can only be successful if the services which manage them have access to a highly experienced and comprehensive multidisciplinary team. Admission is only worthwhile if recommendations that arise from the assessment can be transferred to the community and those involved in supporting the young person are motivated to work in collaboration with the inpatient team.

People with Asperger syndrome are at increased risk of co‐morbid mental health problems. The core features underlying autism are likely to play an important role in offending behaviour amongst this population. Forensic rehabilitation includes a multidisciplinary approach and combination of therapeutic interventions. However there is limited evidence in the literature of what constitutes effective treatment within this setting, and how the process of rehabilitation is experienced by patients. The purpose of this paper is to describe a case of Asperger syndrome with co‐morbid psychosis and offending behaviour and the process of forensic rehabilitation.

The authors briefly review the literature related to Asperger syndrome, offending in this population and co‐morbidity. The authors then describe and reflect on a case of a young man with Asperger syndrome, sexual offending and the process of forensic rehabilitation, and offer an insight from the patient's perspective.

Co‐morbid mental illness, when detected early, can be successfully managed with limited additional disability. The process of forensic rehabilitation includes a multidisciplinary approach. Therapeutic interventions specifically aimed at addressing core features of autism, risk and offence‐related factors are effective in promoting recovery amongst those with autism and offending behaviour.

The paper highlights how core features of autism can lead to offending behaviour, the importance of early recognition and treatment of co‐morbidity, and the process of forensic rehabilitation and recovery. Also included are quotes from the patient's perspective on what it is like to have Asperger syndrome, and what has been the key learning from the rehabilitation process.

Nurses and nursing students often hold stigmatizing attitudes toward patients with mental illness, contributing to poor health outcomes. To address this, direct contact with persons with lived experience in mental illness (i.e. consumers) has been integrated into training curricula. This has shown decreased negative attitudes and increased empathy, but gains are not typically maintained at follow-up. The purpose of this paper is to explore acceptability (i.e. feasibility, process and fidelity) and stigmatizing attitudes of nursing students after the completion of a mentor-based direct-contact curriculum to decrease stigmatizing attitudes toward persons with mental illness.

A five-week manualized contact-based mentorship program, with a mentor (i.e. consumer)–mentee (i.e. student) pairs implemented as a supplement to the clinical curriculum for 23 baccalaureate-nursing students. Feasibility (i.e. attendance), acceptability, fidelity and stigmatizing attitudes were evaluated. The Error Choice Test and the Attribution Questionnaire (AQ-9) were used to assess stigmatizing attitudes.

Feasibility was 100 percent for face-to-face meetings and participants were satisfied with the integration of the program into their curriculum, indicating high acceptability. A repeated measures ANOVA yielded significant findings for stigmatizing attitudes (F (2, 21)=6.96, p<0.02, η²=0.23). This suggests that a consumer-led mentoring program may reduce mental health stigma within student-nursing populations. The AQ-9 did not yield significant results.

This study lacked a comparison group. Future research should include a randomized controlled trial.

This study demonstrates capacity for high feasibility and acceptability for an anti-stigma curriculum in this educational context.