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This study aims to understand the perceived causes and consequences of weight gain within a secure psychiatric inpatient service in South Wales.

A purposive sample of 12 staff members were interviewed. These interviews were transcribed verbatim and analysed using thematic analysis.

Three themes were identified, these were increasing demand for integrated physical health care, unhealthy lifestyles and weight gain viewed as a symptom of poor mental health.

It is a unique insight into the factors that contribute to obesity in a Welsh secure unit and adds to current understanding of the challenges of improving weight management services within this sector.

Attachment Theory can be regarded as central to the concept of relational security. There is a paucity of research examining the coherence of this construct for ward-based staff. The paper aims to discuss these issues.

Five female nurses from the acute admission and assessment ward of a UK medium secure unit acted as participants. Semi-structured interviews were conducted, and inductive thematic analysis was applied.

Six themes; “staff-service user relationships”, “staff diversities”, “service user backgrounds”, “variability in service users’ presentations”, “service users with personality disorder are problematic” and “nurses do not use attachment” emerged from the data. The nurses used heuristic models of attachment-related behaviour and they lacked knowledge of constructs associated with Attachment Theory.

Acute admissions may not be representative of all treatment contexts. Traditional models of attachment style may have only limited relevance in forensic services.

Limited knowledge and confidence in the nurses regarding how Attachment Theory might apply to service users is interesting because it may limit the extent to which care, treatment and risk management might be informed by an understanding of service user representations of therapeutic relationships. Training and educational interventions for nurses that enhance understanding of personality development and attachment styles are warranted.

The importance of nurses for achieving relational security is emphasised and the adequacy of their training is questioned.

The aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.

Retrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.

Attachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.

The sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.

Attachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.

Mental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.

This study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.

The purpose of this paper is to outline the work of a service provider, service user and carer group created to develop a strategy for service user and carer co-production.

A reflective narrative account is given of the process through which the group formed and began to develop a working model aimed at shaping a cultural shift towards more co-produced services. The paper has been co-produced and includes the collaborative voices of service users, carers, multi-disciplinary staff, third-sector representatives, managers and colleagues from associated services.

The model developed outlines three stages for services to work through in order to achieve meaningful and sustainable co-produced services. The importance of developing associated policies related to such areas as recruitment, payment, support and training is also outlined. Challenges to co-production are noted along with suggested approaches to overcoming these.

The ethos of co-production is relatively new in the UK and so knowledge of the process and model may help guide others undertaking similar work.

Far too much weight seems to have been given to the Local Government Board circular which mentioned public libraries as institutions whose expenditure should be examined with a view to effecting economies. This, to the ordinary person, would seem to call on library committees to exercise special care to prevent unnecessary expenditure, and more particularly to see that capital expenditure on new buildings and extensions is not made. The first of these requirements has been common for years; had there been wasteful expenditure, and if librarians had not carefully financed their resources, half the libraries in England would have been bankrupt long ago. The second requirement is just, and would be accepted even by the most unbridled library enthusiast. But local bodies have not been content so to read the circular. They have frequently interpreted it to mean that “libraries must mark time,” are “of small value in peace and less in war,” and the war is being made an excuse by old‐standing opponents of public culture to do as much damage as possible to the library movement.

The report recently issued by the joint committee, appointed by various Administrative Counties and County Boroughs in the North of England, to inquire into the subject of milk contamination, is an important document to which reference was made in the last number of this journal. Unfortunately little permanent good is likely to result from such reports unless the circumstances which have given rise to the grave faults to which attention is called be dealt with by authority. Such reports are admittedly of great interest. They contain much valuable and important matter, and are full of first‐hand and reliable evidence collected by experts at the expenditure of much time and trouble. As a general rule, however, they are too technical in their wording to appeal directly either to the general public or to the ordinary milk dealer. Still, the bearing of the matters they refer to on the every‐day life and health of the nation is so great that they should not be allowed to sink into oblivion by failure to bring their essential features before the wider public to which they are in tended to appeal. On these grounds the suggestion contained in the report that a pamphlet, should he issued containing the results of the committee's investigations is an excellent one. The means that are taken from time to time to rouse public interest in the important and allied questions of meat and milk are unfortunately characterised by their spasmodic, if vigorous, nature. The agitation dies down after a time and is not renewed until perhaps the original question again rises in a sufficiently acute form. The work has then to be done over again. It is necessary to bring home to the public the importance of, say, a pure milk supply, but to produce a permanent impression it is needful to proceed by an educational process and not by one that is based on unorganised agitation. The methods pursued in the United States in relation to food questions are not always to be commended, but in relation to the educational methods to which reference has just been made we may usefully consider the means adopted by the State authorities of the Republic. They are in the first place nothing if not practical. There, as here, the greatest hope of a would‐be reformer lies in his being able to rouse up public opinion. Hence we find questions such as these are kept steadily to the front by the authorities, by means of official publications and the public press, with the avowed object of enlisting the trade on the side of the law to aid in keeping food products up to reasonable standards of quality. In a report recently issued by the State Agricultural Station of Kentucky dealing with the question of the milk supplied to the town of Louisville it is said that the result of inquiries instituted by the station showed “the large majority of dairymen to be anxious to co‐operate with the officials in the enforcement of all fair regulations; that they need help in an educational way and are eager for any practical information which will help them to better their plants; that to accomplish this both the State and the city should maintain, not at the dairyman's expense, sufficient experts in dairying science, and veterinarians to constantly inspect the districts, helping wherever possible, not only pointing out deficiencies, but suggesting remedies, and, finally, reporting for prosecution or withdrawing the permit of the dairyman not complying with the regulations necessary to produce wholesome milk.” What is said in this report might equally well apply to affairs on this side of the water as regards the milk supply. The authorities in Kentucky have had exactly the same problems to face and deal with as those referred to in the report of the Joint Committee. The same want of attention to cleanliness, to light, ventilation, and drainage in the cowshed; the same unpleasant methods of dealing with the milk during the process of transport; and the same want of cleanliness in the shop characterised many of the small and large dealers in Kentucky as in this country. For all that we cannot assume the milk dealer or cowkeeper to be invariably in the wrong through malice aforethought. The Kentucky report just quoted states that the time and money spent in telling the cowkeeper and dairyman not to do this or that would be in many cases better spent by showing him how to do things. “Most dairymen would be willing to make improvements if they knew exactly how to go about it.” It appears that three‐fourths of the dairymen who supply Louisville with milk are co‐operating with the health authorities in the task of “cleaning up.” We must not assume that the British cowkeeper or dairyman is less willing to do the right thing than is his American confrére. The position of such an institution as a State Experiment Station is probably peculiar to the United States. It is in intimate touch with the requirements of every farmer in the State. It deals with all problems relating to the rearing and diseases of cattle, their housing, food and treatment; with the products of the dairy, farm, and stockyard. It is consulted by farmers on all conceivable subjects affecting their business at all times. The interests of the station do not end here. Not only is it concerned with the cattle and their products as such, but the Experiment Station is authorised by the legislature to concern itself with the distribution and sale of all dairy produce including, of course, milk and allied substances, with the hygienic and veterinary inspection of buildings and cattle, as well as with the conditions prevailing in dairies and milkshops. Moreover, the inspection of food products of all kinds and their analysis under the Pure Food Law of the State is frequently placed by the State in the hands of the experts attached to the Experiment Station. Under these circumstances such an institution is exceptionally well qualified to judge the requirements or faults of any process or institution affecting the food supply. In the case under review the Experiment Station sent round a circular letter to all cowkeepers and dairymen concerned, pointing out what it proposed to do, and asking for comments and suggestions. The object, in fact, was to make all farmers and dairymen feel that in the authorities of the Experiment Station they had to deal with a friendly body and not one whose desire was merely to catch them tripping. This they have apparently succeeded in doing, and with good results. The position of affairs in this country seems rather to suggest that public authorities and the milk trade occupy two hostile camps, and if this be so the fact is regrettable.

Some people assert that the tendency of modern Governments is to be too grandmotherly. They urge that people must not depend on the Government preventing them from coming to harm, and that they should be self‐reliant. This is very true, but nowadays one individual cannot be a specialist in everything. The ordinary person has to take a great many things on trust. For instance, a passenger by train is not able to inspect the engine and look at all the wheels, examine the whole length of railway, and in other ways assure himself that he and his are fairly safe from the results of the carelessness of others. On the contrary, he has to trust to the “powers that be” that they have adjusted the laws concerning responsibility in case of accident to any train that, on the average, the proper amount of care has been exercised. It is the same with weights and measures; a purchaser cannot always carry about with him a pair of scales and a set of weights to ensure his not being cheated; he has to trust to the Government and its inspector. And the Food and Drugs Acts constitute an attempt to protect people who are not in a position to protect themselves from being cheated. It has been suggested that the same principle should be extended to ensuring the proper cooking of food. The digestibility of most foods depends very largely upon the cooking, and yet how many of those who keep restaurants or roadside inns are really capable of cooking food properly? A busy man at the lunch hour and a cyclist at an inn are usually in a hurry. They have to eat the food supplied or go for some hours without any, and there ought to be some means invented to ensure the food being fit to eat. There would, of course, have to be some legal definition of “well‐done” or “under‐done” meat, and what a cup of “fresh” tea ought to be. The exact hardness of potatoes allowable by law would give rise to appeal cases, and some glaring case of an egg boiled too hard might send a landlord to prison for a month. Boarding‐houses might even be brought within the administrations of the Proper Cooking of Food Acts.