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Over the last decade there has been considerable growth in the role that psychiatric nurses play in providing care for the mentally disordered offender (MDO). Yet there has been little written about this specialty from a global perspective. Examination of the literature illustrates a large body of research and development programmes reporting the development of services to the MDO, for example, self‐harm and clinical risk assessment. Such service development is growing at a rapid pace, yet training and education to meet the needs of this patient group is something that is added onto post registration courses. Furthermore, the lack of vision and career pathways into forensic care is stifling a growing profession, which is subject to continual permanent change and investigation. Leaders and professional associations have contributed little to this unique nursing group which plays a major role in the multidisciplinary care of a very demanding set of patient needs.

One of the challenging facets of mental health care can be that of trying to deal with a patient's level of insight. Problems that seem apparent to assessing practitioners are sometimes not regarded in the same way by the patient. Measuring a concept like insight is not easy. The Behavioural Status Index (BSI) breaks insight into components and measurable criteria. Such a measurement instrument provides opportunities for detailed analysis of function, opportunity for very specific interventions, further detailed assessment and measurement of progress. This paper begins with a theoretical introduction to the concept of insight and a description of the BSI. Data analysis then follows for the BSI insight subscale. Data were collected, using a repeated measures method from a sample of 503 individual patients in two high‐security mental health hospitals. Results are reported for the central tendency and spread of items; the differences between the Mental Health Act 1983 classifications of mental illness, psychopathic disorder and learning disabilities, patient‐ward dependency level and gender; and the relationship between items, within the subscale. The relationship between items suggests two distinct groupings of acceptive (the ability to recognise and differentiate inner feelings of tension or anger) and cognitional (conscious awareness of inner states) behaviours.