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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.

The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions.

Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas.

Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space.

Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes.

This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services.

This article aims to describe the development of secure services for women with intellectual disability in the UK and to outline what is known about their mental health needs.

The paper is a general review which is based on what is known historically about the subject, findings from the current literature and the author's own personal knowledge of these specialist services.

Secure services for women with intellectual disability have developed out of mainstream forensic and learning disability services.

Although there is a reasonable body of literature on offending in the intellectually disabled population as a whole, little of this is specific to women. Despite this, the evidence there is suggests that women continue to require secure services and that they have significant mental health needs.

A new service was developed to provide transitional care between acute and secure services for people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is to evaluate the work of the service by examining referrals made, strategies employed for each referral, and patient outcomes, as well as investigating issues in the service's development and implementation.

A retrospective descriptive study by review of 38 case notes, and qualitative interviews of 47 staff within the service and those referring to the service.

In the first eight months, 38 patients were referred due to violence, aggression and management problems. Most interventions provided by the service involved working with referring staff, rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security. Interviews showed the team's aims needed to be more clearly established, but that ward staff found the service to be a useful and productive resource.

The study is descriptive and retrospective, but showed that the service provided appropriate interventions for managing patients with serious mental illness and challenging behaviour.

A transitional service may have value in keeping patients in the least restrictive setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective management.

The service under study was novel, and may be useful in facilitating successful transfer from, or preventing admission to, secure services.

Individuals being treated in medium secure hospitals have typically engaged in some form of offending in other service settings or while in the community. Although psychological treatment for addressing such behaviour in medium secure hospitals is beginning to be developed, at present there is a lack of evidence of ‘what works’. This paper reports a review of the type and level of offending behaviour engaged in by those in a single medium secure service, including the conviction histories for such behaviours and the psychological approaches to risk reduction and offending behaviour taken in medium secure hospitals in England and Wales. The need to develop an evidence base for psychological treatment in medium secure services including at the individual level is clearly indicated.

The nutrition and eating habits of women in a secure psychiatric service were surveyed using in vivo participation, observation and self‐report procedures. It was predicted that high levels of obesity were partly related to unhealthy eating preferences, over‐consumption of food and environmental factors that supported an unhealthy lifestyle. The results indicated an obesogenic environment in which patients made unhealthy food choices to supplement meals. Post‐survey initiatives have led to increased satisfaction with a healthier and more palatable diet and proactive attempts to help patients engage with a therapeutic and healthier lifestyle to address obesity. The importance of environmental change, education and motivational strategies to engage patients is highlighted.

The study presented here examines the reporting of patient‐to‐patient bullying in a high secure psychiatric hospital housing adult men. It examines official records of bullying recorded on Suspected Bullying Report forms (SBRs), noting motivations for bullying and exploring how information was recorded. Its subsidiary aim was to explore the value of official records, presenting comparison data from three patient bullying surveys completed at the same hospital. All suspected reports of bullying in the hospital documented for a two‐year period were collected. The patient surveys included data from three data‐sets collected at the same hospital over a five‐year period. The prediction that the patient surveys would suggest a higher level of bullying behaviours than official records was confirmed. Results for official records also demonstrated that motivation for bullying was either not recorded or was reported as a typology, bullying was not likely to be recorded as hospital incidents, and perpetrators were unlikely to be offered supportive intervention. The results are discussed with regard to the value of official records as a reporting mechanism.

There is not only an absence of guidelines for the development of medium and low secure units but also confusion over the definitions of these types of provision.

The aim of this pilot study is to explore women's experiences of forensic mental health care with a view to designing a larger scale research project.

In‐depth interviews were undertaken with seven self‐selected women who had experience of using secure services currently or in the past.

The findings revealed three key themes: women's experiences of settings and treatments; relationships with staff; and how placements impacted upon important social contacts with family and friends. Despite their relatively disadvantaged position, the women were able to articulate what worked and offered clear solutions for implementing best practice.

The women's experiences testified to the importance of meaningful relationships with professionals, and with families and friends, as protective factors to help manage risk. This “relational security” is particularly for women in secure services and can be promoted in a range of ways, hinging upon consistency of care, well managed transitions, and appropriate therapeutic treatment.

The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.

The extant literature on CBT as applied to women in secure settings is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a women's medium secure service.

Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment.

There is comparatively little work on CBT group treatments for women in secure settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment developments.