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Obesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings.

This study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust.

The survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery.

Secure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact.

To the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

Three deaths at Cawston Park Hospital shed a bright light on Norfolk’s services for people with learning disabilities and autism, including those operated by the company that ran the hospital. The purpose of this paper is to review Norfolk County Council's current position from the unique aspect of a senior manager wihtin the system.

This paper reviews the unique perspective of a social worker from within the system.

The process of making change included engagement and action concerning such thorny challenges as the pressures on community services; the undervaluing of care-giving as a career; and the continuing admissions to specialist mental health services at a time when hospital discharges are being expedited.

Norfolk’s investment in improving its services involves the adoption of a human rights approach; a capital programme to facilitate new developments; nurturing care-giving as a career; and bringing a clearer evidence base to this work programme.

The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.

To ensure health, social and criminal justice services are suited to the complex and dynamic needs of people with learning/intellectual disabilities (LD) at risk of offending, it is important to systematically analyse the needs and characteristics of this population. This study aimed to analyse the patterns of referrals to a single community forensic LD service before and during the COVID-19 pandemic.

A structured audit was conducted on all referrals to the service (n = 37) across a three-year period (May 2019 – end of July 2022).

The majority of the overall sample were male (36, 97%) and Caucasian (24, 65%) with a mean age of 32.9 years and mild LD. The most prevalent current offending type was sexual offending (17, 44%), whereas the most prevalent historical offending type was violence (17, 35%). The most common service/function offered by the service was advice and consultation to other professionals and agencies (10, 19%). The service user and forensic/legal characteristics measured did not differ significantly before and during COVID-19.

To the best of the authors’ knowledge, the project is the first to systematically analyse and compare community forensic LD service referral patterns before and during the COVID-19 pandemic. This study also provides an example of how a structured audit tool can be used to benefit individual services and the wider literature on assessing the needs and characteristics of adults with LD who live in the community and are at risk of [re]offending.

This study aimed to explore the psychological and relational processes of a service user reflective group on a medium secure forensic ward. The group was conceptualised by the service as a component of the therapeutic offer contributing to the patients’ journey towards recovery and this study aimed to explore whether the group was being experienced as beneficial, by service users and staff, in relation to recovery concepts.

Qualitative data were collected using semi-structured interviews from 10 participants who had experience of an existing service user reflective group on a medium secure forensic ward. Participants in the study were patients who attended the group (6) and staff members who facilitated the group (4). The data collected were analysed using constructivist grounded theory methodology.

Results formed a flexible, cyclical model based on five key categories: “Group Identity”, “Linking Self with Others”, “The Changing Self”, “Living Visibly in a System” and “Moving On.”

Findings indicate that service user reflective groups in forensic inpatient settings can contribute to increased interpersonal effectiveness and personal recovery.

The role of service user reflective groups in secure recovery has not been explored empirically to date, although they are a suggested intervention to enhance relational security and to aid therapeutic progress within a secure recovery framework. This study aimed to begin to address this gap in research and understanding.

The current study aimed to examine the population of girls in two secure children’s homes (SCHs) in the North East of England to consider the impact of menstruation on girls’ physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice.

A case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023.

Of the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls’ menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls’ presentations.

The results indicate the impact of menstrual cycles on girls’ physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research.

This paper aims to focus on the involvement of mental healthcare professionals in a co-design process of a digital healthcare platform. Many people with severe mental disorders need constant support and monitoring, and with long waiting lists and scarce resources in mental healthcare, there is a dire need for innovative digital solutions to counteract those issues. This paper elaborates on a co-design process of a digital platform and mobile app designed for people with mental disorders. The platform primarily considers two perspectives: i) the patients and ii) the healthcare professionals.

This paper is based on canonical action research, where the co-design involvement with 13 healthcare professionals is analyzed and their interactions with three primary scenarios are focused.

The main contribution of this paper is three co-design principles: i) clarity and information accessibility regarding the patient's side, ii) efficiency and flexibility when it comes to the healthcare professional's side and iii) a notification function in the mobile application.

The theoretical contribution is the conceptualization of the three co-design principles that others can use when designing digital platforms in healthcare in general and psychiatric care in particular. The practical contributions are firstly outlined through the co-design process itself, where scenarios to guide the work are used, and secondly, the improvements made in the digital platform derived from the results of the co-design process.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.

A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.

A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.

This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

The second chapter of this text provides an introduction to policy relating to mental health, addiction and dual diagnosis from three jurisdictions [Ireland, UK and Australia], chosen because of their close links to Irish people and mental health service provision. The chapter begins with an introduction, reflecting on key points raised in Chapter 1 and how they are relevant to this present chapter. A critical exploration of the policies within these three jurisdictional areas is then presented to highlight the strategic direction of mental health and addiction service provision within the three jurisdictions. This includes the acknowledgement that mental health and addiction services need to be integrated as the presence of dual diagnosis in modern society increases at an alarming rate. Finally, this chapter concludes with a link to each of the policies mentioned herein for those who wish to explore these issues further.