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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.

The purpose of this study is to analyse the characteristics of all the referrals to the forensic MHIDD service over the past five years and to compare these characteristics to the cohort of service users attending the three general MHID services based in Dublin which are Service 1, Service 2 and Service 3.

This is a cross-sectional study of adults attending the three generic MHID services and the national forensic MHIDD service. The medical files of service users attending the MHID services were reviewed, and data such as age, gender, level of intellectual disability and psychiatric diagnoses were extracted and compiled into a database. The forensic MHIDD service has since its inception maintained a database of all referrals received and reviewed. The characteristics data needed were extracted from the forensic MHIDD database. All these data were then analysed using the Statistical Package for Social Sciences (SPSS).

The majority of the three MHID service users were in the moderate to profound range of intellectual disability, while the majority of the cases assessed by forensic MHIDD had normal IQ, borderline IQ and mild intellectual disability with 66.1%. The prevalence of neurodevelopmental disorder, schizophrenia and emotionally unstable personality disorder in the forensic MHIDD is comparable to the three MHID services. The prevalence of depression, bipolar affective disorder (BPAD), anxiety disorder and obsessive-compulsive disorder (OCD) is higher in the three MHID services than in the forensic MHIDD service.

The FHMIDD received referrals at a greater level of overall ability, with two-thirds of the service users having mild intellectual disability to normal IQ. The prevalence of neurodevelopmental disorder such as ASD and schizophrenia is comparable between the forensic MHIDD and the three MHID services. There is a higher prevalence of depression, BPAD, anxiety disorder and OCD in the three MHID services as compared to the forensic MHIDD service.

This paper aims to investigate the role of aripiprazole once monthly as a maintenance treatment in a sample of patients with schizophrenia comorbid with alcohol and substance use disorder (AUD/SUD).

A sample of 24 Italian adult patients has been recruited and treated with aripiprazole once monthly after clinical stabilization with oral aripiprazole during May 2021 and June 2022. Clinical evaluations have been performed at the baseline (T0) and after 12 (T1) and 24 (T2) weeks.

During the study period, an improvement of both the clinical condition and general health from baseline was observed, as well as a reduction of craving for alcohol/substances. However, from T0, the number of patients who continued with this study decreased at T1 (n = 8) and then at T2 (n = 4). No serious adverse events were reported, including changes in weight, lipid/glucose metabolism, electrocardiogram and extra-pyramidal side effects.

Although limited by the high number of drop outs, this observational real-world study provided insights into the use of aripiprazole once monthly among a sample of patients with schizophrenia and comorbid SUD/AUD. Further studies of longer duration and on a larger sample are needed.

Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.

A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.

A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.

This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide “lockdown” of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients’ perspective.

A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021.

Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients’ experience: “treading water”; how they managed: “learning to swim”; and what was helpful during this time: “in the same boat”.

Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research.

To the best of the authors’ knowledge, this is the first study to explore secure patients’ experience of COVID-19 from the patients’ perspective, within a population often neglected within recovery research.

Some individuals with autism may engage in violent behaviour. Research into autism specific factors (ASFs) that may contribute to violence is limited. The purpose of this paper is to explore the feasibility of use of an ASF framework which was developed to inform risk formulation and treatment needs.

Retrospective identification and evaluation of ASFs in offenders with autism (N = 13) at childhood, time of index offence and in current risk behaviours. The ASFs described in the framework were repetitive behaviours and circumscribed interests; poor social understanding and empathy; sensitivity to sensory stimulation; and disruption to rigid behavioural routines or difficulties coping with change.

There was evidence for all four ASFs being consistently present in childhood, contributing to violent behaviour at the index offence and current risk behaviours in at least one case. Poor social understanding and empathy was often present at both childhood and index offence in all cases. Of the seven cases with offence paralleling behaviour, five had at least one ASF present at each timepoint.

This proof-of-concept study provides initial support that ASFs play a role in offending behaviour of individuals with autism. Clinicians working in specialist and generic forensic services, with an in-depth knowledge of autism, could use the ASF framework to enhance risk assessments and facilitate more targeted treatment planning for offenders with autism in specialist and general forensic services.

To the best of the authors’ knowledge, this study is the first to test the application of the ASF framework in an autistic offending population.

This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key concepts, reciprocal and refutational translation and lines of argument. Inclusion health (IH) practice suggests that the needs of excluded groups are more effectively addressed through collaborative working. Interprofessional education (IPE) occurs when two or more professions engage in shared practice and learning, resulting in improved collaboration and quality of care. Studies on IPE to train staff in fields relating to IH exist, but without a settled consensus on the best approaches/activities to foster inclusive practice.

This synthesis is underpinned by a meta-ethnographic approach. It provides explicit stages of data collection and interpretation, while providing space to engage with emerging themes and concepts iteratively (reflecting on author experiences) and inductively (reasoning and interpretation). This study made use of electronic databases and journals for English language peer reviewed articles between 2000 and 2020. Of the 2217 articles, 19 papers were included. The lead author and reviewer completed the review process and a second reviewer reviewed 10% at each stage. The quality was assessed using a modified CASP checklist. Iterative analysis involved PPI and staff stakeholders.

A total of 16 concepts embedded in 19 papers provide insight into the nature of IPE in IH (IH) for staff. It was found that IPE in IH covers a broad group of practitioners and is a complex activity involving individual and organisation readiness, practical and pedagogical factors, influenced by setting, method, curriculum, lived experience, reflection and a learner-driven approach. Barriers to design, implementation and translation into practice were also found to exist.

Most studies used a combination of core learning and group work. Educational modes include mentoring or coaching, reflective practice, immersive learning and people lived experience of exclusion involved in or facilitation thematically centred in trauma-informed informed care, cultural competence, communities of practice and service learning. The aim of these methods was to promote collaboration through identifying shared experiences, problems and tensions and critical reflection of services and organisations. Such transformative learning is reported to challenge stigma, discrimination and misinformation and promote collective empowerment to address social injustice through human connection. Effective models of IPE re-instated the therapeutic relationship and alliances between patients and staff.

This review also calls for the development of health and care workers’ professionalism in relation to their own reflexivity, establishing anti-racist curricula, challenge stigma and ensuring clinicians are aware of and able to negotiate tension and difference identified within the consultation and between themselves. Apart from developing generalist skills, this analysis suggests that IPE in IH may be able to challenge stigma and discrimination towards IH groups by destabilising existing norms and siloed working with the aim of achieving robust interprofessional practice.

IPE in IH is a complex activity affected by individual and organisation readiness, setting, experiential, practical and pedagogical factors. Models of teaching are focused on re-instating the therapeutic relationship. There are no systematic reviews in this field and previously there was no settled consensus on the best approaches and learning activities to foster inclusive and collaborative practice.

There are no existing tools to capture resources needed to support people with intellectual disability in an inpatient setting on an individual patient basis. The purpose of this paper is to describe the development of a new tool called Universal Needs Based Resource Assessment (UNBRA).

Using the Delphi method, focus groups were used to generate factors determining resource use. From these, themes were identified, a scoring system was created and the UNBRA tool was developed. This was piloted in two NHS inpatient units and modified following feedback.

The UNBRA tool holistically assesses resource requirements of an individual with intellectual disability supported in an inpatient setting. It considers ten factors grouped into the six themes of staffing, indirect work, clinical/ multi-disciplinary work, incidents, carer link activity and discharge process. UNBRA scores allow intra- and interpersonal comparison as well as comparison between units and can support resource allocation and operational decision-making.

To the best of the authors’ knowledge, there is no suitable existing tool to capture individual resource requirements of patients in intellectual inpatient settings. The development of the UNBRA tool fills this gap.

The purpose of this study is to assess if the new community-enhanced rehabilitation team reduced anxiety and readmissions in service users discharged from an inpatient rehabilitation setting.

The study used both qualitative and quantitative methodology. Service user’s anxiety level was measured before being discharged and at the end of the Community Enhanced Rehabilitation Team (CERT) transition intervention. Six service users were interviewed to gain further understanding of their experiences of anxiety.

Findings showed the anxiety score was significantly lower (M = 1.5, 95% CI [0.051,2.99], t(20) = 2.159, p = 0.043) following the CERT intervention (M = 8.6, SD = 6.4) compared to before (M = 10.1, SD = 7.0). No service user receiving the CERT intervention was readmitted to hospital within 12 weeks of discharge from the inpatient setting, compared to three service users (15% of those discharged) who were discharged to other community services.

Community rehabilitation pathways would benefit from having interventions to aid patient transitions from inpatient to the community. The National Health Service (NHS) trusts develop community rehabilitation teams as recommended by the National Institute for Health and Care Excellence (NICE), and they should consider including transitional support as part of their model.

It is recommended that as NHS trusts design and implement community mental health teams, they should consider including transition support as part of their model.

People with severe and enduring mental health difficulties who have been in an inpatient rehabilitation setting would benefit from community transitional support. This study suggests that such support helps reduce anxiety and readmission.

Community rehabilitation teams are currently being developed across the NHS as part of the NHS long-term plan. These teams are new, and as such, there is a dearth of information regarding their effectiveness. To the best of the authors’ knowledge, this is one of the first studies to evaluate outcomes in these new teams.

Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.