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The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure psychiatric care (HSPC). Key areas of examination include the prevalence of ASD in HSPC, how individuals with an ASD differ from other patient groups in clinical and cognitive characteristics, the views of staff regarding patients with an ASD, an exploration of the experiences and quality of life of patients with an ASD, as well as treatment and interventions.

A review of the published literature.

Although individuals with an ASD comprise a relatively small proportion of the total HSPC cohort, they appear to be over represented relative to the general population prevalence. Several research projects suggest that individuals with an ASD present with difficulties and needs different to other patient groups, as well as being viewed by staff as potentially vulnerable and requiring a different care approach. Individuals with an ASD report both positive and negative aspects to life in HSPC.

Suggestions are made with regard to how individuals with an ASD might be better managed in HSPC. Following the spirit of various pieces of government legislation such as the Autism Act (2009) and the Equalities Act (2010) the role of a specialist ASD HSPC service is proposed.

This paper provides a detailed review of the research to date exploring the assessment and management of individuals with an ASD detained in HSPC. It outlines key research findings, highlights limitations with it and provides a personal perspective on future research and clinical targets.

Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion of patients detained in high-secure psychiatric care (HSPC), previous research suggests that such individuals present with difficulties and needs significantly different from non-ASD patient groups. However, to date, there has not been any formal examination of how individuals with an ASD are represented in records of key risk management actions (i.e. seclusions and incompatibilities with other patients). The paper aims to discuss these issues.

An observation of hospital data examining two key risk management actions for a group of individuals with an ASD is detained in one HSPC hospital. These include the number of formal incompatibilities with other patients and the number of, and hours in, seclusion. Both actions require extra staff and security provisions and can decelerate the rehabilitation and recovery process.

In addition to suggesting an overall increase in the general prevalence of ASD within the hospital compared to previous estimates, individuals with an ASD appear to have a disproportionately higher number of incompatibilities with other patients compared to those patients without an ASD and experience more and longer periods of seclusions.

Although the methodological limitations of the study are acknowledged, explanations for the findings are discussed along with future research and recommendations as to how ASD patients might be best managed in the hospital. It is argued that the findings add further support for a specialist ASD service within HSPC.

The purpose of this paper is to evaluate autism awareness training provided to staff working in a high secure psychiatric care (HSPC) hospital.

An online survey of staff views who had completed an autism awareness training day.

All staff who completed the evaluation questionnaire reported that an autism awareness training day had been useful and had increased their knowledge of how to work with individuals who have autism. However, most staff also reported that one day was not long enough and that more case discussion would have been helpful. Although most staff also reported that autism awareness training should be mandatory, motivation to attend such training was considered important. In terms of the number of staff who had completed the training, whilst a wide range of staff groups had attended training, only a minority had done so, with the number of staff completing the training each year remaining relatively constant over a five-year period.

Within the context of promoting Enabling Environments in forensic settings and the recent government consultation paper exploring whether autism awareness training should be mandatory for all those working in health care, further investigation is required into how to increase staff motivation to attend autism awareness training and to explore how it is used during everyday work with patients.

As an initial evaluation of optional autism awareness training delivered in HSPC, the project offers some valuable information in terms of the number of staff who attend such training, what they find useful and how it might be improved for this setting.

Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and needs. There is also evidence that if detained individuals with an ASD experience particular difficulties within custodial environments as a result of a mismatch between the difficulties associated with their ASD and the environmental demands. The purpose of this paper is to explore the experience of individuals with an ASD admitted to a high secure psychiatric care (HSPC) hospital.

Using both a semi-structured interview and a quality of life self-report measure (the Lancashire Quality of Life Profile) the experiences and views of seven patients with an ASD detained in one HSPC hospital were qualitatively explored.

Whilst a diverse range of negative and positive aspects of being within HSPC were identified by patients interviewed, those with prison experience thought HSPC was a less stressful environment with more therapeutic opportunities. As a group, patients with an ASD reported a similar or significantly better quality of life in many domains (global, leisure, financial and living situation) compared to other detained forensic patient groups.

Although most patients with an ASD interviewed reported positive experiences, there are a number of practical improvements that could be made within the hospital to reduce experienced stress levels and perhaps improve therapeutic outcomes.

Within the context of the Department of Health's autism strategy (2010) and subsequent update think autism (2014), the survey highlights continued ASD awareness training for staff as important. In responding to the risks and needs of individuals with an ASD in HSPC there is further support for the development of an ASD specialist service.

This paper aims to provide a discussion and summary of a clinician survey exploring the experiences of suspected feigned autism.

This study is an online survey targeting a range of autism professionals, with varying levels of experience, working in different clinical settings.

Approximately half of the professionals who completed the survey reported experiencing situations of suspected feigning of adult autism across a range of clinical contexts and with various motivations. In terms of best indications of potential feigning, most clinicians reported “textbook” self-descriptions of problem behaviours with vague examples, as well as inconsistent presenting problems and mismatch with any known developmental history. Approximately half of clinicians expressed the view that autism was more difficult to feign than a psychiatric disorder and had experienced situations involving differences in professional opinion as to an individual autism diagnosis.

The survey is limited by a potential sample bias and no information regarding the clinical characteristics of those suspected to have feigned autism. However, these initial findings offer further questions for future research to pursue.

As an initial examination of practicing clinicians’ experiences of suspected feigned autism, the survey highlights the complexities of an autism diagnosis and suggests feigning is a potential clinical scenario. Some guidance as to when to suspect possible feigned autism is also offered, as well as a provisional assessment protocol.

This paper aims to examine the relationship between neuropsychological functioning as assessed following admission to a high secure psychiatric care (HSPC) hospital and subsequent time spent in long-term segregation (LTS). Evidence from forensic populations suggests neuropsychological functioning difficulties can increase vulnerability to interpersonal violence. However, the impact of this relationship on restrictive interventions used in these settings is poorly understood.

This study quantitatively examined the neuropsychological profiles of 80 male HSPC patients as assessed during routine admission assessments, comparing data against any subsequent LTS duration during a one-year period, and a non-LTS control (n = 27).

Analysis found individuals who were willing and able to complete a routine neuropsychological admissions assessment spent significantly less time in LTS than those unable to complete the assessment. Performance within a test of novel problem solving (Key Search Test) was significantly worse in the LTS group than controls. Performance within a visual memory task (Immediate Recall section of the Rey Complex Figure Test) significantly correlated with LTS duration. Additional findings suggest the absence of self-reported planning difficulties as measured by a Dysexecutive Questionnaire (DEX) negatively correlated with LTS duration, while self-reported restlessness was positively correlated with LTS.

This has implications for early assessment of LTS risk and potential use of cognitive interventions to reduce the use of restrictive practices.

The results suggest some aspects of neuropsychological performance as assessed during admission to a HSPC hospital appear to be related to subsequent time spent in LTS.

The purpose of this paper is to report an analysis of arrangements in English mental health trusts to meet the needs of adult service users who are homeless. Homelessness is associated with various forms of mental ill-health, yet homeless people are not always well-served by statutory mental health services. In recent years, practice guidance seeking to improve health outcomes for the homeless has emphasised the need for NHS services to improve care pathways and professional provision for this service user group, in part by collaborating more closely with homelessness organisations.

Responses to freedom of information requests sent to trusts were analysed. The requests asked trusts for information concerning partnerships with external agencies, particular projects/staff, training available to trust professionals, referral pathways, and intervention models/approaches informing work with homeless service users.

In total, 49 trusts provided information that could be used in the analysis. Just under half of these had dedicated arrangements or resources, including outreach teams and clinical staff co-located in accommodation and support services for the homeless. The remaining trusts indicated that they either had some limited specific arrangements, such as links between local agencies working with the homeless and existing services, or no dedicated arrangements in place. Training to improve staff awareness around, and knowledge in, working with homeless service users tended to be minimal if provided at all.

This analysis further evidences gaps in the way the needs of the homeless population are addressed by statutory mental health services and adds support to concerns about the homeless having equitable access to care and treatment.

This perspective paper explores ongoing research into stimuli that promote environmental responsibility in family business contexts. It also delineates emerging patterns and possible directions for future research within this domain.

The authors synthesise, critically assess and integrate existing research to make current thinking about the environmental responsibility of family businesses more accessible to a wide range of readers.

This paper offers a comprehensive overview of multifaceted triggers and sheds light on how they interact and influence the environmental performance of family businesses. The authors delve into family dynamics and values, examining how they enable a business to develop environmental responsibility practices. Simultaneously, the authors emphasise the importance of probing the impact of the macro environment within which family businesses operate, which either might incentivise or challenge their pursuit of environmental responsibility initiatives. The need to design a robust tool to measure the environmental consciousness of familiness, applicable to specific contextual settings, has been identified. Investigating how accounting and control systems act as supportive management tools to enhance the efficacy of overall corporate performance in family businesses is another area for future research. Moreover, examining these dynamics within the unique landscape of emerging economies offers a promising field of exploration.

This article consolidates existing research on the environmental responsibility of family businesses and puts forward potential avenues for future research.

To combat climate change, protect biodiversity, maintain water quality, facilitate a just transition for workers and engage citizens and communities, a diversity of stakeholders across multiple levels work together and collaborate to co-create mutually beneficial solutions. This paper aims to illustrate how a 7.5-year collaboration between local communities, researchers, academics, companies, state agencies and policymakers is contributing to the reframing of industrial harvested peatlands to regenerative ecosystems and carbon sinks with impacts on ecological, economic, social and cultural systems.

The European Union LIFE Integrated Project, Peatlands and People, responding to Ireland’s Climate Action Plan, represents Europe’s largest rehabilitation of industrially harvested peatlands. It makes extensive use of marketing research for reframing strategies and actions by partners, collaborators and communities in the evolving context of a just transition to a carbon-neutral future.

The results highlight the ecological, economic, social and cultural reframing of peatlands from fossil fuel and waste lands to regenerative ecosystems bursting with biodiversity and climate solution opportunities. Reframing impacts requires muddling through the ebbs and flows of planned, possible and unanticipated change that can deliver benefits for peatlands and people over time.

At 3 of 7.5 years into a project, the authors are muddling through how ecological reframing impacts economic and social/cultural reframing. Further impacts, planned and unplanned, can be expected.

This paper shows how an impact planning canvas tool and impact taxonomy can be applied for social and systems change. The tools can be used throughout a project to understand, respond to and manage for unplanned events. There is constant learning, constantly going back to the impact planning canvas and checking where we are, what is needed. There is action and reaction to each other and to the diversity of stakeholders affected and being affected by the reframing work.

This paper considers how systemic change through ecological, economic, social and cultural reframing is a perfectly imperfect process of muddling through which holds the promise of environmental, economic, technological, political, social and educational impacts to benefit nature, individuals, communities, organisations and society.

The purpose of this article is to explain recent enforcement trends under the Foreign Corrupt Practices Act (FCPA), providing examples of recent cases.

The paper describes recent trends in FCPA enforcement, including increased enforcement by US authorities, greater vigilance by private industry, and global anti‐corruption efforts. It provides an overview of the FCPA, including the original reason why the Act was passed, its anti‐bribery provisions, the need to show corrupt intent, the interstate commerce requirement, exceptions and affirmative defenses, record‐keeping and control provisions, and penalties. It describes recent FCPA prosecutions and enforcement actions and draws conclusions on how to reduce FCPA risk.

The FCPA is a Watergate‐era law that was passed in response to disclosures by a number of large US corporations that they had made illicit payments to foreign government officials. The FCPA applies to bribes by any US issuer or domestic concern, paid to any foreign official, foreign political party, official or candidate, or official of a public international organization in order to assist in obtaining, retaining, or directing business. To prosecute, the government must show corrupt intent. The FCPA also contains provisions that require accurate record‐keeping and internal controls of US issuers. Violations of the FCPA are subject to both criminal and civil penalties.

The paper presents a thorough explanation, practical advice, and examples of recent violations and penalties by experienced lawyers specializing in FCPA compliance as well as white‐collar defense, securities regulatory matters, internal investigations, and anti‐money laundering.