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This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services.

A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having “major” relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes.

There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery.

This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English.

This review makes a unique contribution, highlighting that, to the best of the authors’ knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary.

Using a mixed methodology comprising interviews, case file analysis and descriptive statistics, this study aims to examine the experiences of all 43 young people in Wales subject to secure accommodation orders between 1st April 2016 and 31st March 2018.

Children in the UK aged 10–17 years who are deemed to be at a significant level of risk to themselves or others may be subject to a secure accommodation order, leading to time spent in a secure children’s home (SCH) on welfare grounds. Following a rise in the number of children in Wales referred to SCHs for welfare reasons, this paper describes these young people’s journeys into, through and out of SCHs, giving insight into their experiences and highlighting areas for policy and practice improvements.

Findings indicate that improvements in mental health support and placement availability are key in improving the experiences of this particularly vulnerable group of young people throughout their childhood.

Other practical implications of the study’s findings, such as improvements in secure transport arrangements, are also discussed.

While the findings are limited by the reliance on self-report methods and the size of the study, namely, the small number of young people with experience of SCHs who were able to participate, the findings build on the existing knowledge base around children’s residential accommodation and provide new insights into how best to support these children.

In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide “lockdown” of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients’ perspective.

A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021.

Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients’ experience: “treading water”; how they managed: “learning to swim”; and what was helpful during this time: “in the same boat”.

Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research.

To the best of the authors’ knowledge, this is the first study to explore secure patients’ experience of COVID-19 from the patients’ perspective, within a population often neglected within recovery research.

Secure children’s homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral.

A retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral.

In total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation.

The study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs.

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.

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.

The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.

A systematic review of qualitative literature was conducted. The data was sourced from the electronic databases: PsychINFO, CINAHL, Medline and the Web of Science Core Collection using pre-defined search terms. A total of 17 studies, conducted in various countries worldwide and covering high, medium and low secure inpatient settings, were included for review. The analysis involved integrating findings from across the literature and was guided by thematic synthesis.

A total of eight themes were generated from the data, three of which provided an understanding of the experience of forensic secure care, and the remaining five themes provided an understanding of the factors which may influence the experience of secure care.

Developing understanding of patient experience can lead to service improvements, potentially impacting patients’ motivation and engagement and thus reducing admission times, potential recalls and recidivism.

To the best of the authors’ knowledge, this is the first systematic review to date to exclusively explore the broad topic of the patient experience of secure mental health care.

After completion of this case study, students should be able to reflect on the concept of creating shared value and then determine whether Shesha Geza can be referred to as a shared value company and, if so, what level of shared value it demonstrates. They will be able to subjectively and objectively understand the possible meaning of when a social enterprise embarks on a strategy to scale the organisation; clarity of construct will enable managers to better plan and successfully implement scalability goals. They will also be able to recognise, once scalability goals are better understood and planned, that there are a multitude of intra-organisational levers and drivers that may contribute to the organisation’s ability to scale its operations, which are related to specific internal organisational capabilities of social enterprise companies. In addition, there are situational factors that may affect the business either positively or negatively in relation to the scalability success of which a social entrepreneur should be aware.

In April 2021, Dean Boniface and his brother, Roger, had just signed off a new informational video for their Shesha Geza innovation, a low-cost hand-washing station designed for use at commuter hubs and high-traffic areas across the African continent. The unit used diluted chlorine instead of alcohol-based sanitisers to ensure a more expedient and sustainable solution, one better suited to Africa’s logistical challenges. Boniface, the co-founder of Vue Architects, had conceptualised the idea of the hand-washing hub during South African Government’s enforced COVID-19 lockdown from 27 March 2020 to 1 May 2020. Shesha Geza’s speed to market was a key contributor to its successful response in solving a critical social need. Throughout 2020, Boniface and his team built successful partnerships and secured an impressive order pipeline within a short span. Export opportunities across Africa, installations and maintenance of a sizable number of units across South Africa and the development of a behavioural change programme aimed at hygiene in schools kept the momentum going in the business. However, a year into the business and the future sustainability of a crisis–response enterprise and the ability of a shared value enterprise to scale were playing on Boniface’s mind. He was worried about the future of the small resource-constrained business. Holding onto the mental map of everything the team had learned over the past year, Boniface was confident about one thing: “All the programmes we build around Shesha Geza are value-adds to our current business. Hand hygiene will not diminish after COVID-19; it will continue to be an important social issue across the African continent.”

This case is intended for discussion in post-graduate-level courses such as an MBA and in postgraduate courses focused on business model innovation or on creating shared value. This case is suitable for use in the environment of business courses in relation to environmental situational factors that may affect the ability to scale social enterprises or strategic implementation courses, considering the still pervasive challenge of scaling increasingly important social impact enterprises.

Teaching notes are available for educators only.

CSS 11: Strategy.

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.

“Buy X Get X Free” promotions are popular across retail settings. Retailers promote a variety of products using this promotional frame. However, past research contains mixed findings about the effectiveness of this promotion compared to the straightforward discount on a single unit of a product. The goal of this research is to employ a theoretical lens to examine the effectiveness of “Buy X Get X Free” promotions.

The theoretical framework was tested in two experiments using different products and samples. The data collected from each experiment were analyzed using both descriptive and inferential techniques to assess support for the theoretical arguments.

Findings reveal that at identical levels of per-unit discount, the “Buy X Get X Free” promotion is perceived less favorably by consumers than a straightforward single-unit discount. Consumers perceive lower transaction value and acquisition value and, thereby, a lower purchase intention, from the “Buy X Get X Free” promotion compared to a single-unit discount.

This research was conducted keeping in mind the popularity of the “Buy X Get X Free” promotion in the real world. The findings caution retailers against indiscriminately using this promotional frame.

Using a theoretical lens, this research proposes and validates a framework to systematically examine consumers' perceptions of the two popular discount frames. The proposed theoretical framework provides a richer understanding of the underlying consumer psychology that drives the evaluation of these promotions. Further, primary data from lab experiments validates the framework. The research also helps advance the understanding of consumer evaluation of sales promotions in general.