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In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian government several convictions from the Human Rights Court in Strasbourg. In an attempt to facilitate admissions from penitentiary to psychiatric hospital, the Forensic Department of the psychiatric hospital in Rekem (OPZC Rekem), has piloted the InReach project. The paper aims to discuss these issues.

The objective of this project is to engage a psychiatric nurse on the ward in pretherapeutic and motivational activities on a regular basis in the penitentiary for vulnerable groups of forensic psychiatric patients, forming a bridge between penitentiary and hospital. The InReach project even considers patients who have no desire to leave the penitentiary (e.g. due to their psychiatric profile). A motivational approach is used to support these patients in making the transition from penitentiary to hospital.

The current article describes the focus of the InReach project (procedures and InReach candidate profiles) together with the first impressions of the progress that has been made by the InReach project. In addition two case studies of InReach patients are presented. The InReach project is clearly needed in Belgium and because of its success it has been extended to another penitentiary. It is probable the two other medium-security wards will also be included in the project in the near future.

The Belgian government has received several convictions from the Human Rights Court in Strasbourg because a substantial number of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. The InReach project presented in this paper is clearly needed in Belgium and was implemented to initiate and facilitate the transition from penitentiaries to treatment facilities. The need for this type of project is reflected in the number of forensic psychiatric patients that reside within a penitentiary and that are not able or willing to make the transition to a treatment facility because of their psychiatric profile.

Although long a feature of inpatient mental health ward routine, community meetings have not always attracted a clear sense of purpose and value. A common complaint from patients is that community meetings are useless and have no worthwhile purpose. It was thought that staff on acute wards would benefit from having a space to think about community meetings, and a work discussion group was provided over a duration of 18 months. It was hoped that this intervention would enable facilitators to think about these meetings and about their aims and benefits. This paper presents findings from the work discussion group: staff facilitators' experience of facilitating community meetings and patients' direct feedback to facilitators about their experience of these meetings. The conclusions made are that community meetings could provide a useful forum for patients and staff if they:• are of benefit to patients• provide a forum for development of the therapeutic alliance between patients and staff• contribute towards improvement of the ward milieu• provide a forum for staff to develop therapeutic skills• provide a forum for staff to develop working relationships with colleagues and different professionals in the team.

There is a considerable body of research on the assessment and prediction of aggression in psychiatric hospitals. A range of clinical and demographic characteristics associated with aggressive inpatients, such as young age and active symptoms of psychosis, have repeatedly been shown to contribute to aggression. Environmental factors have also been shown to be important. The study examined aggressive behaviours in an Australian forensic psychiatric hospital, using aggression‐specific recording instrumentation developed for the study. The purpose of the study was to compare results using aggression specific‐recording instrumentation with a previous study using retrospective methods relying on standard hospital incident forms, and to examine the relationship between type, direction and severity of aggression with the use of seclusion.In contrast with the results obtained in a previous study, staff rather than patients were more often the victims of both verbal and physical aggression, although patients were more frequently the victims of more severe forms of aggression. Patients were verbally and physically aggressive towards other patients at similar rates, although they were more frequently verbally, rather than physically, aggressive to staff. Acute wards recorded more aggression than rehabilitation wards. Males and females were aggressive at similar rates. A reduction in reported incidents of verbal and physical aggression, particularly against staff, occurred over the course of the study. Patients were secluded and incident forms were completed following approximately 30% of aggressive behaviours. Whether or not a patient was secluded and whether or not an incident form was completed depended on a range of factors, including the nature of the victim and the type and severity of the aggression.

Patients who have intellectual disability and mental illness will occasionally need inpatient treatment. However, research is sparse on psychosocial factors influencing psychiatric units for patients with intellectual disabilities. The aim of this study is to examine whether adults with intellectual disabilities can reliably rate the Ward Atmosphere Scale – Real Ward (WAS‐R).

A total of 17 patients with mild and moderate intellectual disability and 21 staff members were asked to complete the WAS‐R. The authors used six subscales (involvement, support, practical orientation, order and organisation, angry and aggressive behaviour, and staff control) that have proved to be of major importance for patient satisfaction and treatment outcome to measure the patients' and the staff members' perceptions of the treatment milieu. To examine the internal consistency Cronbach's alpha was calculated for the patient and staff scores, respectively.

A total of 16 patients completed the form. Patients with mild intellectual disabilities were able to answer the WAS with some help, whereas patients with moderate intellectual disabilities had major difficulties with understanding more than half of the WAS items. These difficulties were also reflected in the internal consistency scores. Cronbach's alpha was satisfactory (≥0.50) for five subscales for patients with mild intellectual disabilities, but only satisfactory for two of the six subscales for patients with moderate intellectual disabilities.

A replication study should use a shorter version of the WAS‐R, and family or caregivers should answer the WAS‐R additionally to the patients.

This study may encourage more research on treatment milieu for patients with intellectual disability and mental illness.

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services is limited. Staff and patients in Learning Disability services have documented both positive and negative experiences. No research has directly compared the social climate of Learning Disability and non-Learning Disability psychiatric services. The purpose of this paper is to understand how these compare. The study will also compare staff and patient views of social climate and the impact of security on social climate in Learning Disability services.

A total of 64 patients and 73 staff, from Learning Disability and non-Learning Disability psychiatric hospitals completed the Essen Climate Evaluation Schema (EssenCES) measure of social climate.

Patients in Learning Disability and non-Learning Disability services did not differ in their perceptions of social climate. Staff in non-Learning Disability services had a more positive perception of social climate than staff in Learning Disability services. Patients and staff did not differ in their views on climate. Security was negatively related to patients’ Experienced Safety.

The findings suggest that staff perceive that the deficits associated with Learning Disabilities may limit patients’ therapeutic experience and relationships with their peers. Despite this, patients with Learning Disabilities feel supported by their peers, have positive views of the treatment process and feel as safe as non-Learning Disabled psychiatric patients.

The purpose of this paper is to investigate whether acute inpatient psychiatric staffs’ attitudes and self-efficacy towards adults with mild intellectual disability, were different than towards the general mental health population. And whether their understanding of the policy for those with mental illness and intellectual disability differed.

The study is a between-subject design, using a self-administered postal questionnaire. The sample was all qualified staff from the acute inpatient psychiatric provision of an inner London borough. Potential participants were randomly assigned to two research groups, half being given a questionnaire regarding people with intellectual disability and the other half an identical one regarding people with mental illness. Comparisons were made between the two.

The majority of staff were unaware of the current policy direction for adults with intellectual disability although were on the whole in agreement to the idea that they should access mainstream services. Staff overall did not have more negative attitudes to those with intellectual disability although were less likely to empower or encourage self-advocacy. Staff were significantly less confident that they had sufficient training and experience, and in their perceived ability to be able to communicate, assess and treat adults with mild intellectual disability when compared to those with mental illness.

The response rate and small sample size is a limitation. Further research could usefully look at whether self-efficacy and attitudes differ in different models of mainstream psychiatric care.

Government policy in the UK regarding services for people with intellectual disability advocates for inclusion and equality (Chaplin and Taggart, 2012). Those requiring psychiatric care should access this from mainstream services (Department of Health, 2001, 2009, 2011; Foundation for People with Learning Disabilities et al., 2004; Bradley, 2009.) There are, however, no UK-based studies investigating the views of mainstream acute inpatient psychiatric staff towards their role. Intellectual disability staff have concerns about their attitudes and self-efficacy and it is know that acute care is the setting where most adults with intellectual disability will come across mainstream psychiatric staff. Findings have relevance to managers and staff in both intellectual disability and psychiatric services and could be considered in the context of trying to work together as is the direction of policy.

Inpatient violence is a substantial problem in psychiatric wards and de-escalation is difficult. When managing instances of violence through verbal techniques fail, mental health-care staff may use restrictive practices. The Six Core Strategies and debriefing exist for managing violence and restrictive practices in different mental health settings. Debriefing is used to get patients’ views on restrictive practices, ensure proper patient care and strengthen the role of patients as experts. This study aims to provide new information on debriefing implementation and how debriefing was used among different patient groups in a forensic hospital.

Quantitative seclusion time and debriefing reports (n = 524) were examined with Poisson regression analysis. Fisher’s exact test was used to determine the associations between debriefing and seclusion/restraint.

Debriefing (n = 524) was provided in 93% of violent episodes, which is an excellent result on an international level. There was significant variation in how often debriefing was used (p < 0.001) among different patient groups, i.e. dangerous, difficult-to-treat patients and criminal offenders whose sentences have been waived. Previous debriefing research has rarely specified what types of psychiatric patients have been subjected to seclusion or restraint.

The implementation of debriefing requires multiprofessional work within the organization and wards.

Debriefing seems to stimulate reflection at every level of a health-care organization, which fosters learning and can ultimately change clinical practices. The use of debriefing can strengthen the role of patients as well as professionals.

This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings.

Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups.

Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature.

Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent.

Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.

This paper looks at the evolving nature of mental health services. While there has been a shift from asylums to care in the community in recent decades, what is now needed is another shift of acute inpatient psychiatric care, away from psychiatric units to community hospitals and other community settings. It is argued that this would be a further step forward in the evolution of mental health services as it would benefit the service users, their families, carers and staff working in acute psychiatric inpatient units.

The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments.

Milieu treatment is defined and differentiated from TC “proper”. Literature is reviewed covering attempts to use TC methods in inpatient wards, across hospitals, and more recently in the criminal justice system and more widely through the enabling environments initiative.

It is unclear whether TC milieu treatments proved helpful in acute ward environments in their heyday in the 1950s, 1960s and 1970s, in particular those involving people suffering from acute psychosis, and the changing landscape of psychiatric provision may make further investigation difficult. The reasons for this, and for the difficulties reaching a firm conclusion, are outlined. In contrast, TC milieu interventions appear to be demonstrating usefulness more recently in less mixed populations without the implementation of full TC “proper”.

Much of the research is old and the methodology poor, which limits the conclusions that can be drawn.

Recent innovations pick up in a more accessible way principles of therapeutic communities that can inform and improve care in a variety of contexts. They are sufficiently well defined to lend themselves to research, which should now be a priority.

After a gap in developments in the field, recent innovations are reintroducing elements of TC functioning to new contexts including criminal justice settings, inpatient wards, homeless shelters and city communities.