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The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high secure forensic psychiatric care in England. These perspectives are relevant in considering the benefits of a similar long-stay service in England.

A current in-patient detained in a high secure hospital in England and other mental health service users and carers with experience in forensic-psychiatric settings were asked to watch a documentary on a Dutch high secure long-stay service. Then they were invited to make comparisons between this service and high secure care in England. These perspectives were gained in the context of their membership of the Service User Reference Group of an externally funded study on long-stay in forensic-psychiatric settings in England.

The small group of participants highlighted the importance of relational security, meaningful occupation, autonomy, positive therapeutic relationships with staff and a homely environment for those with lengthy admissions and perceived these to be better met in the Dutch service. These factors might contribute to improved quality of life that services should strive to achieve, especially for those with prolonged admissions.

Perspectives of service users with lived experience of long-stay in forensic settings are important in informing service developments. Lessons can be learnt from initiatives to improve the quality of life in long-stay services in other countries and consideration be given on how to best manage this unique group.

To the authors’ knowledge this is the first study asking service users about their view on forensic services in other countries. The findings suggest that service users have valuable contributions to make to aid service developments and should be involved in similar such exercises in the future.

Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.

In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.

A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.

The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.

There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.

The purpose of this paper is to inform the development of an evidence-based and effective rehabilitation programme to address substance use disorders in a population of patients with severe mental illness and mental disorders detained in a secure forensic psychiatric facility. A clinical review identified a high prevalence of substance use disorders in the patient population at a secure forensic facility in Sydney, Australia with only a limited number of patients being assessed and offered interventions for substance use problems.

A literature review was undertaken specifically looking at articles between 2009 and 2017 that considered models of care or approaches to substance use rehabilitation in patients with co-morbid psychiatric disorders. Articles were considered based on their relevance to the purpose and the environment of a secure forensic facility.

The literature review emphasised the need for a cohesive model of care integrating substance use rehabilitation with mental health care. Comprehensive assessment and individualised approaches that incorporated patient choice and stages of change were considered essential components to any dual diagnosis rehabilitation programme.

The literature regarding rehabilitation approaches for those with severe mental illness and co-morbid substance use disorders was reasonably consistent with the models of care used in relation to criminal offenders and mental illness generally. Integrated and individualised rehabilitation approaches for dual diagnosis patients could play a significant role in forensic settings.

Limited robust evidence for substance use rehabilitation has been published. The authors consider the existing evidence base and the underlying theory behind substance use rehabilitation to propose a model for rehabilitation in secure forensic settings. This is the first known review of substance use rehabilitation involving mentally ill offenders with dual diagnoses in secure forensic settings. This paper is the original work of the authors.

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings.

Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed.

To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.

The study explored the relationship between self and informant reports of emotional problems in a forensic intellectual disability sample. The Emotional Problems Scales (EPS) (Prout & Strohmer, 1991), which comprises a Self Report Inventory (EPS‐SRI) and an informant Behaviour Rating Scale (EPS‐BRS), was routinely administered to 30 individuals with intellectual disability in a secure forensic setting, as part of a standard clinical assessment procedure. It was hypothesised that there would be a moderate relationship between corresponding scores on the EPS‐SRI and EPS‐BRS. However, there were no significant relationships between corresponding scales of the EPS‐SRI and EPS‐BRS, apart from the EPS‐SRI and EPS‐BRS scales measuring anxiety (r = .376, p<.05). The results continued to be non‐significant, even when positive impression management was controlled for. The findings suggest little relationship between self and informant ratings in a forensic intellectual disability sample, and therefore support the need to gather information from multiple sources when assessing such individuals.

The purpose of this paper is to adapt a social climate measure for use within a forensic intellectual and developmental disabilities (IDD) service and examine perceptions of social climate and the links with patient aggression across three levels of security.

Four staff participated in a focus group to discuss how the Essen Climate Evaluation Schema (EssenCES) could be adapted for IDD patients. Subsequently, a pilot study with three patients highlighted some difficulties in administering the adapted measure. Alterations in the administration of the measure were implemented with a further ten patients residing across three levels of security. The EssenCES was adapted to include more visual prompts to assist in the patients’ completion of the measure. The frequency of aggressive incidents in each of the three settings was also collated.

Statistical analysis revealed a non-significant trend where positive social climate ratings increased as the security level decreased. There was a significant difference in the frequency of aggressive incidents across the three levels of security; however, there were no significant relationships found between the questionnaire ratings and the frequency of incidents.

The results lacked statistical power due to the low number of participants. Further studies with adapted social climate measures need to be conducted to assess the implications of social climate on individuals with IDD in secure forensic services.

The study adapted and piloted a social climate measure for individuals in a forensic IDD service.

The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting.

Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative phenomenological analysis (IPA).

Four main themes emerged: identity, power, protection and containment, and confusion. The themes of identity, power and protection and containment represented polarised positions which in turn contributed to the theme of confusion.

There are limitations to this study mainly the heterogeneous nature of the sample. However, good quality control and the similarities with previous findings indicate that this study makes a valuable contribution to the understanding of BPD in a forensic setting. In addition it has implications for further research; exploring sense of self and the differences between a sample from a community and a sample from a forensic setting with a diagnosis of BPD.

For practitioners to acknowledge power dynamics and to be able to formulate and address these with patients with a diagnosis of BPD.

This is the first IPA study to ask women with a diagnosis of BPD in a forensic setting what their experience is. It is a qualitative study due to the need to genuinely explore the topic and to provide a basis for others to conduct further research.

Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, specialised private hospitals, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. Rarely is the term defined in the general literature and as a concept it is multifaceted. Concept analysis is a method for exploring and evaluating the meaning of words. It gives precise definitions, both theoretical and operational, for use in theory, clinical practice and research. A concept analysis provides a logical basis for defining terms and helps us to refine and define a concept that derives from practice, research and theory. This paper uses the strategy of concept analysis to explore the term ‘forensic nursing’ and finds a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and to define it more clearly. Forensic nursing is found to derive from forensic practice. A proposed definition of forensic nursing is given.

This study examines the implementation of the recovery model or ‘philosophy’ in a secure NHS forensic service. Twenty‐six (86.7%) staff and seventeen (70.8%) mentally disordered offenders (MDOs) were interviewed in Spring 2009 from the rehabilitation and pre‐discharges units in a medium secure forensic service in Kent, UK. Their views on recovery were measured using the Developing Recovery Enhancing Environments Measure (DREEM: Ridgeway & Press, 2001). Staff consistently rated all 24 elements of recovery as more important than the MDOs. Staff also rated the elements of recovery as better implemented, except Intimacy and Sexuality. There was a significant effect of MDOs' forensic history (restriction status and index offence type) on ratings of how well elements of recovery were implemented. Staff and MDOs rated all elements of recovery as at least moderately important (above median value). The implications of the recovery philosophy in forensic mental health services are discussed.

The purpose of this study is to provide an in-depth account of how individuelas with a mild intellectual disabilitiy or borderline intellectual functioning (MID-BIF; IQ 50–85) perceive their group climate in a secure forensic setting. Giving voice to these service users may provide relevant insights for secure forensic settings.

The interpretative phenomenological analysis was used to explore what individuals with MID-BIF experience with regard to their group climate.

In the interviews about the four domains of group climate (i.e. repression, support, growth and atmosphere), five overarching dimensions appeared, namely, autonomy, uniformity, recognition, competence and dignity. Depending on the person and the (treatment) context in which he/she resides, these five dimensions relate to all four factors of the group climate instrument.

From the perspective of individuals with MID-BIF, this study contributes by providing a framework to “fine-tune” group climate on five dimensions. Training socio-therapists to be sensitive to interpret ambiguous signals on these dimensions can contribute to optimizing group climate in secure forensic settings.