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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.

Despite widespread work on the process of safeguarding vulnerable adults, there is a relative absence of research in secure psychiatric settings where reliance is placed on external community safeguarding teams. This study analyses safeguarding incidents over a three‐year period in a medium secure psychiatric setting for women. It focuses on incident type, the characteristics of victims and perpetrators and safeguarding processes, including protection strategies. The action implications of the findings are discussed with reference to the unique feature of the patient population and setting and the extant research literature.

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.

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.

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.

The purpose of this paper is to examine whether the popular policy assumption of co-production is feasible in secure psychiatric settings.

The assumptions of co-production are listed and then used as a basis for an immanent critique to test the feasibility described in the purpose of the paper. An explanatory critique exploring consumerism in the welfare state then follows. These forms of critique are derived from the philosophy of critical realism.

A distinction is made between the co-production of knowledge about mental health services and the actual co-production of those services. It is concluded that the former has emerged but the latter is not feasible, given the limitations on citizenship imposed by psychiatric detention.

Evidence for the co-production of mental health services (rather than the co-production of knowledge about those services) remains sparse.

The contradictions about citizenship created by the existence of mental health legislation and the social control role of mental health services requires ongoing honest reflects by mental health professionals and those responsible for the development of mental health services.

As described above, mental health legislation pre-empts confidence in the co-production of mental health services.

Whilst there is a small literature on co-production and mental health services, alluded to at the outset, this paper uses immanent and explanatory critiques to deepen our understanding of the topic.

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.

An association between problematic substance use and severe mental illness has been demonstrated in various settings, but not among community forensic psychiatric patients. This paper aims to investigate the prevalence and correlates of problematic substance use among the community patients of one regional forensic psychiatric service.

Historical data on diagnosis, offending and problematic substance use were gathered by reviewing case notes. Current substance use and psychosocial functioning were ascertained from structured interviews with community psychiatric nurses. Outcome measures included HoNOS ratings, the Global Assessment of Functioning, and the Clinical Rating Scale for substance use.

Of 92 patients, 91.2 per cent had a history of problematic substance use and 31.5 per cent of them were currently using substances problematically, most commonly cannabis and alcohol. Current problematic substance use was associated with a range of negative outcomes, in terms of illness severity, compliance with treatment, and psychosocial functioning.

The results may not be generalizable to services in different areas or those with different models of service provision. Causality should not be assumed from a cross sectional study.

Inpatient psychiatric treatment in secure services appears to be associated with a large reduction in the level of problematic substance use, but a large residual need remains among community patients. Services which provide community care for forensic patients must seek to integrate treatment for problematic substance use with treatment for mental illness.

This is the first description of the substance use related needs among community forensic psychiatric patients.

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 undertake a systematic literature review to appraise the current evidence relating to the factors associated with violence and aggression in adult psychiatric hospital inpatient settings.

A systematic search of following four databases was conducted: Scopus, PsychINFO Medline, CIHAHL and PsychArticle. Following the application of the inclusion criteria, ten papers were extracted and included in the review. A quality appraisal tool, Mixed Methods Appraisal Tool (MMAT) version 2011 (Pluye et al., 2011), was employed for the appraisal of the qualitative and quantitative studies. MMAT has been designed for systematic literature reviews that include qualitative, quantitative and mixed methods studies. Of these, eight were of quantitative methodology and two were of qualitative studies.

These ten papers provide an insight into factors associated with violence and aggression towards nursing staff. Three main themes were identified: the environment, attitudes/interaction of staff, and the patient’s mental illness. The themes were important factors in the causes of violence but were interlinked highlighting the complex nature of violence towards nursing staff. The findings support the need for training for nursing staff and the development of ongoing support and for organisations to consider both the environment and the restrictive procedures to help reduce violence and aggression towards nursing staff.

The paper concludes by outlining the importance of considering the three main themes for clinical practice, training and development of secure services.

This paper gives insight into the factors associated with patient violence and aggression towards nursing staff in a secure setting.