The psychological and psychosocial interventions offered to forensic mental health in-patients: a systematic review

Objective: To examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health in-patients. Design: CINAHL, MedLine, PsycINFO, ScienceDirect, and Web of Science databases were searched for research published in English between 1 January 1990 and 31 May 2018. Outcome measures: Disturbance, mental well-being, quality of life, recovery, violence/risk, satisfaction, seclusion, symptoms, therapeutic relationship and ward environment. There were no limits on the length of follow up. Eligibility criteria: We included randomised controlled trial (RCT) studies of any psychological or psychosocial intervention in an in-patient forensic setting. Pilot or feasibility studies were included if a RCT design was used. We restricted our search criteria to in-patients in low, medium, and high secure units aged over 18. We focused on interventions considered applicable to most patients residing in forensic mental health settings. Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Results: 17,232 citations were identified with 195 full manuscripts examined in detail. Nine papers were included in the review. The heterogeneity of the identified studies meant that meta-analysis was inappropriate. The results were presented in table form together with a narrative synthesis. Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings. The most frequently reported outcomes were violence/risk and symptoms. 61% of the violence/risk comparisons and 79% of the symptom comparisons reported improvements in the intervention groups compared to the control groups. Conclusions: Current practice is based on limited evidence with no consistent significant findings. This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk but there is tentative support they may improve symptoms. More RCTs are required with: larger sample sizes, representative populations, standardised outcomes and control group interventions similar in treatment intensity to the intervention

The effects of training mental health practitioners in medication management to address nonadherence: a systematic review of clinician-related outcomes

Background: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes. Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users’ experiences of taking psychotropic medications, and therefore potentially address nonadherence issues. Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians’ knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians’ knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes. Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians’ experiences of using the approaches in clinical practice

An Explanation of Scientific nomenclature

Volume: XXI

Queering the grammar school boy: class, sexuality and authenticity in the works of Colin MacInnes and Ray Gosling

In 1959 Colin MacInnes published the fourth in his series of social issue novels, Absolute Beginners. In it the unnamed protagonist is constructed as the iconic teenager, slick, cool, creative, with his ex-lover Crépe Suzette as the object of his art and as his Achilles heel. The novel is framed over one summer, against a backdrop of racial tension, which ultimately led the Boy towards adulthood. MacInnes’s protagonist has been dismissed as an emblem rather than a character, and MacInnes himself derided by George Melly as a perpetual teenager. However in this chapter, we will suggest that taken as a whole MacInnes’ work constructs a complex understanding of The Boy’s political possibilities intersecting with sexuality, gender, race and class. By integrating his novelistic work with his journalistic and activist writing, we will demonstrate the complexity of MacInnes’ Boy as an autonomous, queer political agent, embodied in the ultimate Boy; Ray Gosling. Gosling’s own writing becomes a lens through which to root historical understanding of teenagers and teenage cultures as sexual and racial constructs

An examination of service user satisfaction in forensic mental health settings

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the UK. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with the longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills

The Delphi method: methodological issues arising from a study examining factors influencing the publication or non-publication of mental health nursing research

Purpose – The paper describes how the classic Delphi method can be adapted and structured to ensure that specific research questions are clearly addressed. Design/methodology/approach – As part of a larger mixed method project, a modified Delphi study was undertaken to explore factors influencing publication and non-publication of mental health nursing research. Findings - This paper reports brief findings from the Delphi study. However, its main focus is the methodological issues arising from the Delphi method. Implications - The paper argues that the classic Delphi method can be adapted and structured to ensure that specific research questions are able to be clearly answered. The adaptations are pragmatic in approach and in keeping with the general principles underpinning the Delphi method, while successfully addressing the problems of attrition and previous criticism of homogenous panels. Originality/value - This paper offers some practical solutions to issue arising from undertaking research using the Delphi method

Carers of forensic mental health in-patients: what factors influence their satisfaction with services?

Background Families are the main caring resource for service users with severe mental health problems. There has been limited work examining the needs of carers of people using forensic mental health services. Aims This study aimed to gain an understanding of carers satisfaction with services in forensic mental health inpatient settings. Method A survey design was used with 63 carers interviewed by telephone using a structured interview schedule. The data was analysed both qualitatively and quantitatively. Results Most carers were pleased with the service provided although some negative views were expressed with specific types of contact. Giving appropriate information to carers was strongly associated with satisfaction with the service being provided. Conclusions Carer satisfaction with forensic mental health services is likely to be higher with services that address carers’ information needs. New ways of providing this information may offer greater opportunities for working with carers

Driving forces in free visual search : An ethology

Peer reviewedPostprin

A qualitative study of older adults’ experiences of transitioning from secure forensic services – The TOPS Study

This was presented at the Faculty of Medicine, Health and Social Care Lunchtime Research Seminar. The presentation discusses the current findings of Phase 1 and 2 of the TOPS study