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This review aims to discuss the planning, implementation and evaluation of a 24‐session alcohol and drug group for eight service users, based on the Behavioural Treatment for Substance Abuse in Severe and Persistent Mental Illness Model (BTSAS), delivered by a group of multi‐disciplinary staff in a medium secure forensic setting.

Evaluation tools were completed pre‐ and post‐group to measure attendee outcomes and perceptions of their group experience.

The group programme was well received, although adaptations to meet specific medium‐secure needs will be required for future group work.

The development and implementation of the group has raised awareness within the medium‐secure setting, facilitating a less punitive and more collaborative response.

The paper highlights interventions to support the medium‐secure setting to develop a more pragmatic bespoke response to meet alcohol and drug needs.

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.

This survey describes the socio‐demographic, clinical and forensic variables of all patients referred to a medium secure unit in the psychiatry of learning disability. Of the sample, 67.5% were referred following an index offence and 76.6% had at least one previous conviction. Just over half (50.6%) came from either prisons, special hospitals or medium secure units and the remainder from mental health/learning disability hospitals or community resources. The majority (91.7%) had prior contact with a mental health or learning disability team. Most (81.5%) had a mild or ‘borderline’ learning disability, 46.8% had either a psychosis or major mood disorder, 58.4% had personality disorders and 56.6% had a history of illicit substance abuse. Of the 79 referrals 29.1% were accepted for admission. Arson as an index offence and a previous conviction for arson were significantly associated with being accepted for admission.

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.

The purpose of this paper is to explore patient and staff views of a new intervention “Talking Groups” within a medium secure setting.

Seven patients and eight members of staff who had attended Talking Groups in the medium secure wards participated in semi-structured interviews. Interviews were transcribed and analysed using thematic analysis.

The analysis revealed four key themes related to the aims, content and perceived benefits of Talking Groups: information; relationship building; engagement and patient involvement in developing activities/interventions.

If Talking Groups are extended to other wards in the medium secure unit, information sessions should continue as part of the groups, as these were valued by patients and provided useful information about transition, human rights and medication.

The findings suggest that Talking Groups have benefits for patients and staff within this medium secure setting. Findings from this evaluation can be used to inform the development of Talking Groups across different wards in this unit.

The study aimed to identify occupational stressors and measure experiences of clinical burn‐out among a group of mental health nurses and occupational therapists in a medium secure service. All the nursing staff (n=115) and occupational therapists (n=9) on three wards in a medium secure hospital were asked to partake in the study, and to complete a modified version of the Psychiatric Nurse Occupational Stress Scale (PNOSS), the Maslach Burnout Inventory (MBI) and a demographic questionnaire designed for the study.Results from the PNOSS revealed that organisational issues elicited the greatest stress and were most strongly related to high burn‐out scores, identified by the MBI. Limited resource and staff conflict were also associated with stress and burn‐out. Patient care had a relatively small impact. MBI findings were that a substantial proportion (54%) were experiencing high burn‐out in relation to emotional exhaustion.

There is growing awareness in New Zealand (NZ) of the impact that Autistic Spectrum Disorder (ASD) has on individuals and their families and the ability to engage in health services. Although it is a relatively rare condition, approximately 1 per cent of the population will have ASD, directly affecting approximately 40,000 individuals in NZ. The purpose of this paper is to provide some reflections and questions on what we can learn from a NZ perspective. This is based on an overview of the limited literature around ASD and offending and the author’s experience in the UK working in a medium secure unit.

Through a past site visit as part of the annual international conference on the Care and Treatment of Offenders with an Intellectual and/or Developmental Disability in the United Kingdom (UK), the author became aware of the medium secure forensic unit for male patients with ASD at the Roseberry Park Hospital (UK’s Tees, Esk and Wear Valleys NHS Foundation Trust). During the author’s advanced training in forensic psychiatry with the Royal Australian and New Zealand College of Psychiatrists the author was privileged to be able to apply and be accepted for a four-month sabbatical training position at this hospital.

Outlined is background information about ASD and review findings from the limited literature on ASD and offending. Also outlined is the author’s learning as a trainee working in medium secure unit for people with ASD who have offended, and finally how this experience may help in the development of services in NZ, given that at this stage such services are under-developed.

To be able to share the valuable experience and learning opportunity the author was able to have, as well as raise the awareness of ASD generally, and specifically the need for specialist services for the small number of people with ASD who come into contact with Justice Services.

In recent years there has been growing interest in the fate of those women with mental disorder who come into contact with the criminal justice system. This interest has stemmed from growing recognition that traditional forensic services could not offer the appropriate care required by this group in a conventional mixed‐gender environment. Women‐only services have begun to be developed in generic psychiatric settings, spurred on by the national service framework (NSF) which set a time limit for the development of segregated in‐patient facilities. Forensic services for those with learning disability have been slower to take up the challenge of how best to place women with learning disability who offend and require an in‐patient secure environment. This article describes how one such service attempted to rise to this challenge and build a service for this often neglected group

The purpose of this paper is to describe the architectural design considerations and effects of moving patients from an adapted Victorian medium secure unit to a purpose built facility.

Patients and staff views of the old and new unit environments were compared in terms of homeliness, architectural features, ward atmosphere (WAS) and patient satisfaction.

The new unit was rated as more homely. The change of environment did not increase risk behaviours and was associated with a reduction in symptomatology.

Limitations of the study include the small‐sample size and choice of measure of WAS. More research is needed into the constituents of “planned” environments where the physical environment is the primary intervention.

These include the need for close collaboration among architects, clinicians and patients in order to maximise the therapeutic benefit of the built environment.

This paper contributes to a small literature that “bridges” architectural, psychiatric and environmental domains.

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.