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This paper aims to discuss an audit evaluation of a specialist independent mental health advocacy service based in the London Borough of Bexley.

The audit included qualitative interviews with ten service users, resident in two specialist forensic mental health and challenging behaviour units. All participants were long‐term in‐patient residents. A number of ethical issues required consideration, in particular respondent confidentiality and informed consent.

Findings indicate that the service's approach, which combines formal advocacy methods with a proactive ethos, had a positive impact on engagement. The importance of trust in the relationships between advocates and service users was also highlighted by the study and is discussed here. The audit also indicates a significant increase in self‐reported wellbeing, self‐efficacy and empowerment for participants. Given that enhancing personal empowerment is one of the primary objectives of the advocacy service, the positive wellbeing outcomes reported are encouraging.

The paper relies on a small number of individuals. There is no attempt to claim representativeness or endeavour to generalise from the findings.

It is recommended that, in the absence of a comprehensive national evidence base, the advocacy needs of patients in forensic and specialist settings be constantly reviewed. Additionally, further action research, to inform educational material and guides for advocacy in specialist settings, may be beneficial and timely.

The objective of this study was to investigate attitudes towards individuals who commit different types of sex offence, with subsidiary aims of exploring the influence of respondent sex and the influence of personal experience of sexual abuse. The sample comprised 139 participants (49 students and 90 forensic staff). All were provided with a vignette depicting a specific type of sex offence, and asked to complete a scale assessing attitudes towards sex offenders (Hogue, 1993). Forensic staff were more likely than students to view sex offenders in positive terms, viewing them as individuals who could be rehabilitated. Participants who reported being victims of sexual abuse, or that someone close to them had been abused, viewed sex offenders less negatively than non‐victims. Men demonstrated less positive attitudes towards child incest and child indecent assault offenders than to stranger rapists. Women held more positive views towards sex offenders than men, and this was consistent across offence type.

Patients treated within secure/forensic settings experience numerous barriers to meaningful vocation, including restrictions under the Mental Health Act, which limit community access. The purpose of this paper is to describe the development of Real Work Opportunities, an inclusive and accessible vocational rehabilitation programme within a forensic intellectual disability service. The programme involved setting up employment and interview workshops, interviews, and interview feedback, and job roles within the secure service, to simulate the real work process.

A reflective account of the development and implementation of the Real Work Opportunity programme with a forensic intellectual disability population.

The programme was well received by the patients involved and a high attendance rate was maintained over time despite the demands that were expected. Roles have been advertised for two employment periods and have had two sets of successful candidates. Patients demonstrated skills development throughout the employment process, including general work-based skills, punctuality and time management, managing duties, responsibility, specific role-related skills, interpersonal skills and personal presentation.

Despite limited experience of work prior to admission, many patients were enthusiastic and motivated to work. The initial trial of the programme has been well received by both patients and staff. Future developments will include widening the number and types of opportunity offered by the programme.

This paper describes a vocational rehabilitation programme for a particularly marginalised population, people with intellectual disabilities within a forensic service. The programme proved highly popular with patients, and enabled them to develop transferable employment skills.

The potential transformative role of recovery colleges is well-documented in community mental health settings. The purpose of this paper is to reproduce the principles of the recovery college approach in a forensic setting in Devon.

This paper describes the inaugural two-year development process, from ideas to a functioning service, accessible to patients in both medium secure, low and open settings on the Langdon hospital site, drawing on qualitative accounts from staff and service users involved.

Creating and maintaining an educational space within the forensic environment where people have real choices to learn and work on their recovery is possible and valued by service users and clinicians alike.

Langdon was one of the first forensic hospitals in the UK to introduce a recovery college, and the report of the positive impact and challenges involved may be useful to others setting out on this journey.

The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care.

The paper uses a retrospective survey of routinely collected incident data from one 207‐bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability.

In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other‐directed aggression, 31.8 per cent self‐harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self‐harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway.

Incidents, especially those of lower severity, can be under‐reported in routine practice. Information about incident severity was limited.

Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility.

This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.

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.

The purpose of this paper is to establish staff and patient opinions on the acceptability, feasibility, and utility of using the Clinical Outcomes in Routine Evaluations – Outcome Measure (CORE‐OM) in secure hospitals.

Patients and nurses (male patients and their key workers) from high, medium and low secure hospitals participated in semi‐structured interviews after completing CORE‐OM or CORE‐OM (SV).

Template themes were acceptability, feasibility, relevance, suitability, changes to treatment, and understanding. Findings suggest that the CORE‐OM is acceptable and potentially useful in secure settings.

This paper suggests that the CORE‐OM is acceptable to patients and staff in secure settings and appears to be a feasible measure for such settings. Further research and accumulation of a referential database of item scores is needed for PROMS, including the CORE‐OM, to be fully useful in secure settings.

This paper will be of use to clinicians working with forensic mental health settings. It is one of only two papers which investigate the use of the CORE‐OM in forensic settings.

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.

Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.

Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).

The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.

To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

Increasing attention is focusing on the role of environments in the rehabilitation of offenders, with a range of reported outcomes in the literature. The purpose of this paper is to explore forensic environments and the outcomes and changes that result, in order to assess the current knowledge in this area and to inform current and future practice.

Using a systematic review approach with an extensive literature search and robust application of appraisal methods, nine studies were identified. The studies included one mixed method study (n=1), qualitative methods (n=4) that utilised thematic analysis, interpretative phenomenological analysis and Foucauldian discourse analysis and quantitative methods (n=4) that utilised the responses to psychometric measures including the EssenCES and correctional institution environment scale (CIES) to assess the quality and outcomes associated with environments in forensic settings.

Three superordinate themes were identified: factors required for successful environments, factors that influence successful environments and factors affected by successful environments.

Further research would be beneficial around motivation, as it appears to influence the success of environments and be a potential outcome of environments. Further research might usefully explore the ideal time in services, for optimal outcomes in order to advise those currently commissioning services of this nature.

In addition to outcomes, this review found factors required for forensic environments that are consistent with previous literature within the field, and factors that might influence how successful environments can be.

The purpose of this paper is to identify the psychosocial approaches that have been studied and for which positive outcomes have been reported for individuals with schizophrenia in correctional and forensic psychiatric settings.

A rapid review of the literature was undertaken. A search was conducted on MEDLINE and PsycNET electronic databases. Each identified approach was analyzed to define their types and components.

In total, 24 studies pertaining to 18 different psychosocial approaches were identified. Half of the studies used a quasi-experimental design with control group. Most frequent outcomes reported were improvements in knowledge about illness and problem solving. Seven studies reported positive outcomes related to issues more specific to this population (violence, aggression, and recidivism). Approaches associated with these studies used mainly traditional cognitive behavior therapy and cognitive remediation. The focus was on neurocognition, social cognition, social skills, emotion management and problem solving.

This rapid review may enlighten clinical settings on psychosocial approaches for which positive outcomes have been reported with individuals with schizophrenia in correctional and forensic psychiatric settings. The picture obtained supports the idea of using integrated rehabilitation approaches that cover the aforementioned intervention focuses with this population.

A significant contribution of the rapid review is based on the analysis of the psychosocial approaches identified. This process offers a closer look at the nature and content of the approaches used according to the outcomes reported.