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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.
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Are accelerometers a useful way to measure activity in care home residents?Introduction: Accurate measurement of activity in care home residents is important for monitoring and evaluating interventions for activity promotion. Accelerometers provide a potential method. However, their usefulness in this population has not been well documented. We aimed to explore the feasibility of these in care home residents. Method: Mobile residents who had fallen in the past year, were asked to wear a tri-axial accelerometer (ActivPAL3TM) on the lower thigh for 7 days. Care staff were trained in device application. Users' skin and problems with use were checked daily. Activity data sought were: step count, time sedentary, time standing and Metabolic Equivalent of Task. Care records were checked for falls. Results: 10/16 residents agreed to wear accelerometers. 7 wore them for 7 days and the remainder for 4, 5 and 6 days respectively. No falls were recorded. Data indicated 1 resident continuously standing which was disconfirmed through observation. Problems were: data disturbance through removal/fidgeting, hydrofilm dressing flaccidity, premature detachment, care staff non-compliance to waterproof continuous wear, resident skin check non-compliance, prior leg ache attributed to accelerometers (with no worsening), pink skin and activity restriction by care staff. The accelerometers and attachment materials total cost was £2062.59.
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Collaborative risk assessment and management planning in secure mental health services in England: protocol for a realist reviewIntroduction Secure mental health pathways are complex. They are typically based around secure hospitals, but also interface with justice agencies and other clinical services, including in the community. Consideration of risk is fundamental to clinical care and to decisions relating to a patient’s stepwise journey through the pathway. Patient autonomy and involvement in decision-making are policy priorities for health services. However, improving collaboration in risk-related decisions in secure services is complicated by potential issues with insight and capacity and the necessary involvement of other agencies. In addition, although some collaborative approaches are feasible and effective, their impact, mechanisms and the contexts in which they work are not well understood. Therefore, using realist methodology, this review will outline what works, for whom, why and under what circumstances in terms of collaborative risk assessment and management in secure services. Methods and analysis The review will consist of four stages: (1) Development of an initial programme theory to explain how and why collaborative risk assessment and management works for different groups of people, (2) search for evidence, (3) data selection and extraction and (4) evidence synthesis and development of a final programme theory. Our initial programme theory will be informed by an informal search of the literature and consultation with experts and patient and public involvement and engagement representatives. Following this, our formal literature search will include both the published and unpublished literature. During full text screening, each document will be assessed according to the principles of rigour and relevance and, if included, data will be extracted and synthesised to refine the programme theory. Ethics and dissemination This protocol is for a review of published literature and so does not require ethical approval. The main output will be the final programme theory. Remaining gaps will inform planned future work to further refine the theory using mixed methods. Our dissemination strategy will be codeveloped with our public and patient involvement group and will include publishing findings in a peer-reviewed journal and presenting findings at relevant professional conferences, as well as engaging patient, carer and clinician groups directly.
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Reflecting on episodes of rapid tranquilisation in forensic MDT settingsAims. Rampton Hospital is the High Secure Hospital of Nottinghamshire Healthcare NHS Foundation Trust's Forensic Service. It is one of three such hospitals in England, following Security Directions set out by the Department of Health. Patient management occurs through the implementation of strict policies and procedures. Policy requirements highlight the need for MDT post-incident discussion of restrictive interventions, and in particular, of Rapid Tranquilisation (RT). This primary audit aimed to ascertain current practice and if necessary, suggest interventions to ensure that patient-care remains safe, effective, and well-led. Methods. To establish current practice with regards to the discussion of individual cases of RT in MDT settings, specifically in Ward Round, we commenced a retrospective data collection from electronic notes covering all directorates within the High Secure estate between May and June 2022. From these notes, we tried to ascertain whether the following policy standards were being met: * A de-brief with the patient should take place as soon after the incident as is practicable and reasonable, ideally within 72 hours. * The MDT meeting post RT episode should explicitly discuss the episode, and consider medication and any triggers of periods of acutely disturbed behaviour. * There were 81 data sets to explore. Results. Not all data sets were viable. Out of those analysed, less than 10% were found to have met the aforementioned ideal policy standards of having had a reflective discussion within 72 hours with both the patient and as an MDT, exploring the episode itself and its antecedents. Conclusion. There are several interesting factors to consider from the results obtained. We postulate that the frequency of episodes of RT makes meeting the policy standard problematic; pragmatically, there is a significant time barrier to exploring these incidents in detail and the various teams, operating in dynamic and highrisk environments, may find it difficult to coalesce in order to debrief appropriately. Furthermore, the reflections may actually be happening, but the burden of documentation mean that these are not being recorded formally in a way that can be measured. There are limitations to the searches of electronic notes and we did not have access to Incident Reports, often completed at the time of these episodes; further information may have been uncovered if they were available. Despite this, there is room for interventions that inform staff of this need and to provoke improvements in current practice.
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Physical Health Monitoring of Patients on Antipsychotic Medication at a Medium Secure UnitAims. People who have a serious mental illness have a higher prevalence of physical health problems as compared to the general population; with a 2-3 times greater risk of cardiovascular morbidity and mortality, double the risk of obesity and diabetes, three times the risk of hypertension and metabolic syndrome and five times the risk of dyslipidaemia than the general population. There is a concern that some antipsychotic drugs have metabolic consequences that contribute to the risk. As such, it is imperative that patients treated with antipsychotics receive appropriate health monitoring. Physical health monitoring of antipsychotic medications is an essential aspect of our practice, and despite assurance in previous audits, we agreed to monitor biannually to ensure we were maintaining standards. Additionally, this audit aimed to look more closely at special monitoring requirements for drugs such as Olanzapine, Chlorpromazine, Clozapine and Quetiapine which had not been measured in previous audits and would likely highlight some areas for improvement. Methods. Audit standards were drawn from the Maudsley Prescribing Guidelines in Psychiatry 14th edition, in addition to NICE Guidance CG178 - Psychosis and schizophrenia in adults: prevention and management. A random number generator was used to select patients from each of the 7 wards, giving a sample size of 21 patients. Data were collected on Weight, BP, ECG and various blood tests conducted from February 2021 - February 2022. Data was collected from a combination of patient electronic record, CPA reports, and online blood results system. Data were inputted to MS Excel which created percentage compliance in each domain. Results. 1. Blood Pressure: General compliance in the taking of BP met our standard of 100% 2. Weight: Annual monitoring compliance was 93% however compliance fell short for special recommendations for Clozapine, Olanzapine and Chlorpromazine. 3. ECG: Our compliance fell short in the recording of an ECG on admission, or at reaching target medication dose. Annual monitoring compliance was 93%. 4. Bloods: Annual compliance for FBC, LFT, U&Es, Lipids, Prolactin and 5. Glucose were 100%, however our compliance fell short for baseline recording and interim 3-6 monthly monitoring for various blood tests. Conclusion. Overall results demonstrate good, safe practice, particularly during a challenging period for clinical teams. Shortfalls particularly at baseline were related to risk issues making investigations impractical. It was agreed that there should be an increased frequency of regular glucose monitoring and that HbA1c monitoring was a reasonable measure for this.
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Collateral history-taking on acute general adult and older person inpatient wards: A quality improvement projectAims. To investigate current practice of collateral history-taking on inpatient adult and older person wards in Leicestershire Partnership Trust. COVID-19 visiting restrictions raised concerns that the collateral history may be side-lined due to the physical absence of carers. Collateral history is important in developing a working diagnosis and assessing level of function, and is part of ongoing assessment and formulation. Methods. An initial audit of 46 patient records from 3 inpatient wards (2 adult and 1 functional old age) was carried out in January 2021 when visiting restrictions were in place. In response, a questionnaire was distributed and 2 focus groups of junior doctors conducted later in 2021; the aim being to explore factors affecting collateral history taking. A re-audit was completed in October 2022 when visiting was reinstated. 48 patient records were audited. Old Age organic wards for dementia assessment were not included in data collection, as collateral history-taking is unavoidable for initial assessment of those presenting with significant cognitive impairment. Results. In 2021 and 2022, 33% and 38% of sampled patients had a collateral history taken in the first 14 days of admission. Where a collateral history was omitted, only 10% and 13% were attempted and 46% and 27% planned. Associated themes were identified from the questionnaire and focus groups including consent; accessibility of contact details; lack of confidence and variability in history-taking; accountability/ clarity on whose role it is to complete the task; lack of time/space and poor consensus on how to document a collateral history. Conclusion. The results of the re-audit continue to show poor collateral history completion early in admission for both old age and adult inpatient wards despite reinstatement of visiting after the COVID-19 pandemic. Numerous issues affect the completion and documentation of good quality of collateral histories within inpatient settings of Leicestershire Partnership Trust. These have been categorised into staff, system, environmental and other factors. This audit forms part of a wider quality improvement project. The proposed actions are as follows: 1. To share findings locally via the Trust Audit and Quality Improvement department, Trust email and Consultant Medical Advisory Committee; 2. To improve education through Trust induction, regular bitesize teaching and development of a crib sheet to be placed on each ward; 3. To consider wider quality improvement projects in line with themes identified above; 4. To undertake a further re-audit in November 2023.
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Metacognition, philosophy in prisons and the demands of rehabilitationAbstract This article sets out the case for providing regular philosophy sessions in prisons by focusing on its role in improving metacognition. We start by drawing attention to an important body of research on metacognition that is relevant to supporting prisoners in transitioning towards more prosocial lifestyles, as well as navigating the complexities of life both during and post-incarceration. We then make the case for offering philosophy programmes in prisons in order to help nurture and develop metacognitive skills in this population.
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Defining health management: A conceptual foundation for excellence through efficiency, sustainability and equityThe practice of healthcare management is essential for the efficient operation of health services, encompassing leadership, management, and direction within healthcare organisations. 'Health management' extends beyond healthcare management by integrating principles of public health and health policy. As health management is commonly practised but not cohesively recognised, the European Health Management Association (EHMA) conducted this study to develop a cohesive definition of health management. Developed through a qualitative methodology comprising focus group discussions and validation through quantitative expert interviews, this study proposed a holistic definition of health management, incorporating social, environmental and economic determinants of health, cross-sector collaboration, and the 'One Health' approach. The publication of this unified definition has important implications for professional training, policy development, and health outcomes. It provides a foundational framework for curricula, informs precise policy formulation, and promotes excellence through health service delivery that reflects efficiency, sustainability, and equity.
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Bridging the gap: A qualitative study exploring the impact of the involvement of researchers with lived experience on a multisite randomised control trial in the national probation service in England and WalesINTRODUCTION: Methodological and ethical arguments support the involvement of individuals with lived experience in research to reduce engagement barriers and ensure those directly affected by studies contribute to knowledge generation. However, there is limited evidence on the impact of including researchers with lived experience of serving a prison or community sentence in clinical trials. This qualitative study aimed to explore the value of involving researchers with lived experience of the criminal justice system as data collectors in the Mentalization for Offending Adult Males (MOAM), a multisite RCT conducted in the National Probation Service in England and Wales. METHODS: Semi-structured interviews were conducted with 30 trial participants and 17 key stakeholders, either in person or via telephone. The interviews were transcribed verbatim and analysed thematically. FINDINGS: Five themes emerged for trial participants and 11 for key stakeholders. For some, lived experience researchers helped overcome engagement barriers by fostering common ground with participants who were serving a prison or community sentence during recruitment. Participants reported that the involvement of lived experience researchers enhanced the study by facilitating knowledge transfer in certain instances. However, their inclusion did not eliminate all barriers and, for some participants, introduced new challenges to engagement. CONCLUSION: Forensic lived experience researchers bridged the gap by fostering trust between data collectors and participants. Future studies should ensure that lived experience researchers receive adequate clinical supervision to support their role. The adopted methodology challenged assumptions about knowledge generation and stereotypes associated with being an ex-offender, benefiting both lived experience and traditional researchers. PATIENT OR PUBLIC CONTRIBUTION: The study was developed in collaboration with User Voice (charity number: 1136047), who contributed to the study's design and conduct. The service user organisation co-designed the interview schedule and directed the protocol for participant payments, emphasising a consistent approach to avoid tokenism and ensure equal recognition of all contributions. The dissemination plan was developed in partnership with individuals with lived experience of the criminal justice system.
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Barriers and facilitators to increasing physical activity in medium secure mental health settings: An exploration of staff perceptionsPurpose: The benefits of physical activity for people with severe mental illness (SMI) is widely recognised but for those in medium secure settings there are additional environmental barriers to being active that have not been fully explored. The aim of this study was to explore the perceived barriers and facilitators from the perspective of staff within the medium secure setting. Method(s): Semi-structured focus groups were conducted with qualified and unqualified staff (n = 24) across two UK medium secure NHS settings. Michie's COM-B framework was used to inform the topic guide and the analysis of the data. Result(s): The opportunities to be active in medium secure settings depend not only on access to facilities but also staff availability and willingness to support such activities. When an individualised approach is taken, and staff are skilled and motivated to support such activities then it is possible for people with SMI in medium secure settings to be physically active. Conclusion(s): People with SMI in secure settings have reduced autonomy to increase their own physical activities but it was suggested that with the appropriate opportunities and the motivation of staff their capability to be active could be enhanced.
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IntroductionThe introduction explores some of the reasons why trauma has been overlooked in forensic psychology, despite its prevalence in forensic populations. Reasons include the complexity of the relationship between trauma and offending, difficulty in defining trauma and societal pressures that favour punishment over rehabilitation. Nevertheless, there is reason to believe that a trauma-informed approach may be a new paradigm in forensic psychology.
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First do no harmNo abstract available
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Risk Assessment and ManagementNo abstract available
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Reciprocal roles between therapies – a dialogueNo abstract available
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Line manager training and organizational approaches to supporting well-beingBACKGROUND: Employee mental health and well-being (MH&WB) is critical to the productivity and success of organizations. Training line managers (LMs) in mental health plays an important role in protecting and enhancing employee well-being, but its relationship with other MH&WB practices is under-researched. AIMS: To determine whether organizations offering LM training in mental health differ in the adoption of workplace- (i.e. primary/prevention-focused) and worker-directed (including both secondary/resiliency-focused and tertiary/remedial-focused) interventions to those organizations not offering LM training and to explore changes in the proportions of activities offered over time. METHODS: Secondary analysis of enterprise data from computer-assisted telephone interview surveys. The analysis included data from organizations in England across 4 years (2020: n = 1900; 2021: n = 1551; 2022: n = 1904; 2023: n = 1902). RESULTS: Offering LM training in mental health was associated with organizations' uptake of primary-, secondary-, and tertiary-level MH&WB activities across all 4 years. The proportion of organizations offering primary-, secondary- and tertiary-level interventions increased over time. On average, tertiary-level activities were most adopted (2020: 80%; 2021: 81%; 2022: 84%; 2023: 84%), followed by primary-level activities (2020: 66%; 2021: 72%; 2022: 72%; 2023: 73%) and secondary-level activities (2020: 62%; 2021: 60%; 2022: 61%; 2023: 67%). CONCLUSIONS: Offering LM training in mental health is associated with the adoption of other MH&WB practices by organizations. Suggesting that organizations that are committed to the mental health agenda are more likely to take a holistic approach (including both worker and workplace strategies) to promoting workforce mental health, rather than providing LM training in isolation.
