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Two Years OnNo abstract available
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Predictors of psychological well-being during imposed prolonged absence from workBackground Between March 2020 and September 2021, 11.7 million employee jobs were furloughed through the UK Coronavirus Job Retention Scheme (JRS). Imposed work absence shielded workers from job loss, but furloughed workers had increased risk of poor mental health compared to those who stayed working. Understanding the factors that mitigate psychological distress during imposed work absence can inform actions to be taken in future crises. Aims To explore the relationships between (a) work and home demands with well-being outcomes, and (b) personal and organisational resources with well-being outcomes, during periods of imposed prolonged absence and uncertainty. Methods We analysed online survey data collected with furloughed workers in the UK ‘Wellbeing of the Workforce Study’. Measures included psychological well-being, anxiety, life satisfaction, job insecurity, home demands (quantitative and emotional), organisational support for work-family balance, and personal resources (resilience, purpose, and coping ability). Results Psychological well-being was associated positively with quantitative home demands (β = 0.24, p < 0.05) and personal resources (β = 0.45, p < 0.001). Life satisfaction was associated negatively with emotional demands at home (β = –0.26, p < 0.05) and positively with personal resources (β = 0.30, p < 0.05). Perceived job insecurity was positively associated with anxiety (β = 0.36, p < 0.001). Conclusions Job-related factors are less influential during periods of employment uncertainty compared to personal and home resources. Decision-makers should provide psychological support during periods of job uncertainty and bolster the essential benefits of personal and home resources. Moving forwards, these findings may have broader applicability to other challenges and crises, such as suspension from work, or role changes resulting from organisational restructuring.
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Characteristics of women admitted to medium secure care : a comparison of patients admitted to specialised single-sex and mixed-sex services in an English forensic psychiatric hospitalBackgroundForensic mental health care has evolved from mixed-sex provision to specialised sex-specific services. It is important to understand how the characteristics of women admitted to medium secure care have changed over time and how this may impact on their outcomes after discharge.ObjectiveThe study aims to describe and compare admission and discharge characteristics of two consecutive cohorts; women admitted between 1983 and 2001 to a mixed-sex medium secure care (‘Mixed’ cohort) and women admitted between 2005 and 2013 to single-sex medium secure care (‘Specialised’ cohort).MethodsData came from a 30-year study of outcomes for first admissions to an NHS medium secure hospital (the ALACRITy study). Follow-up data were available up to a census date of June 30th 2013.Results93 women comprised the Mixed cohort (mean age 29.3 years; 81% White ethnicity; 49% personality disorder diagnosis) and 45 women comprised the Specialised cohort (mean age 32.4 years; 76% White ethnicity; 49% personality disorder diagnosis). The Specialised cohort were more likely than the Mixed cohort to be admitted from high security, or under a forensic section of the Mental Health Act. The Specialised cohort were more likely than the Mixed cohort to have previous convictions, or to have committed a ‘grave’ index offence warranting a life sentence. Over 95% of all women had received previous inpatient psychiatric care. The Specialised cohort had greater prevalence of alcohol use, self-harm and childhood adversity than the Mixed cohort. At the census, 99% of the Mixed cohort and 42% of the Specialised cohort had been discharged. Women in the Specialised cohort had a longer median length of stay than the Mixed cohort; 859 days and 229 days respectively. Over 80% of patients in the Mixed cohort were readmitted during the follow-up period.ConclusionThe study provides empirical data for two consecutive cohorts of women admitted to one medium secure hospital over the course of thirty years. Women admitted to single-sex services had more criminological and adverse trauma histories than women admitted to the earlier mixed-sex service. Further research is required to establish the long-term outcomes of women admitted to specialised single-sex medium secure care.
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A Qualitative evaluation exploring co-production of falls management in care homesABSTRACT Background Co-production approaches are increasingly used in research but are rarely evaluated in care home settings. This study explored factors influencing key principles of co-production in a series of workshops around falls management in care homes. Methods Stakeholders (care home residents and relatives, care home staff, and health and social care staff) participating in co-production workshops as part of a research study were invited to take part in this qualitative evaluation. The workshops were developing a model to implement falls training in care homes as part of a systemic action research study. Non-participant observations of workshops explored stakeholder interactions. Stakeholders participated in reflection meetings about their experiences of co-production. Framework analysis mapped key themes to the National Institute for Health and Care Research's (NIHR) principles of co-production. Results Nine themes were identified. Sharing power was affected by two themes: opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and integrating a disjointed system. Including all perspectives and skills was influenced by two themes: involvement of key stakeholders and a flexible approach. Respecting and valuing knowledge was impacted by two themes: respecting and utilising expertise and experience, and confidence. Two themes relating to reciprocity were identified: benefits and potential harms. One theme related to building and maintaining relationships: team dynamics. Conclusions Co-production in this context is complex and affected by multiple factors. Separate stakeholder groups, a flexible approach and recognising different experiences and expertise facilitated co-production in line with its key principles. Potential reputational risks, confidence levels and limited involvement of residents, relatives and care home staff in a variety of roles were identified as barriers. Future studies in care homes should consider organisational power dynamics and create safe spaces, providing opportunities for inclusive participation. Patient and Public Contribution A collaborator group, including a patient and public involvement and engagement (PPIE) advisor and health and social care professionals, contributed to the research methods, presentation of findings and authorship. Care home residents informed the design of the co-production workshops.
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Stakeholder acceptability of the ROWTATE vocational rehabilitation intervention in England : an interview studyOBJECTIVES: The ROWTATE intervention helps people experiencing trauma to return to work (RTW) through vocational rehabilitation (VR) support from occupational therapists (OTs) and clinical psychologists (CPs). This study aims to explore and understand the acceptability of VR after traumatic injury for patients, therapists and employers. DESIGN AND SETTING: Qualitative interviews in eight major trauma regions, UK. PARTICIPANTS: Interviews were undertaken with a range of stakeholders-15 patients, 15 therapists and 6 employers. Data were analysed using the theoretical framework of acceptability. RESULTS: Stakeholders understood the aim of the intervention was to support people to RTW and perceived it as effective in achieving this. Patients and therapists understood the benefits of working with a combination of occupational therapy and clinical psychology. The intervention fits with the values of patients wanting to recover, therapists wanting to offer support and line managers wanting to meet employer and employee needs.Patients reported they could not have achieved RTW without the intervention, and their therapist helped them feel less alone. Therapists felt that their work was rewarding, effective and had good outcomes. Patients perceived remote delivery as less burdensome than attending in person. Therapists felt they wasted time on non-patient activity, such as (re-)arranging appointments.Employers discussed the difficulty of balancing employer and employee needs and managing uncertainty. Some workplace policies lacked flexibility, and without the ROWTATE intervention, employers lacked confidence in supporting employees RTW. CONCLUSIONS: A VR intervention delivered remotely by OTs and CPs is acceptable to patients, therapists and employers. TRIAL REGISTRATION NUMBER: ISRCTN43115471.
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Prevalence and factors associated with restraints in mental health in-patient wardsAIMS AND METHOD: Restraints in mental health in-patient settings can negatively affect recovery. This study aimed to examine the prevalence and associated factors of restraint use. A retrospective cohort study was conducted in a rural NHS mental health trust in the UK, covering all adult in-patients from July 2020 to July 2021. RESULTS: The prevalence of restraint was 34%. Factors associated with restraint included age 18-25 or ≥65 years, female gender, disability, long-term sickness benefits, detention under the Mental Health Act, frequent admissions and a diagnosis of depressive or severe mental illness. Statistically significant associations were found for age ≥65 years (odds ratio 3.920), Section 2 detention (odds ratio 5.72), more than ten previous admissions (odds ratio 5.672) and depressive disorders (odds ratio 3.478). CLINICAL IMPLICATIONS: Restraint use remains common and is linked to identifiable risk factors. These findings support the need for targeted interventions to reduce restraint, particularly for high-risk patient groups.
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Patient and public involvement in secure mental health research : setting-specific considerations and a protocol for involvement in the CORAS study (COllaborative Risk ASsessment and management)BACKGROUND: Patient and Public Involvement and Engagement (PPIE) is important in secure psychiatric research because it can help ensure that research is relevant and meaningful, and a positive experience for those participating. However, there are significant challenges to embedding PPIE in research in secure hospital settings, including practical barriers to involvement. A lack of reporting of PPIE practices makes it harder for researchers to learn from previous projects, leading to missed opportunities to improve PPIE in secure settings, and there are no current setting-specific guidelines for best practice. The CORAS study aims to examine collaborative risk assessment within secure psychiatric settings. In this study, PPIE is fully integrated throughout the research cycle, and this protocol describes the PPIE methodology being adopted. By highlighting these approaches and principles, this protocol is intended to be used as a transferrable framework for developing best practice for PPIE in research in these settings. METHOD: This protocol describes the ways in which we will ensure that PPIE remains central to each stage of the research project, from the formation of a smaller grant application PPIE group, through to dissemination of outputs. We discuss principles of recruitment into the PPIE group, ensuring that all areas of the secure mental health pathway are represented, and formally embracing equality, diversity and inclusion principles through the use of an Equality Impact Assessment. We also describe the core activities of the PPIE group, including the co-design of the research materials, recruitment strategies and dissemination plans, how the impact of PPIE will be examined, and practical elements such as around reimbursement and ensuring the wellbeing of PPIE group members. CONCLUSIONS: PPIE in secure mental health service research is important and challenging. This protocol outlines how we will address these challenges and ensure that PPIE is fully embedded in the design and delivery of a large study in secure settings. Although the prospective nature of this protocol precludes the sharing of outcomes and learning from the PPIE, it can nevertheless serve as a transferrable framework for the development that is urgently required in this clinical research field, as well as allow transparent future reporting of what was achieved. Involving people with their own lived experience in the design and running of clinical research studies can improve the quality and impact of these studies, as well as the experience for people taking part in them. In some clinical settings this involvement might be more difficult. In secure psychiatric hospitals things like security can make it difficult for people to be involved in this way in research. There is not much guidance available for researchers on how to do this better when running studies in secure settings. The CORAS study (COllaborative Risk ASsessment and management in secure services) is a research study in these settings that is exploring how to involve patients and carers in their risk assessments and risk management plans (or safety plans). We have developed detailed plans for how to make sure that patients and carers have a central role in all areas of this study, including designing parts of the study and how best to make sure that the results of the study reach patients and carers. This paper outlines how we are planning to do this, so that other researchers designing studies in these clinical settings can understand and build on some of the practical ways of involving people with lived experience. eng publication: N/A. Competing interests: The authors declare no competing interests.
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Web-Based interactive training for managers (Managing Minds at Work) to promote mental health at work : pilot feasibility cluster randomized controlled trialBACKGROUND: Line managers play a key role in preventing poor mental health but often lack necessary skills and knowledge. Existing interventions typically focus on mental health awareness rather than practical skills. The evidence-based Managing Minds at Work (MMW) web-based training program was developed to address this gap by enhancing line managers' confidence and competence in prevention. OBJECTIVE: This study piloted the MMW intervention to assess its feasibility. Objectives included evaluating (1) uptake potential across small, medium, and large companies; (2) perceived suitability and effectiveness of the intervention; and (3) feasibility of outcome data collection methods. METHODS: We conducted a 2-arm pilot cluster randomized controlled trial of a self-guided, web-based training intervention for line managers. Twenty-four organizations were randomly assigned to the MMW intervention or a 3-month waitlist. A total of 224 line managers completed baseline measures (intervention: n=141, 62.9%; control: n=83, 37.1%), along with 112 of their direct reports (intervention: n=74, 66.1%; control: n=38, 33.9%). Follow-up data were collected at 3 and 6 months. Semistructured interviews with line managers and stakeholders (n=20) explored experiences with the study and intervention, and qualitative data were analyzed thematically. Line managers also completed feedback forms after each of the 5 MMW modules. RESULTS: The recruitment of organizations and line managers exceeded targets, and retention rates of line managers were good at 3 months (161/224, 71.9%) but not at the 6-month follow-up (55/224, 24.6%). Feedback on the intervention was very positive, indicating that line managers and organizational stakeholders found the intervention acceptable, usable, and useful. We observed significant improvements with moderate to large effect sizes for all trial outcomes for line managers in the intervention arm from baseline to the 3-month follow-up. Line managers completed a variety of questionnaires, which showed increased scores for confidence in creating a mentally healthy workplace (intervention group: mean change 3.8, SD 3.2; control group: mean change 0.6, SD 3.2), mental health knowledge (intervention group: mean change 1.9, SD 3.0; control group: mean change 0.2, SD 2.9), psychological well-being (intervention group: mean change 3.6, SD 8.3; control group: mean change -0.7, SD 7.7), and mental health literacy at work (intervention group: mean change 11.8, SD 8.9; control group: mean change 0.8, SD 6.2). Collecting data from direct reports in both study arms was challenging, with results inconclusive regarding observed changes in trial outcomes. Time constraints and workload were commonly cited barriers to completion of the intervention. CONCLUSIONS: This pilot feasibility trial provides strong evidence for the usability and acceptability of the MMW digital training and the research design. MMW shows potential to improve line managers' confidence and competencies in promoting mental health. The study also identified key considerations for future large-scale implementation and evaluation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019.
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Exploring the organisation and delivery of falls management in care homes for older people in EnglandBACKGROUND: To explore the organisational context of English care homes in delivering falls management and identify barriers and facilitators to help design future service delivery. METHODS: Non-participant observations and semi-structured interviews in one region of England with care home staff, commissioners and individuals involved in the organisation of falls management, care home managers, care home owners and residents. Barriers and facilitators were identified by thematic analysis and mapped against the Consolidated Framework for Implementation Research (CFIR). RESULTS: 17 interviews were undertaken including staff and a resident from three care homes. Delivering falls management in care homes was complex and challenged by difficulties in integration across a disjointed system, workforce challenges and managing complexity of resident needs with multiple competing priorities. Facilitators included consistent and regular multi-disciplinary support, valuing team working within the care home, and between the care home and external agencies, and the ability to retain care home staff who developed and honed skills over time and who valued their advocacy role for residents. Variation in care home environments, and access to healthcare support were highlighted. CONCLUSIONS: The delivery of falls management in care homes is complex and involves a number of interacting systems. Implementation strategies to support future delivery need to consider the pressure on care homes and wider systems, workforce challenges and variation between settings.
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A systematic environmental intervention, nidotherapy, given to whole communities : protocol for a randomised stepped-wedge trialBACKGROUND: Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities. AIMS: A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400. METHOD: Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months. RESULTS: The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction. CONCLUSIONS: The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.
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Violence reduction, revisiting a public health approachObjectives Propose and test an alternative method for identifying population targets for public health model derived violence reduction programmes. Study design Quantitative and qualitative focused on neighbourhoods in the 75th percentile of violence or higher, using Lower Super Output Areas (LSOAs) as the data collection/integration focus. Methods Cluster analysis to group similar LSOAs together. Significant factors in the regression analysis plus violence rates were entered into a k-means cluster analysis creating five groupings and a short list to include in the quantitative and qualitative arms. Results Local Government Area (LGA) or a city-wide perspective, masks locations with high violence rates and misses potential solutions. Crime and violence are more prevalent in areas with high deprivation, poor design of housing and space associated with isolation and fear. Less considered violence vectors were identified. Conclusions Deprivation was the strongest predictor of violence, but there are highly deprived areas that do not have high levels of violence and conversely high-violence neighbourhoods in non-deprived areas. A granular and dynamic understanding of these patterns should form the basis of future investment and intervention efforts.
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Transforming healthcare delivery : a comprehensive review of digital integration, challenges, and best practices in integrated care systemsDigital transformation in healthcare, particularly within Integrated Care Systems (ICS), offers significant potential to improve the quality, accessibility, and efficiency of care. This narrative review examines the best practices, challenges, and outcomes of digital healthcare transformation within ICS, with a focus on the integration of key technologies such as electronic health records (EHRs), telemedicine, and artificial intelligence (AI). The review highlights the critical role of leadership, stakeholder engagement, and staff training in overcoming barriers to successful digital adoption, including resistance to change, interoperability issues, and financial constraints. It further explores the impact of digital tools on patient outcomes, operational efficiency, and patient engagement. Despite the promise of digital transformation, several challenges persist, including technological barriers, regulatory complexities, and the need for significant investment in infrastructure. To maximize the benefits of digital healthcare tools, the review recommends fostering collaboration among healthcare providers, prioritizing staff involvement and leadership support, implementing digital solutions in phases, and addressing financial and regulatory challenges early in the planning process. By addressing these challenges and implementing recommended strategies, ICS can enhance care coordination, optimize resource utilization, and ultimately improve patient outcomes, paving the way for a more sustainable healthcare system.
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The lasting impact of COVID-19 on forensic mental health : a review of shifts in patient profiles, service delivery, and legal considerationsThe COVID-19 pandemic has had a profound and lasting impact on forensic mental health, reshaping patient profiles, disrupting service delivery, and introducing new legal and ethical challenges. This narrative review examines the long-term implications of the pandemic on forensic psychiatric populations, mental health service provision, and the justice system. Evidence suggests that rates of severe mental illness, including psychosis, depression, and anxiety, have increased among forensic patients, exacerbated by isolation, stress, and reduced access to care. Additionally, substance use disorders, and co-occurring psychiatric conditions have become more prevalent, complicating treatment and rehabilitation efforts. The pandemic also accelerated the adoption of telepsychiatry in forensic settings, improving accessibility but raising concerns about the reliability of remote assessments for competency evaluations and risk assessments. Inpatient and prison-based forensic psychiatric services experienced staff shortages, increased patient aggression, and limited access to therapeutic programs, further straining the system. Court closures and legal case backlogs delayed forensic evaluations, raising human rights concerns for detained individuals. Ethical dilemmas emerged regarding involuntary hospitalization, treatment prioritization, and resource allocation. As the forensic mental health field transitions into a post-pandemic landscape, key lessons include the need for hybrid forensic assessment models, strengthened forensic infrastructure, and better integration of legal and clinical perspectives. Future research should focus on developing resilient forensic mental health policies and ensuring equitable access to care while maintaining legal and ethical standards.
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Examining the effects of mental health literacy on stigma : study of Zimbabwe Prisons and Correctional Service (ZPCS)Background Mental illness affects an estimated 500 million people globally, with 85% living in low- and medium-income countries (LMICs). Research has shown that people with mental illness are over-represented in the criminal justice system compared with the general population. There is limited information available on institutional attitudes towards mental illness in LMICs. Aims This study aimed to examine mental health literacy (MHL) and mental health stigma (MHS) among Zimbabwe Prisons and Correctional Service (ZPCS) officers. Method A cross-sectional study using an online survey was conducted among ZPCS officers (N = 163) between August and December 2022. Data were collected using the Mental Health Literacy Scale (MHLS) and Attitudes Towards Mentally Ill Offenders (ATMIO). The primary hypothesis was that increased MHL is inversely related to MHS in this group. Results A significant inverse correlation was found between MHL and MHS (r = 0.36, P < 0.001). A regression analysis controlling for age and sex showed that MHLS is a statistically significant component in this model, indicating that MHL is associated with reduced MHS (P < 0.001). Conclusions In this group, increased MHL is associated with decreased MHS. This suggests that interventions to increase MHL should be further evaluated in these settings. Copyright © 2025 The Author(s).
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A feasibility study of a physical activity intervention for people with severe mental illness in medium secure psychiatric services in the United KingdomBackgroundIn the UK, there are approximately 3500 individuals detained in medium secure service. Service users in such settings have complex and severe mental illness (SMI), often with co-morbid physical health problems, shorter life expectancy and low levels of physical activity (PA). However, there are few studies about PA interventions for medium secure service users in the United Kingdom. Therefore, the aim of the study was to co-produce, with medium secure service users and staff, the content and delivery of an intervention to increase PA.MethodsA feasibility and acceptability study were conducted to test the PA intervention using the Capability, Opportunity, Motivation Behaviour Change Model (COM-B model) as the underpinning theoretical model. Both female and male service users, with personality disorder and/or mental illness, were recruited from two medium secure services in the UK.Outcome measures were collected at baseline, after the intervention and at follow up (3-months after intervention), and included PA levels, mental well-being, data on recruitment and retention and causes of drop out.ResultsA total of 33 participants were recruited. Seven participants withdrew during the intervention period and 26 participants completed the PA intervention. During the follow up stage, three participants withdrew. Following the intervention participants increased PA and improved physical health and wellbeing. Overall, there was good retention for the PA interventionConclusionRetention rates and completeness of data at both study sites indicate that it is feasible and acceptable to co-produce, deliver and maintain commitment to a PA intervention in such settings for service users with SMI. A future pilot randomised controlled trial (RCT) will allow further understanding about the effectiveness of the PA intervention in medium secure psychiatric services.Clinical trial registrationhttps://doi.org/10.1186/ISRCTN15546527, ISRCTN Registry – ISRCTN15546527.
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A conceptual framework outlining the use of compassionate mind training following incidents of moral injury within forensic mental health servicesPurpose: Forensic mental health professionals often face challenging situations that can lead to moral injury. This occurs when individuals' experiences or actions conflict with their values and moral beliefs, leading to psychological distress or discomfort. Moral injury has been shown to be linked with a plethora of adverse psychological health outcomes, and can impair both occupational and personal functioning, including the quality of care delivered to service users. Design/methodology/approach: This paper details how forensic mental health professionals can respond to threat-based thinking, emotions and self-criticism using compassion following incidents of moral injury with compassionate mind training (CMT). Finding(s): CMT has been found to alleviate psychological distress and support development of soothing capabilities (Gilbert and Procter, 2006). Practical implications: This paper describes the central tenets of CMT and how it supports the balancing of three motivational systems: threat, drive and soothing systems. Originality/value: It further highlights the three flows of compassion: compassion from others, compassion towards others and compassion for self and how this can influence staff well-being in relation to moral injury. Copyright © 2025, Emerald Publishing Limited.
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Mechanical restraint in inpatient psychiatric settings : a systematic review of international prevalence, associations, outcomes, and reduction strategiesBACKGROUND: There is increasing emphasis on reducing the use and improving the safety of mechanical restraint (MR) in psychiatric settings, and on improving the quality of evidence for outcomes. To date, however, a systematic appraisal of evidence has been lacking. METHODS: We included studies of adults (aged 18-65) admitted to inpatient psychiatric settings. We included primary randomised or observational studies from 1990 onwards that reported patterns of MR and/or outcomes associated with MR, and qualitative studies referring to an index admission or MR episode. We presented prevalence data only for studies from 2010 onwards. The risk of bias was assessed using an adapted checklist for randomised/observational studies and the Newcastle-Ottawa scale for interventional studies. RESULTS: We included 83 articles on 73 studies from 1990-2022, from 22 countries. Twenty-six studies, from 11 countries, 2010 onwards, presented data from on proportions of patients/admissions affected by MR. There was wide variation in prevalence (<1-51%). This appeared to be mostly due to variations in standard protocols between countries and regions, which dictated use compared to other restrictive practices such as seclusion. Indications for MR were typically broad (violence/aggression, danger to self or property). The most consistently associated factors were the early phase of admission, male sex, and younger age. Ward and staff factors were inconsistently examined. There was limited reporting of patient experience or positive effects. CONCLUSIONS: MR remains widely practiced in psychiatric settings internationally, with considerable variation in rates, but few high-quality studies of outcomes. There was a notable lack of studies investigating different types of restraint, indications, clinical factors associated with use, the impact of ethnicity and language, and evidence for outcomes. Studies examining these factors are crucial areas for future research. In limiting the use of MR, some ward-level interventions show promise, however, wider contextual factors are often overlooked.
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Black psychiatrists' experience of discrimination and related behaviours in the workplace : UK surveyAIMS AND METHOD: In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being. RESULTS: Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance. CLINICAL IMPLICATIONS: These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.
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Artificial intelligence in forensic mental health : a review of applications and implicationsThis narrative review explores the transformative role of artificial intelligence (AI) in forensic mental health, focusing on its applications, benefits, limitations, and ethical considerations. AI's capabilities, particularly in areas such as risk assessment, mental health screening, behavioral analysis, and treatment recommendations, present promising advancements for accuracy, efficiency, and objectivity in forensic evaluations. Predictive models and natural language processing enhance the precision of high-stakes assessments, enabling early intervention and optimized resource allocation. However, AI's integration in forensic mental health also brings significant challenges, particularly regarding data quality, algorithmic bias, transparency, and legal accountability. Limited access to high-quality, representative data can hinder reliability, while biases within AI models risk perpetuating existing disparities. Ethical concerns surrounding data privacy and the "black box" nature of many AI algorithms underscore the need for transparency and accountability. The review highlights future directions for responsible AI use, including improving data standards, fostering interdisciplinary collaboration, and establishing robust regulatory frameworks to safeguard ethical and fair AI applications in forensic settings. Balancing technological innovation with ethical considerations and legal obligations is essential to ensure AI supports justice and upholds public trust. This review calls for ongoing research, policy development, and cautious implementation to harness AI's potential while protecting individuals' rights within the justice system.
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Medication required : p*RN - promoting healthy attitudes and improved access to pornography in wathwood hospitalAims. The key aim of this project was to update and modernise the hospital procedure on how patients access pornographic material whilst detained at Wathwood Hospital. Within the update, we aimed to promote inclusivity and acceptance of all patients' sexual identities as well as utilising the opportunity to emphasise healthy consenting sexual relationships. Patients in Forensic Mental Health settings are often inpatients for a significant amount of time, with multiple restrictions imposed on their private and family life. Current policy allows patients to purchase pornography for private use in their own room. It must be material of the same nature available in a main street outlet. In practice, material is usually purchased in DVD format from the Amazon website and subsequently screened for suitability by Security staff and finally approval by the Responsible Clinician. There have been numerous incident reports involving the trading of pornographic material. Methods. Qualitative semi-Structured group interviews (up to 5 people at a time) were conducted with patients in the mediumsecure forensic services of Wathwood Hospital. They were recruited from the fortnightly Patient Forum. Anonymised questionnaires involving Likert scales and free text response spaces were also distributed at the Patient Forum. Data gathered investigated the percentage of patients who were aware of the current procedure, if they felt it worked well and what they thought the impact of accessing pornographic material might be. Staff were invited to complete a similar anonymised questionnaire, again considering their opinions on the positive or negative impacts of pornography for patients. In addition, we gathered data on whether there was a difference on the degree of comfort/discomfort about pornography, depending on whether the material involved opposite sex or same sex couples. In total, there were 40 survey participants. Results. Some key areas for concern were found, for example, only 17% of staff and 16% of patients thought the current policy works well despite 69% of staff and 84% of patients feeling it is a patient's right to access pornography. Free text and focus group feedback established many benefits to it. It was clear that there were some areas of difficulty in the hospital policy, which would benefit from being refreshed. Conclusion. Staff and patients overall feel that access to pornography is important for many of the patients. We identified areas for improvement in how this is accessed and a need to continually be considering the need to consider meeting the holistic needs for the patients.
