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Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care. African-Caribbean people are asking for a more culturally competent mental healthcare system.

This chapter aims to address the following issues: how African-Caribbean people reflect on mental health and mental ill health. Their reflections are drawn from interviews done with African-Caribbean people who are involved with Hagar, a mental health charity in Lewisham, London. Mental health and mental illnesses will be examined, followed by the Psychiatrists’ use of the diagnostic tools that do a disservice to Black people. The Trans-Atlantic slave trade and its contribution to the mental ill health of Black people will be addressed, thus providing a historical underpinning for much of Black people’s struggle with mental ill health. Racism and its contribution to mental health issues will be presented. The views of the Black Psychiatrist Franz Fanon will be argued as a way of understanding oppression, alienation and mental ill health in Black people, and going on to open up ways of providing treatment and care. Finally suggestions will be made about how to provide a culturally competent mental health service to African Heritage peoples.

Recidivism is often used to measure the success of the criminal justice initiatives. We explore alternate measures of success that were identified for special offenders through the development of program theory. Using content analysis of 50 closed files from the Special Offenders Services program in Lancaster County, PA, we found that most offenders completed the program without re-offending, maintained their medication, participated in counseling, fulfilled their court cost obligations, and had few housing transitions. However, there were differences between parolees and probationers in terms of their outcomes. We recommend that special offender programs use uniform data-recording procedures.

Records of violent incidents were retrospectively analysed to identify trends associated with violent incidents within an NHS medium secure psychiatric unit. Over a 12‐month period, 116 incident forms related to 112 incidents. These incidents were compared with a study from the previous 12 months within the same unit. Both studies were based upon work from within a high‐security setting (Caldwell and Naismith, 1989). There was a significant reduction in the overall number of violent incidents.The majority of incidents continued to occur within the intensive care admission unit. There continued to be a higher incidence of assaultive behaviour throughout the afternoon and evening. Seasonal variations demonstrates a reduction of incidents throughout the autumn and winter months compared with the previous year, and a significant change in the number of incidents that occurred during the summer.There remain opportunities for comparison with other secure units and further refinement of the methodology.

A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues.

A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire.

Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning.

Studies using cross-section can only provide information at fixed points in time.

The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility.

This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.

Goal setting is a crucial aspect of client-centered practice in occupational therapy (OT) for mental health conditions. However, it remains to be seen how goal-setting has been delivered in mental health, particularly the OT process. The purpose of this scoping review was to explore the nature and extent of goal setting delivered in mental health and informed OT practice.

The authors followed the guidelines of Arksey and O’Malley (2005) and searched three databases using key search terms: “mental disorder,” “goal setting,” and “occupational therapy” and their synonyms.

After excluding duplicate records, the authors initially screened 883 records and resulted in 20 records in total after the screening process. Most of the identified articles used goal-setting delivered by both a health professional and a client (n = 14), and focused on people with schizophrenia or schizoaffective disorder (n = 13), but three interventions were delivered by occupational therapists. Further research needs on goal-setting in mental health OT, exploring the reliability and validity of different goal-setting strategies and investigating the effectiveness of goal-setting for promoting behavior change and client engagement across various mental health conditions and settings.

The scoping review has some limitations, such as not investigating the validity and reliability of goal-setting strategies identified, and excluding conference papers and non-English articles.

This scoping review presents a mapping of how goal-setting has been delivered in mental health and informed OT practice. The findings suggest limited research in OT and highlight the need for more studies to address the evidence gap in individualized client-centered OT.

Psychological and epidemiological literature suggests that the built environment plays both causal and therapeutic roles in schizophrenia, but what are the implications for designers? The purpose of this paper is to focus on the role the built environment plays in psycho‐environmental dynamics, in order that negative effects can be avoided and beneficial effects emphasised in architectural design.

The approach taken is a translational exploration of the dynamics between the built environment and psychotic illness, using primary research from disciplines as diverse as epidemiology, neurology and psychology.

The built environment is conceived as being both an agonist and as an antagonist for the underlying processes that present as psychosis. The built environment is implicated through several means, through the opportunities it provides. These may be physical, narrative, emotional, hedonic or personal. Some opportunities may be negative, and others positive. The built environment is also an important source of unexpected aesthetic stimulation, yet in psychotic illnesses, aesthetic sensibilities characteristically suffer from deterioration.

The findings presented are based on research that is largely translated from very different fields of enquiry. Whilst findings are cogent and logical, much of the support is correlational rather than empirical.

The WHO claims that schizophrenia destroys 24 million lives worldwide, with an exponential effect on human and financial capital. Because evidence implicates the built environment, architectural and urban designers may have a role to play in reducing the human costs wrought by the illness.

Never before has architecture been so explicitly implicated as a cause of mental illness. This paper was presented to the Symposium of Mental Health Facility Design, and is essential reading for anyone involved in designing for improved mental health.

Over 100 years ago, Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's discoveries have since become the “twin pillars” of mainstream psychiatric thinking, practice, and research. Today, however, a growing number of researchers, clinicians, and mental health service users have rejected this model and call for a symptom‐led approach to prioritise subjective experience over diagnostic category. The purpose of this paper is to ask: how can the published first‐person accounts of experts by experience contribute to these debates?

This paper analyses the representation of psychiatric diagnosis in two prominent autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007).

As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold.

The paper introduces two popular autobiographical accounts of schizophrenia which may be useful resources for mental health service users and clinicians.

The paper highlights the complex ways in which people interpret and make meaning from their psychiatric diagnosis.

The paper demonstrates that first‐person accounts make an important, if frequently overlooked, contribution to debates about psychiatric diagnosis.

Rabbit syndrome (RS) is an antipsychoticinduced rhythmic motion of the mouth/lips resembling the chewing movements of a rabbit. The movement consists of a vertical-only motion, at about 5 Hz, with no involvement of the tongue. Long-term exposure to typical antipsychotics has clearly been associated with RS, but little is known of the risk of RS due to exposure to newer atypical antipsychotics. There have been isolated reports of RS in patients treated with the atypical agents risperidone, aripiprazole, olanzapine, and clozapine. We present the case history of a 44-year old female patient treated for paranoid schizophrenia for 22 years and RS during her last 10-month clozapine treatment. Background information from the literature is also discussed.