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The purpose of this study is to analyse the characteristics of all the referrals to the forensic MHIDD service over the past five years and to compare these characteristics to the cohort of service users attending the three general MHID services based in Dublin which are Service 1, Service 2 and Service 3.

This is a cross-sectional study of adults attending the three generic MHID services and the national forensic MHIDD service. The medical files of service users attending the MHID services were reviewed, and data such as age, gender, level of intellectual disability and psychiatric diagnoses were extracted and compiled into a database. The forensic MHIDD service has since its inception maintained a database of all referrals received and reviewed. The characteristics data needed were extracted from the forensic MHIDD database. All these data were then analysed using the Statistical Package for Social Sciences (SPSS).

The majority of the three MHID service users were in the moderate to profound range of intellectual disability, while the majority of the cases assessed by forensic MHIDD had normal IQ, borderline IQ and mild intellectual disability with 66.1%. The prevalence of neurodevelopmental disorder, schizophrenia and emotionally unstable personality disorder in the forensic MHIDD is comparable to the three MHID services. The prevalence of depression, bipolar affective disorder (BPAD), anxiety disorder and obsessive-compulsive disorder (OCD) is higher in the three MHID services than in the forensic MHIDD service.

The FHMIDD received referrals at a greater level of overall ability, with two-thirds of the service users having mild intellectual disability to normal IQ. The prevalence of neurodevelopmental disorder such as ASD and schizophrenia is comparable between the forensic MHIDD and the three MHID services. There is a higher prevalence of depression, BPAD, anxiety disorder and OCD in the three MHID services as compared to the forensic MHIDD service.

Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.

A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.

Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.

Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.

To the best of the authors’ knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

Service users’ voice is at the forefront of movements within psychiatry that look to create more humanising care. Although genuine co-production of knowledge is limited by the power differential intrinsically functional to the health care setting, the arts have the potential to create collaborative environments and equalise relationships. The purpose of this case study is to describe and discuss the design and pilot evaluation of creative writing workshops in a forensic mental health ward as an innovative method for humanising care.

A creative writing intervention focussing on everyday experiences was implemented in a forensic mental health ward and involved four residents and four mental health professionals working together. Interviews were conducted with the four mental health professionals as part of a service evaluation. Transcripts were analysed using thematic analysis.

Two themes emerged from the analysis of interviews with mental health professionals: “a new way of learning about each other” and “imagining beyond the staff-resident relationship”. The authors discuss the intervention’s benefits in terms of its potential to foster mutuality and empathy beyond the illness narrative.

Creative writing can be used to engage patients and mental health professionals to jointly share everyday experiences and identities beyond illness.

The creative writing workshops present an innovative approach concerning the use of creative arts for humanising care through mutuality.

The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.

A systematic review of qualitative literature was conducted. The data was sourced from the electronic databases: PsychINFO, CINAHL, Medline and the Web of Science Core Collection using pre-defined search terms. A total of 17 studies, conducted in various countries worldwide and covering high, medium and low secure inpatient settings, were included for review. The analysis involved integrating findings from across the literature and was guided by thematic synthesis.

A total of eight themes were generated from the data, three of which provided an understanding of the experience of forensic secure care, and the remaining five themes provided an understanding of the factors which may influence the experience of secure care.

Developing understanding of patient experience can lead to service improvements, potentially impacting patients’ motivation and engagement and thus reducing admission times, potential recalls and recidivism.

To the best of the authors’ knowledge, this is the first systematic review to date to exclusively explore the broad topic of the patient experience of secure mental health care.

Readmission to hospital can be distressing, costly for the National Health Service (NHS) and legally it should be a last resort as it entails restriction of liberty. This study aims to develop an understanding of factors leading to readmission for a cohort of service users under the care of a community forensic mental health team (CFMHT) in England to consider how support could be improved to reduce incidence of future readmissions.

Thematic analysis was used to examine case recording relating to 13 service users who were readmitted to hospital within a specified time period. The same service users were invited to complete questionnaires regarding their views of what contributed to the readmission to cross-reference with themes identified.

The analysis of case notes produced eight sub-themes. These were sorted into three overarching themes, illustrating the challenges that service users face upon discharge from hospital, the sense they make of these challenges and the impact upon relational patterns, in particular with the CFMHT. Researchers highlight that the multiple challenges can increase service users’ sense of being under threat which can lead to distrust of professionals.

Practical suggestions arising from the study were fed back to the subject team and are listed at the end of the paper.

Findings from this study parallel those previously reported. This study contributes an inter-relational aspect of the factors and the central role of meaning-making in the path of recovery and building a life in the community.

Stalking is considered a public health priority with a range of adverse outcomes. This paper aims to explore existing literature on children and adolescents as perpetrators of stalking, with a focus on rates of stalking and victim and perpetrator characteristics associated with stalking.

A review of research where stalking was engaged in by those 18 years old and younger was conducted, where 17 manuscripts met criteria for review.

This review found a prevalence of young people engaging in stalking of between 5.3% and 36%. Considerations including demographics, typologies, prior relationship characteristics, stalking and pursuit tactics, cyberstalking and a brief consideration of the impact are given.

Literature considering perpetration remains thin, and future research should seek to move towards a widely acceptable definition of stalking, as well as considering effective interventions for early intervention, and to consider the role of mental health services in supporting perpetrators and victims, who may not always be mutually exclusive groups.

This paper extends previous literature reviews; the authors understand this to be original work that contributes to a gap in the literature.

The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.

Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

Secure mental health services in one UK region have acted within a network to develop a range of involvement practices. A new quality benchmarking tool has been created to appraise the implementation of these involvement practices. The purpose of this paper is to report upon a qualitative evaluation of this development.

Staff and service users involved in the co-production of the benchmarking tool were engaged in a series of focus groups and participatory inquiry approaches enacted in the course of scheduled network meetings. Data thus collected was subject to thematic analysis.

Four distinct themes were identified which were titled: Taking time, taking care; The value not the label; An instrument of the network; and All people working together. These are discussed in relation to recent theorising of co-production.

Effectively, this study represents a case study of developments within one region. As such, the findings may have limited transferability to other contexts.

Staff and service users can work together effectively to the benefit of each other and overall forensic services. The benchmarking tool provides a readymade mechanism to appraise quality improvements.

Despite a prevailing culture of competition in wider health-care policy, cooperation leads to enhanced quality.

The benchmarking tool is a unique development of a longstanding involvement network, demonstrating the positive implications for enacting co-production within secure services.

In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide “lockdown” of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients’ perspective.

A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021.

Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients’ experience: “treading water”; how they managed: “learning to swim”; and what was helpful during this time: “in the same boat”.

Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research.

To the best of the authors’ knowledge, this is the first study to explore secure patients’ experience of COVID-19 from the patients’ perspective, within a population often neglected within recovery research.