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The aim of the project was to evaluate the short‐term treatment outcomes of patients treated in a medium secure service for people with intellectual disability. A total of 138 patients, 77 discharged and 61 current inpatients, treated over a six‐year period were included in the audit. Information on demographic and clinical variables was collected on a pre‐designed data collection tool and analysed using appropriate statistical methods. The median length of stay for the discharged group was 2.8 years. About 90% of this group were discharged to lower levels of security and about a third went directly to community placements. None of the clinical and forensic factors examined was significantly associated with length of stay for this group. There was a ‘difficult to discharge long‐stay’ group which had more patients with criminal sections, restriction orders, history of abuse, fire setting, personality disorders and substance misuse. However, when regression analysis was done, most of these factors were not predictive of the length of stay. Clinical diagnosis or offending behaviour categories are poor predictors of length of hospital stay, and there is a need to identify empirically derived patient clusters using a variety of clinical and forensic variables. Common datasets and multi‐centre audits are needed to drive this.

The purpose of this paper is to provide an overview of the implementation of a peer support volunteer scheme in a high secure setting and to explore the peer support volunteer’s experiences conducting this role, based predominantly on an assertive rehabilitation ward.

This paper has outlined the implementation of the peer support volunteer scheme in a high secure setting and has explored the peer support volunteer’s experiences conducting this role and has explored the views of newly transferred patients who have accessed this scheme. The peer support scheme is based predominantly on an assertive rehabilitation ward. The data have been collected through the completion of detailed questionnaires that have been disseminated to participants through the clinical team.

This paper has outlined the implementation of a peer support scheme on an assertive rehabilitation ward within a high secure forensic mental health setting. This paper has explored the role and experiences of a peer support volunteer on an assertive rehabilitation ward and has explored the experience from a service recipient’s perspective also through the completion of questionnaires. This paper has explored the overall benefits of peer support within mental health services to both the volunteer, staff members and to a patient newly admitted to the ward, and has identified the skills that the volunteer is able to develop following contribution in to the peer support scheme.

This paper has acknowledged that there have been challenges introducing this particular scheme into mental health service teams. Challenges have included establishing appropriate boundaries and dilution of the role due to power imbalances, both between the peer support volunteer and the service recipient, but also between the clinical team that supervises the overall peer support scheme (Christie, 2016). The clinical team within this particular ward have been mindful with regards to the approach that has been utilised and has therefore, included the service users within the overall development of the scheme to encompass the recovery principles, but have continued to review the progression as a team and have taken into consideration all aspects of relational security.

The paper relating to the implementation of the peer support volunteer scheme in a high secure setting has not been published before and is not under consideration for publication with another journal.

Discharge preparation from high to medium levels of security has received little attention from researchers to date, but is a critical stage in a patient's pathway. This paper aims to capture the perspectives of patients who are preparing to move on from high to medium security.

Nine patients who were in the “discharge preparation” stage of their pathway were interviewed to capture their perspectives on the process. Interview transcripts were analysed using thematic analysis.

Nine themes were identified as representing the patient interviews: trust and support, feeling empowered, journey of self-acceptance, skilling-up, getting to know the Medium Secure Unit (MSU), feeling disempowered and unvalued, issues with the system, anxiety about endings, and stigma and society.

This paper gives voice to patients across clinical directorates at a UK high secure hospital regarding their perspectives on what has helped and hindered their discharge preparation. It presents some new findings, and recommended good practice, which should be of use to clinicians and managers who wish to enhance discharge preparation interventions for patients within high secure services.

How should we judge a readmission to high secure psychiatric services? A case‐by‐case view is insufficient to make sense of potential service deficiencies. People in high secure psychiatric settings more often than not test our services and cause considerable alarm. The local clinical response is to seek to improve the condition, and they enter the high secure service. The political, legal and clinical imperatives ensure that patients return just as soon as they are ‘fit’. This paper details the career paths of 11 ‘readmissions’ to Ashworth Hospital, now part of Mersey Care NHS Trust, and suggests that it is more a question of tackling gaps in our combined services than of ascribing individual failings.

Recent changes in UK immigration policy have led to increasing deportation of foreign national offenders and more than 5000 were deported in 2008. This rise follows a review in 2006 which found that some foreign national offenders were being lost due to disposal or transfer through mental health services. As a result, a department was set up within the United Kingdom Border Agency (UKBA) to identify and review those detained under Restrictions Orders who were due to be conditionally released from hospital, so that they could be considered for deportation. As a result of these changes, forensic clinicians are more frequently presented with detained patients who have immigration problems that can lead to problems in the care pathway through secure services. A local audit was carried out in an inner‐London medium secure service to quantify the number of detained patients who are born abroad, and to review their care pathways to determine whether they are affected by immigration difficulties. It is hoped that the discussion of the issues identified by this audit can support service improvement and provide better care for patients in medium secure services.

In the present climate of risk assessment and management, the risk posed by the mentally disordered offender might be considered central to the role of mental health professionals working with this population. To discipline risk is a challenge that involves making something uncertain somehow quantifiable, so that decisions about the short‐longer‐term future of another individual can be made and justified (Rose, 1998). Although unauthorised patient absence from secure hospitals in the UK is an infrequent phenomenon, there are often prominent repercussions, perpetuated by negative media coverage, often resulting in responses from the highest political level. This article will attempt to highlight known statistics on absconsion from secure hospitals, including frequency and consequences, and impact of negative media coverage and various reviews, inquiries and proposed recommendations, which have resulted in the proposed reforms of the Mental Health Act 1983. Finally, the article will outline the work conducted by the social work department at Chadwick Lodge and Eaglestone View (medium secure hospitals) in the development of an 'absconsion pack'. This development provides an example of safe practice through its use of collaborative inter‐professional and multidisciplinary team working, resulting in a procedure that should reduce the risks in the event of an absconsion from a medium secure hospital. The wider implications of this work will be discussed.

There are few reliable psychometric measures of the psychopathology of offenders with intellectual disabilities (ID). However, previous research has indicated that the emotional problems scale (EPS) is useful in identifying a range of treatment needs and in predicting risk to self and others. The purpose of this paper is to compare the severity of the emotional and behavioural problems of a small sample of offenders with ID in medium and low secure services, as assessed by EPS. Additionally, the data are tentatively compared with those reported in previous research to precipitate discussion regarding the changes in clinical populations in secure care over time.

The study collected demographic and EPS data for patients with ID (n=25) on medium secure and a low secure wards. Data were collected as part of routine clinical practice, with EPS forms being completed by nursing and other multi-disciplinary staff.

It was found that there was no statistically significant difference in EPS scores between medium and low secure patients with ID. The authors also highlight differences between the current sample and the normative data collected by previous research.

The data regarding the psychopathology of medium and low secure patients with ID provide insight into the ever changing resourcing needs and risk profiles of this complex patient group. In addition, there is a dearth of empirical research that comments on the clinical differences observed over time in forensic populations. As the current data differ from pre-existing normative data, the potential shift in populations and also implications for the accuracy of clinical decision making based on the assessment are discussed.

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation on aspects of trauma experience and post‐trauma symptoms in the current population. File information and self‐reports indicated that most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma‐related symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was limited information about the events themselves, and there was no information to suggest that any trauma‐specific assessments had been used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma‐specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and abuse by conducting routine structured assessments, offering adapted evidence‐based psychological interventions where appropriate, and providing trauma‐specific education for staff to promote a compassionate approach.

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.

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.