Obesity and associated morbidity and mortality are major challenges for people with severe mental illness (SMI, including schizophrenia and bipolar disorder), particularly in secure (forensic) mental healthcare (patients who have committed a crime or have threatening behaviour). This research aimed to explore experiences of obesity in secure mental health settings, through a survey, focus groups and interviews. The survey was delivered to secure mental healthcare staff in a National Health Service (NHS) mental health trust in Northern England, and received 79 responses. Nine focus groups were conducted with current and former patients, carers and multidisciplinary staff in the same trust. Eleven semi-structured interviews were undertaken with multidisciplinary staff in a second NHS mental health trust in Northern England. Through thematic analysis two overarching issues were identified, concerning the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. Overall, secure care was highlighted as an ‘obesogenic’ environment, conducive to excessive weight gain. Seven key influences included: medication, sedentary behaviour, patient motivation and intrinsic factors, catered food and alternatives, role of staff, and service delivery. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact
