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There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services.

The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined.

Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services.

The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice.

These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities.

Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings which in general do not have a 'longer term focus'. The aim of this investigation was to assess and describe the needs of these patients. A survey questionnaire was designed and sent to responsible clinicians who had patients admitted at least five years previously to the Three Bridges Medium Secure Unit (males) in West London. Carer ratings using the Camberwell Assessment of Need: forensic version (CAN‐FOR) were completed by the primary nurse for each patient, complementing the survey questionnaire. Of 122 medium secure male patients 25 (21%) had been admitted at least five years before. We found high levels of co‐morbidity and treatment resistance. The CAN‐FOR revealed two groups, one with chronic challenging behaviour, treatment‐resistant mental illness and need for a high level of support, and another more able group not needing as much support but with a dependency on the hospital. It is considered here whether certain groups would benefit from a different approach or setting.

This study examines the implementation of the recovery model or ‘philosophy’ in a secure NHS forensic service. Twenty‐six (86.7%) staff and seventeen (70.8%) mentally disordered offenders (MDOs) were interviewed in Spring 2009 from the rehabilitation and pre‐discharges units in a medium secure forensic service in Kent, UK. Their views on recovery were measured using the Developing Recovery Enhancing Environments Measure (DREEM: Ridgeway & Press, 2001). Staff consistently rated all 24 elements of recovery as more important than the MDOs. Staff also rated the elements of recovery as better implemented, except Intimacy and Sexuality. There was a significant effect of MDOs' forensic history (restriction status and index offence type) on ratings of how well elements of recovery were implemented. Staff and MDOs rated all elements of recovery as at least moderately important (above median value). The implications of the recovery philosophy in forensic mental health services are discussed.

In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness and men with learning disability in a secure care pathway. Total and individual HoNOS‐secure item ratings made by multi‐disciplinary teams across the course of a period of admission (mean 15 months) for 180 men were examined. There was significant positive change on the clinical and risk‐related scales of HoNOS‐secure for patients in the learning disability care pathway (N = 48) between initial and final ratings. In the mental health care pathway (N = 132 patients) an apparent lack of change masked a more complex picture, where initial decline in HoNOS‐secure ratings was succeeded by significant improvement. Results suggest that it is challenging to measure clinical and risk‐related medium‐term clinical outcomes objectively for these patients, particularly in relation to core issues of treatment of mental disorder, and reduction of both problem behaviour and risk to others. However, it is important that practitioners continue to strive to demonstrate the benefits of care and treatment through appropriate outcomes measures.

This paper briefly reviews the literature on smoking and smoking cessation programmes for people with intellectual disability, and describes the baseline audit of such a programme for patients resident in a forensic service. The audit describes the prevalence of smoking, its significant associations and the effect of an intervention programme. In total, 79 patients participated in the audit, 48 of whom were smokers on admission (60.8%). Roughly a third of smokers gave up during their hospital stay (N = 15). Those who did not give up significantly reduced the number of cigarettes they smoked per day. Female smokers appeared less likely to give up than men. Length of stay and treatment with anti‐psychotic medication were not significantly linked to smoking behaviour. A simple smoking cessation programme with an emphasis on health education and nicotine replacement therapies appeared to be effective in cutting down smoking rates and tobacco consumption in this population. One should be cautious about generalising the conclusions to all forensic hospital services for people with intellectual disability, as the audit was limited by the lack of a control group and conducted in a single service.

The purpose of this paper is to detail the implementation and evaluation of positive behavioural support within a medium secure mental health service.

Information regarding the policy context, service context and the processes supporting PBS interventions are outlined.

PBS has historically been applied within child services in USA and learning disability services in UK.

Forensic mental health is a new area of implementation and is in line with current policy promoting its use across a number of service contexts.

Substance use contributes to the development of criminogenic behaviour and mental health problems. However, the extent and severity of substance use and the relationship to offending in mentally disordered offenders (MDOs) admitted to regional medium secure units has received relatively limited research attention.

Case note reviews (n=57) and semi-structured interviews (n=21) of past substance use levels, substance use problems and forensic history were conducted at a medium secure unit in South East England.

Results highlighted the high prevalence of substance use among MDOs, especially when determined by self-report. At least one-third (case note review) or almost half (self-report) used alcohol at the time of their index offence, although many failed to recognise use as problematic. Significant correlations were found between heavy past use of alcohol and use of alcohol at time of offending. Past heavy use of alcohol significantly predicted whether or not the individual was convicted of a violent offence.

The small sample from one area limits the generalisability of findings as substance use demographics vary. Methodological shortcomings were noted when comparing data from self-report and case note information. Retrospective recall bias may influence past perceptions of substance use.

These preliminary findings indicate the importance of assessing substance use in MDOs and considering its relationship to offending behaviour in treatment and risk management.

Although anecdotally substance use is known to be high and likely to be related to offending behaviour amongst MDOs, there is little previous research highlighting this.

The purpose of this paper is to demonstrate the implementation of modern technology by using a web camera to facilitate a family intervention (e‐FI) in the treatment of schizophrenia, within a forensic service.

A case study using questionnaire tools to measure outcome variables from the web‐based family intervention was used. Pre‐, mid‐ and post‐treatment scores were compared to present the progression of outcomes throughout the study.

This study provides an account of the successful implementation of a web camera facilitated family intervention in a forensic service. The findings showed improved social, emotional and practical outcomes for the family involved. The ease and acceptability of using the technique is demonstrated.

This study presents a novel application in utilising a web camera to implement family intervention within forensic services with successful outcomes.

Challenging behaviour has been a concern across forensic services. Traditionally these have been managed reactively using medication, seclusion and restraint; however, there is growing evidence that these approaches are ineffective and counter-therapeutic. A number of reports have recommended the use of preventative approaches such as positive behavioural support (PBS). The purpose of this paper is to identify “how staff within a secure forensic mental health setting perceived the application of PBS?”

In total, 11 multi-disciplinary staff were interviewed and thematic analysis was used to identify themes.

Five themes were identified: “The Functions”, “Appraising a new Approach”, “Collaborative Challenges”, “Staff Variables” and “Organisational Issues”.

PBS enables staff to understand challenging or risky behaviour. It empowers patients via collaboration, although there can be some challenges to this. Services need to invest in training, support and leadership to ensure the model is embed and promote fidelity. Consideration needs to be given to how quality of life can be improved within the limits of a forensic setting.

No previous studies asking staff about their experiences of PBS within a forensic mental health context.