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The purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK.

Mixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography.

Decisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users’ involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care.

Future research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved.

Clear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care.

While direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews).

Inpatient violence is a substantial problem in psychiatric wards and de-escalation is difficult. When managing instances of violence through verbal techniques fail, mental health-care staff may use restrictive practices. The Six Core Strategies and debriefing exist for managing violence and restrictive practices in different mental health settings. Debriefing is used to get patients’ views on restrictive practices, ensure proper patient care and strengthen the role of patients as experts. This study aims to provide new information on debriefing implementation and how debriefing was used among different patient groups in a forensic hospital.

Quantitative seclusion time and debriefing reports (n = 524) were examined with Poisson regression analysis. Fisher’s exact test was used to determine the associations between debriefing and seclusion/restraint.

Debriefing (n = 524) was provided in 93% of violent episodes, which is an excellent result on an international level. There was significant variation in how often debriefing was used (p < 0.001) among different patient groups, i.e. dangerous, difficult-to-treat patients and criminal offenders whose sentences have been waived. Previous debriefing research has rarely specified what types of psychiatric patients have been subjected to seclusion or restraint.

The implementation of debriefing requires multiprofessional work within the organization and wards.

Debriefing seems to stimulate reflection at every level of a health-care organization, which fosters learning and can ultimately change clinical practices. The use of debriefing can strengthen the role of patients as well as professionals.

This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services.

A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having “major” relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes.

There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery.

This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English.

This review makes a unique contribution, highlighting that, to the best of the authors’ knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary.

This study aims to examine the scope and contribution of Forensic Clinical Psychology (FCP) advice from the National Crime Agency (NCA) to criminal investigations in the UK to address the gap in current knowledge and research.

The 36 FCP reports reviewed were written between 2017 and 2021. They were analysed using Toulmin’s (1958) application of pertinent arguments to the evaluation process. The potential utility of the reports was analysed in terms of the advice provided.

Most of the reports involved murder and equivocal death. The reports focused primarily on understanding the offender’s psychopathology, actions, motivation and risk to self and others using a practitioner model of case study methodology. Out of the 539 claims, grounds were provided for 99% of the claims, 91% had designated modality, 62% of the claims were potentially verifiable and 57% of the claims were supported by a warrant and/or backing. Most of the reports provided either moderate or high insight into the offence/offender (92%) and potential for new leads (64%).

The advice provided relied heavily on extensive forensic clinical and investigative experience of offenders, guided by theory and research and was often performed under considerable time pressure. Flexibility, impartiality, rigour and resilience are essential prerequisites for this type of work.

To the best of the authors’ knowledge, this study is the first to systematically evaluate forensic clinical psychology reports from the NCA. It shows the pragmatic, dynamic and varied nature of FCP contributions to investigations and its potential utility.

The purpose of this paper is to examine the awareness of intellectual disabilities (ID) amongst professionals in the criminal justice system (CJS) and their knowledge of those persons, either as victims, witnesses, suspects, accused or defendants.

A survey of the professionals in the CJS (n=388), combined with a series of focus group interviews with experienced professionals (n=20), was conducted.

One out of three respondents (police, district attorneys and judges) reported that they have regular contact with suspects who have an ID. Differences in knowledge of ID amongst professionals in the CJS can explain awareness and detection of persons with ID.

Non-responders may represent professionals with no knowledge or less interest in these issues.

Reflections on ID have not previously been studied in the Norwegian CJS. The findings serve as a basis and status quo for further research.

The rate of female committals to prison has grown rapidly in recent years. Women in prison are likely to have trauma histories and difficulties with their mental health. This paper aims to synthesise the findings of qualitative literature to gain a deeper understanding of the experiences of women in the context of prison-based mental health care.

A systematic search of five academic databases, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, Psychological Information Database (PsycINFO), Excerpta Medica DataBASE (EMBASE) and Medline, was completed in December 2020. This study’s search strategy identified 4,615 citations, and seven studies were included for review. Thomas and Harden’s (2008) framework for thematic synthesis was used to analyse data. Quality appraisal was conducted using the Joanna Briggs Institute Checklist for Qualitative Research (Lockwood et al., 2015).

Four analytic themes were identified that detail women’s experiences of prison-based mental health care: the type of services accessed and challenges encountered; a reduction in capacity to self-manage mental well-being; the erosion of privacy and dignity; and strained relationships with prison staff. There is a paucity of research conducted with women in the context of prison-based mental health care. The findings suggest there is a need for greater mental health support, including the need to enhance relationships between women and prison staff to promote positive mental health.

To the best of the authors’ knowledge, this is the first systematic review conducted on the experiences of women in the context of prison-based mental health care.

The aim of this study is to investigate the roles of psychiatric mental health nurses during their work experiences in inpatient clinical settings.

A focus group of 10 graduate psychiatric nurses with more than two years’ practice in inpatient psychiatric settings reflected on their last six months’ work placements and continuous employment. The transcripts and field notes were analyzed through thematic analysis of inductive data.

Two main themes emerged: management roles and clinical roles. The participants reflected on caring activities and obstacles encountered in fulfilling their professional roles.

Multiple practice issues emerged. The participants perceived that psychiatric nurse specialists are required to perform more caring functions than practicable in the inpatient setting due to an excess of noncaring duties, structural minimization of the caring role and inadequate training. They felt that many of the functions performed were not within their expectations of the caring role of a psychiatric nurse specialist and believed that changes in nurse education and attention to clarification of nurses’ roles might enhance the role they play in patient care.

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings.

Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed.

To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.

Goal setting is a crucial aspect of client-centered practice in occupational therapy (OT) for mental health conditions. However, it remains to be seen how goal-setting has been delivered in mental health, particularly the OT process. The purpose of this scoping review was to explore the nature and extent of goal setting delivered in mental health and informed OT practice.

The authors followed the guidelines of Arksey and O’Malley (2005) and searched three databases using key search terms: “mental disorder,” “goal setting,” and “occupational therapy” and their synonyms.

After excluding duplicate records, the authors initially screened 883 records and resulted in 20 records in total after the screening process. Most of the identified articles used goal-setting delivered by both a health professional and a client (n = 14), and focused on people with schizophrenia or schizoaffective disorder (n = 13), but three interventions were delivered by occupational therapists. Further research needs on goal-setting in mental health OT, exploring the reliability and validity of different goal-setting strategies and investigating the effectiveness of goal-setting for promoting behavior change and client engagement across various mental health conditions and settings.

The scoping review has some limitations, such as not investigating the validity and reliability of goal-setting strategies identified, and excluding conference papers and non-English articles.

This scoping review presents a mapping of how goal-setting has been delivered in mental health and informed OT practice. The findings suggest limited research in OT and highlight the need for more studies to address the evidence gap in individualized client-centered OT.

A parent who continuously physically abuses her/his child doesn't aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12%) were caused by child battering and 13 (7%) by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot) and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse) were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent) and often substance dependence (31%). None of them were psychotic. Authorities and community members should pay attention to the change in child's behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent's life, the child may be in danger.