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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.

There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security.

Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days.

There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days.

In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved.

This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

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.

A survey was undertaken to determine the number of young people needing secure psychiatric inpatient care as at 1st January 2001. Twenty‐three individuals were identified who were placed in a variety of settings. However, few of the placements could be considered ideal. There was a wide range of diagnoses, and most young people had additional problems of social and education deficits and offending behaviour.Specialist resources need to be made available to local secure and residential facilities to reduce the need for secure placements. However, there may be a case for developing a regional secure service although, given the wide range of needs presented, it is unlikely that a single secure resource could meet them all.

There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these services. There is longstanding tension between security and treatment that can be difficult to resolve. Solution‐focused ideas may provide a bridge between these two issues, by improving multi‐disciplinary working and providing an appropriate relationship style that optimises the delivery of care to forensic patients.

Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings which in general do not have a 'longer term focus'. The aim of this investigation was to assess and describe the needs of these patients. A survey questionnaire was designed and sent to responsible clinicians who had patients admitted at least five years previously to the Three Bridges Medium Secure Unit (males) in West London. Carer ratings using the Camberwell Assessment of Need: forensic version (CAN‐FOR) were completed by the primary nurse for each patient, complementing the survey questionnaire. Of 122 medium secure male patients 25 (21%) had been admitted at least five years before. We found high levels of co‐morbidity and treatment resistance. The CAN‐FOR revealed two groups, one with chronic challenging behaviour, treatment‐resistant mental illness and need for a high level of support, and another more able group not needing as much support but with a dependency on the hospital. It is considered here whether certain groups would benefit from a different approach or setting.

Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and needs. There is also evidence that if detained individuals with an ASD experience particular difficulties within custodial environments as a result of a mismatch between the difficulties associated with their ASD and the environmental demands. The purpose of this paper is to explore the experience of individuals with an ASD admitted to a high secure psychiatric care (HSPC) hospital.

Using both a semi-structured interview and a quality of life self-report measure (the Lancashire Quality of Life Profile) the experiences and views of seven patients with an ASD detained in one HSPC hospital were qualitatively explored.

Whilst a diverse range of negative and positive aspects of being within HSPC were identified by patients interviewed, those with prison experience thought HSPC was a less stressful environment with more therapeutic opportunities. As a group, patients with an ASD reported a similar or significantly better quality of life in many domains (global, leisure, financial and living situation) compared to other detained forensic patient groups.

Although most patients with an ASD interviewed reported positive experiences, there are a number of practical improvements that could be made within the hospital to reduce experienced stress levels and perhaps improve therapeutic outcomes.

Within the context of the Department of Health's autism strategy (2010) and subsequent update think autism (2014), the survey highlights continued ASD awareness training for staff as important. In responding to the risks and needs of individuals with an ASD in HSPC there is further support for the development of an ASD specialist service.

The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings.

The authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need.

In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting.

The multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.

Low security is a poorly understood concept, particularly in relation to people with an intellectual disability. Characteristics of patients offered an admission to low secure intellectual disability settings have not been robustly demonstrated. The same applies to staff perceptions of low security. The aims of the study were to ascertain the characteristics of patients referred to a low secure intellectual disability unit which lead to an offer of admission, identify the views of staff working on the unit on the concept of low security, and use both sets of data to discuss low secure provision for people with intellectual disability. A case‐controlled study was carried out for 33 patients referred to the unit over 42 months. The characteristics of 18 patients offered an admission were compared with those of 15 patients not offered an admission, and five of the staff working on the unit were interviewed about the concept of low security. Patients offered an admission were more able than those not offered an admission, posed more risks and were more complex diagnostically. Staff working on the unit agreed that their patients were complex, but felt that they were appropriately placed overall. The challenges of low secure provision were discussed by staff. Patients sampled were complex and heterogeneous, but not necessarily ‘forensic’. Their complexity requires sophisticated care plans and management strategies. This study has implications for referrers, staff, patients and managers, and highlights areas for future research.

The COVID-19 pandemic significantly disrupted the lives of the deaf community, and the implementation of restrictions on face-to-face meetings resulted in the trial introduction of video remote interpreting (VRI) in a secure psychiatric setting. This study aims to use a qualitative research paradigm to explore user experiences to inform potential future technological developments in this area.

Twelve deaf patients and three interpreters took part in structured face-to-face interviews and discussed their experiences of the use of VRI, with the results being assessed using thematic analysis.

Seven main themes were identified: resource availability, ease of use, technical issues, misunderstandings, medium secure-specific issues, preferences and human factors. All participants agreed that they did not like the VRI technology in the health-care environment in its current format, and their main concern was the difficulty in understanding the information being communicated. It was considered that this had the potential to incur potentially serious medico-legal and safety implications for both staff and patients alike.

This study has provided detailed users’ feedback about the potential future use in this communication tool and can help guide service developers to review the technology design to tailor it towards the users’ needs. While the existing technology is not currently suitable for this deaf population, particularly because of the potential for error, there is potential scope for further research in this area.

The COVID-19 pandemic provided a unique opportunity to explore the potential use of VRI for a deaf patient population within a secure psychiatric setting, where such technology is unlikely to have otherwise been used.