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This study aimed to explore how forensic mental health service users make sense of their past adverse experiences. Secondly, it aimed to explore whether service users considered their adverse experiences to be related to their current stay in a forensic mental health setting.

Interpretative phenomenological analysis was used to analyse interviews with eight service users in low and medium secure care. Six of the participants were male and two were female.

Four super-ordinate themes emerged from the data: “Living amongst adversity”; “Managing adverse experiences”; “Making sense of going into secure care”; and “Coping with the past in the present”. All participants referred to multiple adverse experiences throughout their lives and used harmful coping strategies to manage these. Individual differences in how they related their past experiences to their detention in secure care were evident.

Author guidelines state that this section is optional. Implications for clinical practice are discussed at length in the discussion section.

This study offers an insight into the way in which forensic mental health service users make sense of their past traumas in relation to their current admission to secure services. To the best of the authors’ knowledge, no research has previously addressed this from the perspective of service users.

Peer support workers (PSWs) are individuals with lived experience of mental health difficulties, who apply this to support and inspire others in their recovery. The role of PSWs is relatively new within the forensic health-care service. Although there has been little time for these roles to develop, PSWs have successfully integrated into community teams. Despite perceived benefits of having these workers within a multi-disciplinary team (MDT), the views held by mental health professionals in forensic services have not yet been studied. The purpose of this research is to develop an understanding of the experiences of staff working with PSWs in a community forensic team and the impact this has on them.

Structured, individual interviews were conducted with eight mental health professionals, from a variety of disciplines, used across two community teams within forensic services. The data was examined according to thematic analysis.

The data indicated general positive attitudes held by professionals surrounding the working with PSWs, including the themes “providing alternative perspectives”, “unique relationships” and “hope”. Yet, themes concerned around “role ambiguity”, “boundaries” and “the impact on PSWs” also arose.

This study provides insight into the attitudes held by members of an MDT of working with PSWs. Although seemingly positive, the lack of clarity around the role of the PSW is problematic.

To the best of the authors’ knowledge, this is the first study to explore the employment of PSWs in the context of UK forensic settings, highlighting the benefits and challenges of such from the perspective of staff.

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.

The study aimed to identify occupational stressors and measure experiences of clinical burn‐out among a group of mental health nurses and occupational therapists in a medium secure service. All the nursing staff (n=115) and occupational therapists (n=9) on three wards in a medium secure hospital were asked to partake in the study, and to complete a modified version of the Psychiatric Nurse Occupational Stress Scale (PNOSS), the Maslach Burnout Inventory (MBI) and a demographic questionnaire designed for the study.Results from the PNOSS revealed that organisational issues elicited the greatest stress and were most strongly related to high burn‐out scores, identified by the MBI. Limited resource and staff conflict were also associated with stress and burn‐out. Patient care had a relatively small impact. MBI findings were that a substantial proportion (54%) were experiencing high burn‐out in relation to emotional exhaustion.

The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with intellectual disability (ID), autism and mental health, behavioural or forensic needs in the UK.

The concept of rehabilitation is discussed, as well as the functions and goals of specialist inpatient rehabilitation services with regard to the aforementioned contexts. Current use of rehabilitation beds is considered, both on a regional and national scale, as well as various outcome measures, including effectiveness, patient safety and patient experience.

There is a clear need for specialist inpatient rehabilitation services, though historically there have been instances of inappropriate admissions, as well as lengthy inpatient stays that could have been significantly reduced with the right type of community support package. Such services should be subjected to rigorous measurement of outcome measures, to determine that patients within such services are receiving a consistently high standard of care. Additionally, amendments to current legal frameworks should be considered, with a view to accommodating for individuals with capacity who require continuous community-based supervision.

To the best of the author’s knowledge, this is the first article detailing a professional consensus position for specialist inpatient rehabilitation services for people with ID, autism and mental health, behavioural or forensic needs.

Despite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium.

A case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors.

The study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives.

These findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills.

To the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

This study examines the implementation of the recovery model or ‘philosophy’ in a secure NHS forensic service. Twenty‐six (86.7%) staff and seventeen (70.8%) mentally disordered offenders (MDOs) were interviewed in Spring 2009 from the rehabilitation and pre‐discharges units in a medium secure forensic service in Kent, UK. Their views on recovery were measured using the Developing Recovery Enhancing Environments Measure (DREEM: Ridgeway & Press, 2001). Staff consistently rated all 24 elements of recovery as more important than the MDOs. Staff also rated the elements of recovery as better implemented, except Intimacy and Sexuality. There was a significant effect of MDOs' forensic history (restriction status and index offence type) on ratings of how well elements of recovery were implemented. Staff and MDOs rated all elements of recovery as at least moderately important (above median value). The implications of the recovery philosophy in forensic mental health services are discussed.

In the prison system there are high percentages of mentally disordered offenders, often with co‐morbid psychiatric disorders. In addition, the setting and ward atmosphere in prisons are not designed to care for psychiatric patients and places a burden on vulnerable inmates. Management of care of the different subgroups in the prison population is therefore necessary on four different levels, from basic health care to forensic psychiatric treatment. A fifth level is forensic care, which is directed towards re‐integration into the community rather than treatment at the symptom‐level of disease. Continuity of care, evidence‐based care and coercion within mental health care are discussed with regard to their forensic ethical meaning towards both patients and the community. Drawing on the Dutch situation a case is made for the promotion of voluntary treatment for those prisoners

The purpose of this paper is to assess the training forensic mental health professionals in the USA receive on intellectual and developmental disabilities (I/DD). Given the difficulties obtaining accurate prevalence rates of these disabilities in criminal justice settings, it is important to understand how these disabilities are being evaluated and the level of understanding about these disabilities evaluators hold.

An online survey was distributed to forensic mental health professionals in the USA that included questions on training opportunities in graduate education, post-graduate forensic training, and professional training opportunities. Participants were also asked about their current work, how they assess I/DD, and their estimates on the percentage of cases they see with I/DD.

Respondents reported some training that focused heavily on assessment methods. Most respondents estimated between 5 and 25 percent of their cases involving I/DD and reported using a wide range of assessment methods. Finally, many respondents reporting more training needed in this area.

More training is needed for forensic mental health professionals on identifying I/DD. Additionally, professional guidelines on what tools and methods to rely on to identify these disabilities is paramount to ensure homogeneity of methods and, thus, better estimates of overall prevalence in criminal justice settings.

This is the first assessment focused on how forensic mental health professionals are trained to identify I/DD and can be used to improve identification of I/DD in forensic settings.

The topic of offender rehabilitation has been subject to much research over the past decade. Numerous meta‐analytic reviews of offender treatment, particularly group treatment based on cognitive behavioural principles, have been reported. Together with the ‘triad of principles’ — risk, need and responsivity — they have formed the foundation upon which most offending behaviour interventions have developed. However, outcome data from existing programmes provides mixed evidence, and evidence for interventions for those in forensic mental health settings are still in their infancy. This paper critically considers the current evidence for the treatment of offending behaviour, and its application in forensic mental health settings, in order to inform development of such treatments in low secure mental health care. Most of the research focuses on non‐mental health settings, and is largely what will be considered here. The paper concludes that low secure interventions need to capitalise on the evidence of ‘what works’ while revisiting key concepts such as ‘dose’ and responsivity in order to design appropriate treatments. Individual outcome evaluation needs to form part of development in this area.