Forensic mental health professionals are frequently exposed to inpatient aggression, which may negatively affect their physical and mental health. Current studies offer limited insight into how this may affect staff-patient interactions in the aftermath of aggression. A qualitative study was conducted to explore professionals’ experiences with exposure to aggression. Thirteen semi-structured interviews and three focus groups were conducted with 25 professionals working in a high secure forensic mental health unit. A thematic analysis was conducted in consensus among three researchers. Five main themes were generated in the analysis: exposure to different forms of aggression, factors that shape the impact of aggression, emotional reactions, managing emotional reactions, and managing relationships with patients. These themes form a complex interplay. Feelings of anger and fear, intrusive memories, and avoidant or agitated behavior toward patients are frequently reported, affecting both the personal and professional lives of participants. Interpersonal relationships between team members can promote or hinder adequate management of feelings that arise after exposure to aggressive incidents. The tremendous impact that exposure to inpatient aggression may have on professionals, and the way that they care for their patients requires more attention.

The prevalence of trauma within secure forensic populations is widely acknowledged, yet the implementation of trauma-informed care (TIC) in secure forensic settings (SFS) remains in its infancy. This qualitative study delves into the perceptions and experiences of healthcare professionals (HCPs) adopting a TIC framework in SFS, examining associated barriers and facilitators. 15 participants engaged in semi-structured interviews, and results underwent thematic analysis, yielding five overarching themes and 15 sub-themes. Themes identified include: 1) understanding the TIC experience in SFS, 2) organizational and personal barriers in TIC implementation, 3) facilitators and reflections on TIC benefits, 4) barriers to specific TIC practices, and 5) practical recommendations. Participants emphasized the prevalent nature of trauma in SFS and underscored the perceived advantages of creating spaces for reflection and emotional well-being. Interviewees explored the impact of organizational culture, the demands of frontline roles and training accessibility. Practice implications highlight the need to involve key stakeholders (staff and SUs) in decision making and in assessing the feasibility of implementing TIC. SFS should prioritize TIC by addressing training needs, allocating time for TIC in supervision, providing specialist support for trauma-informed clinical work, and ensuring dedicated spaces for reflection. While the study highlights the power of incorporating HCP perspectives, limitations arise from findings drawn from a single forensic service, emphasizing the importance of further replication. This research contributes valuable insights into advancing trauma-informed care practices within secure forensic settings.

Consultation between mental health professionals and other professionals working with young people can bring together multiple agencies to ensure young people are appropriately supported and referred to specialist care where needed. The aim of this research is to explore the consultation and liaison model of support for young people who are at high risk of engaging in harmful behaviors (e.g., harm to self and others), through the experiences of professionals liaising with specialist Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Interviews with referring professionals (N = 34, from 34 services) were analyzed thematically, themes focused on referrer experiences; impact on the network; and impact on young people and their parents/carers. The combination of forensic mental health expertise in risk assessment and management, with the ability to provide overarching and indirect support to the network is fundamental to the model. Community F:CAMHS’ capacity to manage anxiety in the professional network is likely helped by the one-step-removed position afforded in the consultative role. Adopting a position of authority led to clearer, more co-ordinated and more robust risk management plans. Consideration could be given to adopting the model when working with referrals involving multiple agencies and high levels of anxiety within the network.

Little is known with regard to due process and forensic assessment capacities in Africa, where over one million are deprived of their liberty on any given day. A rapid situation assessment explored multi-stakeholder perspectives regarding the situation of people with a mental illness in the Malawi prison system. In-depth interviews were conducted with 10 regional professional stakeholders, 18 former prisoners, and five prison staff from two maximum-security prisons. Reflexive thematic analysis yielded five themes; occurrence of mental illness among people living in prison; prison environment exacerbating harm and levels of mental illness; security responses to the presence of psychiatric disorders; availability and coverage of specialist psychiatric and psychological care; and diversion, other non-custodial measures and continuity of care on release. Narratives highlight the substantial causal impact of the prison environment in amplifying existing and new mental illness, vulnerability and exploitation of people with a mental disorder. Malawi prisons are hampered by lack of specialist forensic capacity nationally; centralized mental health surveillance system; and insufficient skilled staff to conduct evidence-based screening and care. Security operations implement the use of pharmacological and physical restraint measures at times. Faith-based organizations play an important role in providing psychological and spiritual support. Release and reintegration require family involvement. A cross departmental intersectoral partnership response spanning government ministries, key civil society organizations, the Malawi Prison Inspectorate and Malawi Human Rights Commission is warranted. Recommendations include alleviation of prison congestion, prison staff capacity building and investment in forensic mental health services with adequate geographic coverage.

Forensic mental health, custodial and community forensic services provide care and treatment to individuals with complex histories and needs including the presence of trauma. With increased attention being paid to delivering trauma informed care, this paper presents a framework for supporting safe and effective service delivery. It details ways in which trauma informed organizational consultation and trauma informed staff supervision and reflective practice should be embedded within criminal justice and forensic mental health service delivery. Together these support reflection, learning, decision making and intentional action, helping to meet an organization’s duty of care to both staff and clients. Trauma informed organizational consultation and trauma informed forensic staff supervision and reflective practice provide ways to anticipate and address possible iatrogenic impacts on staff (e.g. burnout, presenteeism and sickness) and on clients (e.g. dropping out of treatment). Together these can enable services to provide and sustain authentic approaches to delivering safe and effective care.

Within forensic populations, exposure to traumatic experiences is high. These experiences are associated with multiple mental and physical health problems later in life. Forensic services would therefore ideally adopt a trauma-informed approach. The aim of this scoping review is to identify trauma-informed training or education for staff within forensic mental health care. A database search of English or Dutch language articles from PubMed, PsycINFO, Embase, Scopus and Web of Science was performed. Researchers reviewed 6,386 articles and nine were included for final analysis, all in justice-involved youth populations. Results show that training in trauma-informed care may facilitate the relationship between staff members and residents and create safer treatment units. Besides this, a reduction in post-traumatic stress symptoms and greater clinical improvement in depression, anxiety, hope and optimism among justice-involved youth was noted. Trauma-informed staff training may also lead to a decrease in incidents taking place as well as a decrease in use of restraints and seclusion.

Exposure to adversity or maltreatment is known to correlate with high-risk behaviors that can increase the risk of contact with the criminal justice system; however, few studies have focused on the role of trauma symptoms and other behaviors that may develop in response to exposure to adverse life events. We also know far less about the role of these experiences in young men compared to young women who have been in contact with the youth justice system. In this study, we examine the associations between different patterns of trauma symptomatology and adverse childhood experienced (ACEs), substance use, behavioral difficulties, and re-offending in a sample of 141 young men under the supervision of a Youth Justice (YJ) agency in Australia. Trauma symptoms were reported by over ninety percent of participants, with Latent Class Analysis used to identify four subgroups of young men based on their clustering of trauma symptomatology: internalizing, externalizing, high, and low trauma symptoms groups. The characteristics of young men across these groups were, however, remarkably similar. Over four-fifths scored in the clinical range for substance use and externalizing behavior problems, while recidivism was reported in over three-quarters of young men across all groups. These findings have implications for the development of trauma-informed responses by specialist adolescent mental health services as well as for adult forensic services that seek to understand the developmental origins of psychopathology and offending behavior. There appears to be a strong rationale for more compassionate and trauma-informed justice system practices.

Pharmacotherapy is a front-line intervention used to address complex health concerns among forensic system consumers. Many are prescribed a polypharmacy pharmacotherapy regimen, though this may pose significant risks to physical health and well-being. Forensic consumers also have evidence of behavioral health concerns that may impact preferred treatment and prescribing practices. We examined the relationship between ACEs, suicide, self-harm, and inpatient aggression with psychotropic polypharmacy using retrospective data extracted from medical records from a US forensic mental health facility (N = 182). Nearly all participants (98.5%) prescribed any medication (72%) received a psychotropic polypharmacy regimen. ACEs were common, impacting 75.8% of the sample. ACEs, self-harm, and inpatient aggression, though not suicide attempts, were positively predictive of psychotropic polypharmacy in a series of regression analyses. Mediation analyses explored the interplay between ACEs, specific behavioral concerns, and psychotropic polypharmacy, though only models involving self-harm were significant. Implications for trauma-informed practice include an emphasis on consumer choice, empowerment, collaboration, and autonomy. Future research should investigate implementation of trauma-informed practices in forensic mental health settings and the effectiveness of nonpharmacological interventions that can be used to reduce dependence on psychotropic medications when managing forensic consumers’ health concerns.

People in secure psychiatric services experience high levels of exposure to early psychological trauma, are often diagnosed with severe mental illness (SMI) and have increased risk for obesity. Developmental trauma, SMI and obesity are associated with poor physical health outcomes and early death. This study aimed to assess the predictive power of Adverse Childhood Experiences (ACEs), self-harm and psychiatric diagnosis for secure inpatient weight gain and obesity. Data for 248 Welsh patients accommodated in low, medium, and high secure hospitals throughout England and Wales was analyzed. Patient admission bodyweight (in kilograms), bodyweight at the time of audit, and patient BMI at the time of audit was collected. Sex, psychiatric diagnosis, length of current admission, number of ACEs, and frequency of self-harm were also examined. Patients gained significant amounts of weight between admission until the time of the audit (median period = 1 – 2 years) and showed high levels of obesity. Self-harm frequency significantly predicted weight difference. Number of ACEs and diagnosis of schizophrenia significantly predicted patient BMI at the time of audit. The study findings indicate that psychological trauma and the nature of mental illness are important factors driving weight gain and excess morbidity in this vulnerable group.

Many people involved with the United States criminal legal system have experienced trauma, the long-term effects of which can challenge capacity to recover, often resulting in an increased risk of contact with the criminal legal system. Training programs can help professionals improve their understanding of trauma and implement trauma-informed responses. Limited research exists on the impact of trauma-informed response training for criminal legal professionals (e.g., corrections officers, court personnel, and law enforcement), and less is known about the effectiveness of the train-the-trainer (TTT) model in this context. In this article, we describe a four-phase, mixed-methods evaluation of a trauma-informed response training program delivered in the context of a 16-h TTT event to 28 criminal legal professionals in the southwest United States. We examine pre- and post-training knowledge acquisition, training experience, and impact on participant behaviors and attitudes 60 days post-training. Results provide preliminary support for the positive impact of trauma-informed response training for criminal legal professionals. We discuss future directions for research on the effectiveness of trauma-informed response training for criminal legal professionals, including, critically, whether trauma-informed training contributes to improved outcomes for individuals involved with the criminal legal system.