AimsThe following project explores where Wathwood Hospital stands in provision of services to its elderly patients.BackgroundThe only dedicated forensic medium secure unit for elderly offenders in England is the St. Andrews medium secure unit in Northampton with only 17 beds. Due to the limited beds, other units must accommodate elderly patients, which raises the question whether these units can provide the appropriate services for this very vulnerable population.MethodInclusion Criteria:Male>55 years of ageAdmitted from 2012 onwards (from when database was maintained)Data were gathered using patient electronic records including index offence, mental disorder, physical health comorbidities and discharge destinations. Patient identifiable data were anonymized to protect their identities.A staff survey was also conducted to find their perspective on managing elderly patients and whether Wathwood Hospital had the appropriate resources for elderly offenders in their area of work.ResultA total of 220 referrals were searched with only 9 patients >55 years. Index offenses, mental disorder diagnoses, physical comorbidities including cognitive assessments in the form of memory tests and brain imaging were also collated for identified patients from electronic patient records.Index offences included violence against person, arson, homicide, robbery, threatening behaviour and dangerous driving and affray. Diagnoses included learning disability, delusional disorder, paranoid schizophrenia, bipolar affective disorder, alcohol dependence, personality disorder and depressive disorder.Patients had multiple comorbidities such as diabetes, COPD, hypertension, coronary artery disease and musculoskeletal problems. Out of the nine admitted patients, only six had an ACE with an average score of 70.83. Five patients had brain imaging, with two normal results and the others showing some degree of atrophy and ischemic changes.Discharge destinations included medium secure units, low secure unit and prison. One patient unfortunately died during admission and four are still inpatients.A staff survey conducted showed their perspective on the challenges in managing elderly patients and whether Wathwood Hospital had the appropriate resources for them to work with elderly offenders in their area of work. All results will be explained through tables and graphs.ConclusionIt's evident that there are challenges in managing elderly patients in units not specifically designed to manage them. This is also due to the lack of geriatric training and resources available to allied health care professionals to carry out their respective work. It's therefore crucial we formulate more inclusive strategies to address these challenges.

Background and aims: Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no reviews studying the use of oxytocin for patients with ASPD. We aim to present the first literature review on the use of oxytocin in patients with ASPD.Method: We searched relevant databases for original research on effect of oxytocin upon persons with a diagnosis of ASPD or healthy participants with symptoms seen in ASPD. Studies were included if they included healthy participants that evaluated the effect of oxytocin on symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility.Results: Thirty-six studies were included. There were a range of study designs, including randomized controlled trials, double blinded, single blinded, and unblinded controlled trials. The sample sizes in studies ranged from 20 to 259 participants. Studies looked at participants with a diagnosis of ASPD and participants with symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Oxytocin was found to demonstrate diversified effects, in most cases being associated with socially positive or non-criminogenic behaviors. However, some studies found opposite, and non-desirable, effects, e.g., an increase in violent inclinations to partners. The two studies looking at participants with ASPD had a number of limitations and had conflicting results on the impact that OT has on aggression in ASPD.Conclusions: This is the first systematic literature review exploring the potential use of oxytocin in managing ASPD and the symptoms of ASPD. It is apparent that there is a body of evidence addressing related symptoms in healthy individuals. There were diversified effects with oxytocin showing some benefits in promoting positive effects on symptoms of ASPD, but there were also studies showing non-desirable effects. It is difficult to draw any direct inferences from healthy control studies. Further high quality large sample studies are required to explore the effects of oxytocin in those with ASPD

PurposeThe purpose of this paper is to conduct a preliminary evaluation of a Violent Offender Treatment Program (VOTP) adapted for use in a medium secure unit (MSU). The patient population is adult male mentally disordered offenders.Design/methodology/approachPatient outcomes are explored using the Reliable Change Index and Clinical Significance Criterion. Outcomes are assessed using VOTP facilitators violence risk assessment (VRS), multi-disciplinary team violence risk assessment (HCR-20 and GAS-V), and patient self-report using two measures (FAVT and STAXI-2).FindingsThere was evidence of improved outcomes for some participants in some areas related to risk of violence.Research limitations/implicationsConsideration is given to using varied risk assessments to evaluate outcomes of an adapted VOTP for a MSU.Originality/valueThere is limited development and evaluation of psychological treatment programmes that aim to reduce risk of violence for male offenders within MSUs. Outcomes of this evaluation could influence treatment delivery and evaluation in other services.

PurposeThe purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support.Design/methodology/approachSemi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines.FindingsThree dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted.Originality/valueThis paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms.

Purpose – The purpose of this paper is to explore the nature and prevalence of bullying behaviours and victimisation experiences among mentally disordered offenders within a medium secure unit (MSU). Design/methodology/approach – In all, 35 adult male patients completed the Direct and Indirect Patient behaviour Checklist-Hospital Version (DIPC-H). Findings – Indirect aggression was reported more frequently than direct aggression, although there was no statistically significant difference between the prevalence estimates. The most prevalent DIPC-H categories were the pure victim and not involved categories followed by bully/victim and pure bully. Membership of the pure bully category was predicted by being on a particular ward. Research limitations/implications – Given that the study was a preliminary investigation into the nature and prevalence of bullying behaviours in a MSU, the sample size is limited. Consequently, it is difficult to generalise the findings. It would be useful for future research to focus on differences between levels of security using larger sample sizes to enable a greater understanding of the prevalence of bullying in secure settings and associated factors. Practical implications – Further evidence is provided by the current research that indirect bullying and victimisation behaviours are reported more frequently by patients. The importance of anti-bullying procedures and interventions in secure settings is emphasised and recommendations that can be applied across various forensic settings are described. Better-informed interventions can then be implemented with the aim to manage bullying behaviours in secure settings. The one “pure bully” in the current study was on a rehabilitation ward. This highlights that such behaviours occur on lesser secure wards and serves as an important reminder to ensure that staff do not become complacent. Originality/value – As there is only one published study to date that has focused on bullying behaviours in a MSU, the current study will contribute to the dearth of literature in this area and assist professionals working in secure settings to better understand the nature and prevalence of bullying behaviours among mentally disordered offenders.

IntroductionA diagnosis of mental illness has been associated with weight gain, particularly among patients suffering from schizophrenia1.Aims & objectivesThis study aims to establish trends in weight gain among inpatients and the effects of several public health interventions between 2006 and 2009.MethodsA body mass index (BMI) was calculated on admission and one of the authors has routinely measured the BMI of all inpatients on an annual basis since 2005 as part of a regular audit cycle.ResultsAdmission BMIs are comparable to the male general population2. The vast majority of patients are prescribed antipsychotic medication, approximately 50% receiving clozapine or olanzapine at any given time. There is a wide range of weight change from admission to discharge (−8.5 kg to +60 kg) but the average BMI of each sample exceeds the general population such that a majority of patients in each sample are clinically obese (BMI ≥30).In response to the audit findings the unit promoted public health and individual care plans (2006–09) aimed at addressing the high rates of obesity. Despite these initiatives there was a substantial rise in mean BMI between July 2007 and February 2008.ConclusionsAdmission to a medium secure unit results in substantial weight gain for the majority of patients. The causes of weight gain in a relatively closed institution are probably multi-factorial in origin.

Research investigating attitudes toward sex offenders has failed to specify the gender of the “sex offenders”. Given that most participants are unlikely to think of women as sex offenders, it is likely that reported attitudes relate to male sex offenders. This study investigated the attitudes towards female sex offenders of 92 members of staff employed by a UK chain store (public sample), 20 probation officers employed by a Regional Sex Offender Unit (forensic professional sample) and 64 undergraduate psychology students (student sample).Participants completed the Attitudes Toward Female Sex Offenders Scale adapted from the Attitudes Toward Sex Offenders Scale. Forensic professionals held significantly more positive attitudes than both the students and public. Comparisons between the responses in this study with those of previous studies revealed that the forensic professionals in this study held significantly more positive attitudes towards female sex offenders than professionals in previous studies did towards “sex offenders”.

Aims and methodA Trust-wide smoke-free policy was introduced in March 2007. This service evaluation retrospectively reviewed the outcome by focusing on recorded changes in behaviour, incidents and prescribing.ResultsThe majority of patients (89%) smoked before the smoke-free policy. There was no significant change in the rate of clinical incidents or the use of tranquillising medication at 3 months and 12 months post-implementation. Clozapine serum levels were raised significantly, necessitating dose reduction in 17% of patients. Fifty-four per cent of patients used nicotine replacement therapy and a small minority continued this treatment for 12 months.Clinical implicationsDespite initial concerns there were no significant problems in implementation of the smoke-free policy. This was assisted by extensive preparation, education, patient advocacy and access to treatment beforehand.

Evidence suggests a complex relationship between substance misuse, mental health, and violence in forensic populations, however, the majority of existing research and interventions focus on these factors individually. This paper reports an evaluation of the first module of an integrated poly-substance misuse group delivered within a medium secure mental health hospital, which was designed to address these factors collectively. Qualitative and quantitative approaches were used to assess participant's subjective views of the program and to gather pre and post quantitative measurement of change. The concordance between self report and observer reports was explored. Recommendations for the development of the treatment and for further evaluation and research are discussed.

Sugarman & Nimmagadda ( Psychiatric Bulletin , November 2007, 31 , 404–406) argue persuasively for equivalent access to Continuing Professional Development, revalidation and appraisal requirements for both private sector and National Health Service (NHS) consultants. But it is disappointing that