International Journal of Forensic Mental Health

We examined associations between group climate as perceived by 212 individuals with mild intellectual disability and work climate as experienced by 262 sociotherapists in a forensic setting. Results showed that if sociotherapists experienced more job satisfaction, they experienced less negative team functioning. Also, more positive team functioning was related to less repression. Workload and negative team functioning were related to less possibilities for growth by clients. No significant associations were found between other work climate and group climate dimensions. This study emphasized the importance of being aware of parallel processes between work climate and group climate in secure settings.

Obesity and metabolic syndrome are disproportionately prevalent among people with mental disorders, particularly those subject to long periods of inpatient care where sedentary lifestyle and medication side effects can be compounding problems. This study reports on a cross-sectional survey of 28 patients under forensic mental health care in a high secure inpatient service in Queensland, Australia. The study comprises a file review, structured questionnaire and an interview, to evaluate the physical health and activity, as well as possible causes of low physical activity of these patients. Rates of overweight (50.0%), obesity (46.6%), and metabolic syndrome (39.3%) were very high within the study population. Mean waist circumference measurements were also high for both females (110.8 cm) and males (109.0 cm). Around one half of the study population (46.4%) did not meet the World Health Organization’s recommended levels of physical activity. Self-reported low levels of physical activity were significantly associated with the presence of comorbid medical illness (p = 0.007). Further research investigating the factors contributing to poor physical health and low activity levels within this population will support attempts to understand and address the physical health needs of this population.

Therapeutic relationships between children and staff across the Children and Young People Secure Estate (CYPSE) is an under-researched area. The aim of this research is to explore the research question, ‘what are the key elements of the development and maintenance of effective therapeutic relationships?’ Qualitative semi-structured interviews and a focus group were conducted with children in Young Offender Institutions, Secure Training Centers and Secure Children’s Homes in England between February–November 2019 (N = 28 children; 25 interviews, 1 focus group). Framework analysis and grounded theory methodology were applied to the data, and 13 themes were generated. The facilitating properties of good communication, understanding, reciprocal respect, trust, and a sense of fairness in these relationships are highlighted. Positive relationships may be facilitated through the formulation process. The varied experiences of children are considered, highlighting the need for knowledge sharing and training staff in effective helping skills.

This study describes and examines the impact of a novel Reflective Practice program tailored to the multidisciplinary clinical workforce at an inpatient forensic mental health setting. Surveys assessing wellbeing, self-efficacy and reflective practice capacity were administered to all clinical staff prior to commencement of the Reflective Practice program, as well as six months post-implementation. Interviews were also conducted with key clinical stakeholders to obtain detailed feedback regarding the impact of the program across the organization following six-eight months of implementation. Staff who participated in post-implementation surveys reported significantly higher confidence in their work when compared to staff at baseline, while clinical stakeholders observed improvements in the cohesion of the multidisciplinary team. In spite of the limitations of the pragmatic study design and small sample size, results suggest the novel Reflective Practice program offers an acceptable model for adoption in an inpatient forensic mental health setting, with potential to improve the wellbeing, learning and morale of a forensic mental health workforce. The findings also highlight the need to support practice development and wellbeing in early career clinicians, where low confidence and high stress are predominant.

Granted leave is an integral part of forensic-psychiatric treatment. To prevent serious crimes or absconding during leave, careful assessment of risk of such misconduct is necessary. This check is carried out by a decision-making process, which considers patients’ freedom, clinical benefits, and the need for public safety. A systematic examination of processes surrounding granted leave can help decision-makers to proceed in more organized and transparent manner. Representatives of all professional groups at 12 forensic-psychiatric hospitals in Bavaria were questioned using semi-structured interviews. Information on granted leave was quantified using a self-constructed checklist and descriptively evaluated. The extent to which legal requirements and other process characteristics are implemented was examined. The implementation of requirements varied across hospitals in terms of organizational and personal framework conditions. A joint agreement among all hospitals regarding the definition and handling of misconduct during granted leave, revocation of granted leave, and risk assessment addressing absconding would be particularly desirable. Common standards of excellence could contribute to more transparency and strengthen the trust of patients and the public in the approach of a hospital.

Structured risk assessment is a widely accepted and recommended approach to establishing an individual’s level of risk for future adverse outcomes, such as violence or victimization, and to guide professionals in effectively managing that risk. A precondition for achieving these outcomes is that the risk assessment procedures are properly implemented and carried out as intended. Although research into the implementation of risk assessment instruments is slowly increasing, most publications do not provide detailed information on the steps that were taken during the implementation process. To help bridge the gap between research and practice, this paper describes step by step the implementation process of the Short-Term Assessment of Risk and Treatability: Adolescent Version in a Dutch secure youth care service. The process was guided by the eight steps suggested in the guidebook for the implementation of risk assessment in juvenile justice by Vincent, Guy, and Grisso. Without pretending to offer the best or most ideal approach, this illustration of a risk assessment implementation process may serve as inspiration for other agencies and service providers who wish to integrate structured risk assessment into their practice.

The effect of medium secure care on reoffending is unknown; adequate control groups cannot be identified and exposure to reconviction may be confounded by onward placement and by legal restrictions. Retrospective analysis of convictions for an England and Wales National Cohort of adults discharged from 35 medium secure services during 1997/8. Data were retrieved from the Offenders Index and from each service. Reconviction risk for 711 cases was estimated using Offending Groups Reconviction Scale-2 (OGRS-2). Reconviction (any standard list offense) served as the sole outcome during a uniform six-year follow up. Reconviction outcomes were highest following transfer to prison, reduced by further secure care whilst restriction orders were effective in reducing convictions only in those at high risk. Substantial reductions in reconvictions were observed across the full range of criminogenic risk after control of the above confounding. OGRS-2 proved a useful assay for estimating the effects of secure services on reconvictions. Analysis of more contemporary samples using the current methods and more recent versions of OGRS is warranted.

The Offender Group Reconviction Scale 2 (OGRS-2) excludes social and clinical factors that are known to be associated with offending risk in people with mental health problems, but shows similar predictive validity to structured professional judgment tools that include them. The aim of this study was to determine whether the predictive validity of OGRS-2 would be enhanced by the addition of social and clinical factors. A retrospective case note analysis was conducted on a national cohort of patients who were discharged from 35 UK medium secure between 01 April 1997 and 31 March 1998. Social factors, clinical factors and OGRS-2 probability scores were combined in a regression model using violent and any reconviction as outcomes across two-, four- and six year follow up periods. The OGRS-2 showed strong predictive validity for both any and violent reoffending, addition of social and clinical factors yielded no significant improvements. OGRS-2 may have reached an accuracy ceiling in predicting re-offending but remains effective for use alone to estimate risk of further convictions following discharge. OGRS-2 retains the well-established limitations of actuarial risk tools but can potentially aid in decision making around supervision and monitoring. OGRS-2 has potential to control for reconviction risk in reoffending outcome studies of medium secure service users.