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An association between problematic substance use and severe mental illness has been demonstrated in various settings, but not among community forensic psychiatric patients. This paper aims to investigate the prevalence and correlates of problematic substance use among the community patients of one regional forensic psychiatric service.

Historical data on diagnosis, offending and problematic substance use were gathered by reviewing case notes. Current substance use and psychosocial functioning were ascertained from structured interviews with community psychiatric nurses. Outcome measures included HoNOS ratings, the Global Assessment of Functioning, and the Clinical Rating Scale for substance use.

Of 92 patients, 91.2 per cent had a history of problematic substance use and 31.5 per cent of them were currently using substances problematically, most commonly cannabis and alcohol. Current problematic substance use was associated with a range of negative outcomes, in terms of illness severity, compliance with treatment, and psychosocial functioning.

The results may not be generalizable to services in different areas or those with different models of service provision. Causality should not be assumed from a cross sectional study.

Inpatient psychiatric treatment in secure services appears to be associated with a large reduction in the level of problematic substance use, but a large residual need remains among community patients. Services which provide community care for forensic patients must seek to integrate treatment for problematic substance use with treatment for mental illness.

This is the first description of the substance use related needs among community forensic psychiatric patients.

There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these services. There is longstanding tension between security and treatment that can be difficult to resolve. Solution‐focused ideas may provide a bridge between these two issues, by improving multi‐disciplinary working and providing an appropriate relationship style that optimises the delivery of care to forensic patients.

The purpose of this paper is to develop a medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe.

Grounded theory of the Charmaz (2006, 2014) persuasion was used. An exploratory qualitative design was utilised. The theoretical framework that was used as a point of departure was Pierre Bourdieu’s conceptual canon. Participants were purposefully and theoretically sampled. These included the judiciary, patients, patients’ family, psychiatrists, nurses, social workers, experts in forensic psychiatric practice. They were 32 in total.

The findings reflected a need to realign the dislocation and dissonance between and within the fields of the prison system, medical system, and the judiciary. The realignment was done by co-constructing a therapeutic jurisprudent medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe with participants who were stakeholders in forensic psychiatric rehabilitation.

The study was focused on male forensic psychiatric patients rehabilitation and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. However, it is possible that including females in the study could have added perspective to the study. This also limits the generalisation of findings beyond the male forensic psychiatric participants. Services beyond the experience of participants translate to the notion that findings cannot be generalised beyond the parameters of the study. Future research and service evaluation and audit need to be considered. The study findings focused on the “psychiatric” aspect and did not emphasise the “forensic” aspect of the service delivery service. Future research may need to feature physical provisions and progression pathways with reference to “forensic” risk reduction as a parallel goal.

The study calls for the following: Transformation of the medico-judicial system, adjusting legislation and restructuring of the public service; changing of public attitudes to enable implementation of the medico-judicial framework; there is need for a step by step process in the implementation of the framework in which training needs of service staff, social workers, community leaders and key stakeholders will need to be addressed; the proposed changes presented by the model will require cultural, financial and infrastructural shifts.

There is need for policy makers to re-enfranchise or rebrand forensic psychiatric rehabilitation services in Zimbabwe. This could positively involve the marketing of forensic psychiatric rehabilitation to the stakeholders and to the public. This is projected to counter the stigma, disinterest and disillusionment that run through both professionals and public alike. This will foster a therapeutic jurisprudence that upholds the dignity and rights of forensic psychiatric patients.

This work is an original contribution to forensic psychiatry in Zimbabwe. Research in that area is prohibitive because of the complexity of processes that are followed. This research is therefore ground breaking.

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

In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian government several convictions from the Human Rights Court in Strasbourg. In an attempt to facilitate admissions from penitentiary to psychiatric hospital, the Forensic Department of the psychiatric hospital in Rekem (OPZC Rekem), has piloted the InReach project. The paper aims to discuss these issues.

The objective of this project is to engage a psychiatric nurse on the ward in pretherapeutic and motivational activities on a regular basis in the penitentiary for vulnerable groups of forensic psychiatric patients, forming a bridge between penitentiary and hospital. The InReach project even considers patients who have no desire to leave the penitentiary (e.g. due to their psychiatric profile). A motivational approach is used to support these patients in making the transition from penitentiary to hospital.

The current article describes the focus of the InReach project (procedures and InReach candidate profiles) together with the first impressions of the progress that has been made by the InReach project. In addition two case studies of InReach patients are presented. The InReach project is clearly needed in Belgium and because of its success it has been extended to another penitentiary. It is probable the two other medium-security wards will also be included in the project in the near future.

The Belgian government has received several convictions from the Human Rights Court in Strasbourg because a substantial number of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. The InReach project presented in this paper is clearly needed in Belgium and was implemented to initiate and facilitate the transition from penitentiaries to treatment facilities. The need for this type of project is reflected in the number of forensic psychiatric patients that reside within a penitentiary and that are not able or willing to make the transition to a treatment facility because of their psychiatric profile.

Various attempts have been made to understand and resolve the enduring lack of cohesiveness of multidisciplinary teams (MDTs), their dysfunctional service delivery and the feelings of distress among some of the professionals who work in them. Distortions in forensic MDTs have sometimes compromised service delivery and effective risk management. Several public inquiries relating to high‐profile incidents in forensic mental health have noted the role of dysfunctional MDTs. This paper describes the philosophy, structure, functions and achievements of a forensic community MDT in Wellington, New Zealand. It explains a model of care that is adaptable, comprehensive, effective and evidence‐based. It highlights the role of the extended MDT and embedded cultural units from which care professionals work together, share a common philosophy of care and tailor their care to the needs of the individuals or populations they serve.

Forensic psychiatric treatment is aimed at reducing violence risk factors (Bonta and Andrews, 2017) and achieving positive, prosocial life goals (Willis et al., 2013). Drama education can be provided as part of this treatment, but the evidence base is scarce. Therefore, the present study aims to provide insight into experiences with drama education as part of forensic psychiatric treatment.

A qualitative study was conducted, based on participant observation and 16 interviews, to explore the experiences of patients and treatment providers with drama education during forensic psychiatric treatment. Analyses were conducted following the consensual qualitative research method (Hill et al., 1997).

The five central themes that emerged from the analysis were knowledge, happiness, excellence in play, community and staff-patient hierarchy. Participants reported that they enjoyed the drama lessons, appreciated the group atmosphere and were able to practice their social-emotional skills. Furthermore, patients and their treatment providers became better acquainted with each other because the power differences between patients and staff decreased during the drama lessons.

Drama education can be considered a useful part of clinical forensic psychiatric treatment, given the positive experience of participants and its perceived positive impact on treatment.

This was one of the first studies to examine the influence that drama education may have on forensic psychiatric treatment. Four of the five themes were in line with the good lives model (Willis et al., 2013), indicating that drama education fulfiled basic human needs or “primary goods” that are important to address in forensic psychiatric treatment, as it decreases the need to compensate these goods with criminal behaviour.

There is a considerable body of research on the assessment and prediction of aggression in psychiatric hospitals. A range of clinical and demographic characteristics associated with aggressive inpatients, such as young age and active symptoms of psychosis, have repeatedly been shown to contribute to aggression. Environmental factors have also been shown to be important. The study examined aggressive behaviours in an Australian forensic psychiatric hospital, using aggression‐specific recording instrumentation developed for the study. The purpose of the study was to compare results using aggression specific‐recording instrumentation with a previous study using retrospective methods relying on standard hospital incident forms, and to examine the relationship between type, direction and severity of aggression with the use of seclusion.In contrast with the results obtained in a previous study, staff rather than patients were more often the victims of both verbal and physical aggression, although patients were more frequently the victims of more severe forms of aggression. Patients were verbally and physically aggressive towards other patients at similar rates, although they were more frequently verbally, rather than physically, aggressive to staff. Acute wards recorded more aggression than rehabilitation wards. Males and females were aggressive at similar rates. A reduction in reported incidents of verbal and physical aggression, particularly against staff, occurred over the course of the study. Patients were secluded and incident forms were completed following approximately 30% of aggressive behaviours. Whether or not a patient was secluded and whether or not an incident form was completed depended on a range of factors, including the nature of the victim and the type and severity of the aggression.

The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.

The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done.

Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented.

The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting.

This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.