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This paper aims to describe the process and outcomes of restorative justice (RJ) between a detained patient with autism and a person he harmed.

A single case study design was used to provide an in-depth description of a RJ referral.

Restorative outcomes that align with the theories of RJ, in particular trauma processing and emotional reconnection, were observed by RJ practitioners and reported by participants. The person harmed reported a “safer” memory of the offence.

The absence of outcome assessments limits the findings to observational data and self-reported experiences from participants. A triangulated outcome approach is recommended.

RJ practices can safely be applied within a secure hospital environment. The RJ process can also be followed by a person with difficulties in social and emotional processing.

The RJ process provides a safe framework within which forensic mental health services can respond to the needs of victims, which are not routinely addressed in standard clinical practice, and in worst case scenarios, may even be overlooked.

Substance misuse (SMU) is widely prevalent in mentally disordered offenders and is linked with violence and offending behaviour. There is however, a scarcity of literature dedicated to investigating SMU and its clinical correlates in relation to patients detained within high secure hospital settings. The purpose of this paper is to investigate the extent and severity of SMU and corresponding treatment needs in patients with a primary diagnosis of personality disorder (PD) in comparison with mental illness (MI) in a high secure hospital.

The responsible clinicians of all patients (n=240) detained in a high secure hospital were asked to record information using a SMU screening questionnaire over a ten-month period. Details requested included substance type, history of past use and assessment and treatment needs. Data were recorded and then analysed: descriptive statistics were conducted to report historical use of substances, cross tabulations and χ² analysis explored the relationship between SMU and treatment status and diagnosis and offending behaviour and a means comparison analysis was employed to explore length of stay and treatment of SMU.

A total of 230 questionnaires were returned (95 per cent of the patient population). A history of SMU was reported in 88.6 per cent of the sample, with alcohol and cannabis misuse being the most prevalent. At least one substance had been abused by 74.3 per cent of the sample. In two-thirds of the sample, SMU was linked with the onset of mental health problems and symptom exacerbation, including violence. Interestingly, patients with a diagnosis of MI as compared with PD were more likely to have used substances (93.3 per cent compared to 81.9 per cent) and were more likely to need treatment for SMU (64.3 per cent compared to 36.8 per cent). In those with an MI diagnosis, SMU was more likely to be linked with violence and index offence (74.3 per cent compared to 59.0 per cent).

SMU is significantly prevalent in high risk mentally disordered offenders and linked to onset of mental health problems and offending. Patients with schizophrenia have a higher prevalence of SMU than PD and are likely to be more in need of treatment. Violence and offending are more likely to be related to SMU in schizophrenia than in PD.

This study substantiates existing evidence that SMU contributes to mental health problems and criminogenic behaviour. Furthermore, the study reports new findings that characterize differences of the relationship of SMU to offending in schizophrenia and PD in forensic psychiatric patients presenting to a high secure hospital.

Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.

In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.

A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.

The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.

There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.

The evidence base for what works with forensic patients in high-security inpatient settings has typically focused on outcome research and not included clinical expertise from practice-based experience, which is an important facet of evidence-based practice. The purpose of this paper is to establish whether experts with clinical and/or research experience in this setting could reach consensus on elements of high-security hospital services that would be essential to the rehabilitation of forensic patients.

A three-round Delphi survey was conducted to achieve this aim. Experts were invited to rate agreement with elements of practice and interventions derived from existing research evidence and patient perspectives on what worked. Experts were also invited to propose elements of hospital treatment based on their individual knowledge and experience.

In the first round 54 experts reached consensus on 27 (out of 39) elements that included physical (e.g. use of CCTV), procedural (e.g. managing restricted items) and relational practices (e.g. promoting therapeutic alliances), and to a lesser extent-specific medical, psychological and social interventions. In total, 16 additional elements were also proposed by experts. In round 2 experts (n=45) were unable to reach a consensus on how essential each of the described practices were. In round 3 (n=35), where group consensus feedback from round 2 was provided, consensus was still not reached.

Patient case complexity, interventions with overlapping outcomes and a chequered evidence base history for this population are offered as explanations for this finding alongside limitations with the Delphi method.

Based on the consensus for essential elements derived from research evidence and patient experience, high-secure hospital services might consider those practices and interventions that experts agreed were therapeutic options for reducing risk of offending, improving interpersonal skills and therapeutic interactions with patients, and mental health restoration.

The study triangulates what works research evidence from this type of forensic setting and is the first to use a Delphi survey in an attempt to collate this information.

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in primary and secondary care. In secure forensic mental health services the evidence is less established. The purpose of this paper is to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital.

In all, 27 male forensic patients completed a manualised CBT group and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU). Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by the Inventory of Interpersonal Problems (IIP-64).

CBT participants showed improvement on negative symptoms; affective flattening, alogia, anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment were found; improvements in depression anxiety and stress were reported by group completers, which contrasted to experiences of the TAU group.

Absence of random allocation to CBP or TAU groups retains the risk of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase risk of a type I error.

CBT for schizophrenia can be effective with clients in secure forensic mental health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular gains. Self-report measures might be subject to specific demand characteristics in such settings.

The evaluation includes a comparator group in a high secure setting, which is typically absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure no adverse effects were experienced from treatment.

The purpose of this paper is to document reflections on experiences of stigma and discrimination as described by predominantly black and ethnic minority (BME) service users in a high security hospital via a slow‐open therapy group. Service users from BME are known to have higher drop‐out rates and poorer treatment outcomes in non‐forensic therapy settings (Rathod et al.). Further, they are over‐represented in forensic services and often disengage, because their views and feelings are poorly understood (Ndegwa).

Thematic analysis was applied to a sample of electronically stored running records of group sessions, in which experiences of care, discrimination, hope, despair, and recovery were shared.

Over a three‐year period, 18 forensic patients participated in the group. Group members' reflections on detention, offending and illness were collected. Themes relating to isolation and distance, other barriers to recovery and strategies for coping “against the odds”, are illustrated via anonymised material from the sessions.

Stigma and discrimination are difficult concepts to hold in mind, and are therefore difficult to access. Nevertheless, their effects can be so all encompassing for patients in high security that hope is hard to sustain. The extent to which the themes generated by this sample are representative of those pertinent to others in similar secure settings is inevitably beyond the scope of this paper.

Service users can, and do, share ideas about possibilities for surviving despite their past. Their comments shed light on barriers to engagement for this potentially marginalized population, and possibilities for improving the capacity of the clinical service to hear their voices on an issue of such importance to their potential for recovery.

Specific attention to the perspectives of all service recipients on the impact of illness and their recovery is required in a modern health service, where inclusion is a guiding principle.

Interventions for addressing stigma for the most marginalized are infrequently described, but are potentially relevant for all.

Public debates and scholarly literature on football fandom are often characterised by generalisation and lacking differentiation. The changing ethnography of fans, affected by the rapid commercialisation and internationalisation of the game, reinforces the demand for contemporary classification criteria and fan typologies that take the complexity and heterogeneity of fans into account and draw a more differentiated picture of fans and sub-groups.

Based on the grounded theory methodology and a systematic literature review on stakeholder theory, stakeholder classification criteria and football fandom, the authors conduct and analyse 14 semi-structured expert interviews with fan managers employed by German professional football clubs. Building on the analysis, the authors identify, present and discuss ten contemporary criteria and five corresponding typologies for the classification of football fans.

The grounded theory analysis suggests that football fans can be characterised according to ten classification criteria. Building on the analysis, the authors derive five fan typologies that differ in their characteristics along the continua of the identified criteria. Typologies comprise (1) active fans, (2) consuming fans, (3) event fans, (4) corporate fans and (5) passive followers.

The paper enlarges prior knowledge on the behavioural and attitudinal characteristics of fans as individuals and adds knowledge regarding relationships within fan groups, and regarding formal and non-formal relations between fans and clubs. The results provide scholars with a framework for further scientific investigation and practitioners with a concept for a more sophisticated and differentiated approach to managing fan relations.

The purpose of this paper is to explore children’s relationships with football teams and players and the influences on these.

A child-centric (Banister and Booth, 2005) inductive qualitative approach was utilised to capture children’s voices. The children were asked to take photographs around the theme of “football in my life” and these served as interview prompts when talking to friendship pairs.

Football played a central role in children’s lives in terms of interest, activity and consumption. The children articulated a portfolio of team (club) and player connections of varying strength. This contrasts with the existing adult fandom literature which focuses on individuals supporting a single team. Another strong theme emerging from the data was the children’s market-centred relationships with football clubs. Children’s connections were shaped by a complex web of influences including family and family history, friends, media and geography.

Existing fan literature has an adult focus which does not appear to fully explain the child fan. This research provides impetus for developing new theory that better captures child fandom. The findings reinforce the idea that football plays an important part in children’s lives and in doing so they establish their own meanings. The findings presented in this paper provide important insights into the lives of children that could be reflected on in the design of policy across a number of areas including education.

This paper presents the first child-centred football fan study.