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The Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) (Wechsler, 2008) is a cognitive assessment that is often used in secure forensic settings, however it has not been normed on this population. The purpose of this paper is to develop forensic normative data.

Patient files in a high secure forensic hospital were reviewed in order to obtain completed WAIS-IV (Wechsler, 2008) assessments and scores from the five indexes (verbal comprehension, perceptual reasoning, working memory, processing speed and full scale intelligence quotient (FSIQ)). This included reviewing patient files from all directorates, including male mental health, male learning disability, male personality disorder and the women’s service, yielding a sample size of n=86.

The qualitative descriptors obtained across the hospital ranged between extremely low and superior. The learning disability service scored significantly lower than the mental health and personality disorder services in verbal comprehension index, perceptual reasoning index, working memory index and FSIQ, and significantly lower than the mental health, personality disorder and women’s services in processing speed index. Mean scores from this study were significantly lower in comparison to those from the UK validation study (Wechsler, 2008).

The significant difference between scores from the current study and those from the UK validation study (Wechsler, 2008) highlights the need to have appropriate normative data for forensic populations. Clinicians should consider interventions that may serve to increase cognitive function, such as cognitive remediation therapy.

Whilst several special group studies have previously been conducted, this study is the first to develop forensic normative data for the WAIS-IV (Wechsler, 2008). Whilst the sample size was relatively small with limited female participants, the data collated will enable clinicians working in forensic establishments to interpret their assessments in light of this information.

The purpose of this paper is to explore staff and service users’ perceptions of therapeutic principles within a unique male high secure learning disability therapeutic community (LDTC).

A qualitative approach was adopted using deductive content analysis and inductive thematic analysis. In total, 12 participants took part in a semi-structured interview to explore their perceptions of Haigh’s (2013) quintessence principles and any further additional therapeutic features in the environment not captured by the theory.

All five quintessence principles were identified in the LDTC environment. Some limits to the principle of “agency” were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional therapeutic features were identified including; security and risk, responsivity, and more physical freedom which appear to aid implementation of the quintessence principles.

The study was performed within a single case study design. Therefore, results remain specific to this LDTC. However, the finding of these principles in such a unique setting may indicate Haigh’s (2013) quintessence principles are evident in other TC environments.

This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The research provides empirical evidence for the quintessence principles in a novel TC setting and suggests recommendations for future research.

The purpose of this paper is to explore service users’ experience of community meetings (CMs) within a high secure setting.

A qualitative design was employed in which focus groups were used to capture service users’ experience of CMs. In all, 12 focus groups comprising a total of 27 participants were carried out using a semi-structured interview schedule. Data were analysed using thematic and saliency analysis, identifying themes which were pertinent to the research aims.

Positive experiences reported by service users included a safe space to explore ward issues and develop skills, with some viewing the meeting as a therapeutic forum in which to facilitate personal growth.

There were a wide range of patient presentations and views. Furthermore, only 20 per cent of the patient population were included within this study.

A number of recommendations have been identified that can have positive implications for patients (quality of life and recovery), staff (resolving conflicts and problem-solving) and the overall therapeutic milieu of the ward.

There are no reviews looking at CMs within the last decade. This paper brings the understanding up to date to allow the development of this potentially positive tool.

The purpose of this paper is to undertake a systematic literature review to appraise the current evidence relating to the factors associated with violence and aggression in adult psychiatric hospital inpatient settings.

A systematic search of following four databases was conducted: Scopus, PsychINFO Medline, CIHAHL and PsychArticle. Following the application of the inclusion criteria, ten papers were extracted and included in the review. A quality appraisal tool, Mixed Methods Appraisal Tool (MMAT) version 2011 (Pluye et al., 2011), was employed for the appraisal of the qualitative and quantitative studies. MMAT has been designed for systematic literature reviews that include qualitative, quantitative and mixed methods studies. Of these, eight were of quantitative methodology and two were of qualitative studies.

These ten papers provide an insight into factors associated with violence and aggression towards nursing staff. Three main themes were identified: the environment, attitudes/interaction of staff, and the patient’s mental illness. The themes were important factors in the causes of violence but were interlinked highlighting the complex nature of violence towards nursing staff. The findings support the need for training for nursing staff and the development of ongoing support and for organisations to consider both the environment and the restrictive procedures to help reduce violence and aggression towards nursing staff.

The paper concludes by outlining the importance of considering the three main themes for clinical practice, training and development of secure services.

This paper gives insight into the factors associated with patient violence and aggression towards nursing staff in a secure setting.

Measures of risk employed in mental health settings in the last 20 years have consisted of clinical scales that comprise both historical and clinical factors. Examples of such tools include the widely used HCR‐20 (Webster et al, 1997), SVR‐20 (Boer et al, 1997) and VRS (Wong & Gordon, 2000). Such tools are time‐intensive and, in the main, completed by an independent rater. At present there is a lack of systems to guide teams to investigate salient risk factors related to mental state and violent offending that inform treatment effectiveness, change and, ultimately, risk assessment decisions. This paper describes the application of such a system. The Standard Goal Attainment Scaling for Sex Offenders (GAS‐S) (Hogue, 1994) has been modified for use with violent offenders and is presented herewith. Application of the tool to the Violent Offender Treatment Programme (VOTP) is discussed, alongside its potential usefulness in informing risk assessment and the effectiveness of treatment intervention.

The Violent Offender Treatment Programme (VOTP) is a cognitive programme which aims to reduce risk of recidivism of mentally disordered offenders. Research has examined the use of various assessment tools to explore the effectiveness of the programme. Examination of service user feedback in relation to mental health service provision and violence risk has not been conducted. This study aims to explore service users' experiences of the VOTP.

Interpretative phenomenological analysis was utilised to explore interviews of seven service users' experiences of the VOTP, within a high secure psychiatric hospital.

Four broad themes were found: consistency, learning and application, the group experience, and programme structure. Findings indicate participants held positive views of the VOTP. They could relate to the material covered and felt this had enhanced their ability to manage violence and aggression. Recommendations to improve the programme included simplifying programme material, maintaining patient motivation, and ensuring effective communication.

The service users whose risk had substantially reduced and thus left the hospital were not included in this study. In addition, there were restrictions on the patients available as current mental health had to be taken into account. Implications include the importance service users place on group process.

Examining service user feedback in relation to mental health service provision had not previously been completed. Findings may be beneficial to other treatment programmes for violence and other group based psychological treatments in similar settings.

The Forward Motion Motivational Group (FMMG) is a psychological group intervention facilitated in the Mental Health Directorate of a high-secure Hospital. Research has highlighted a limited amount of service user involvement within secure settings. The aims of the study were to explore participant's experiences of FMMG, to establish whether these reflected the aims of the programme, to provide participants with the opportunity to recommend changes to the current service provision and to explore whether the programme supported engagement in further psychological interventions.

Ten programme completers were interviewed using a semi-structured interview. The interview transcripts were analysed using thematic analysis (Braun and Clarke, 2006) alongside Beutow (2010) Saliency Analysis Guidelines.

Thematic analysis of the data resulted in five key themes: expectations, group experience, programme facilitators, learning and programme aims and programme development.

Qualitative measures provide an insight into whether participant's experiences reflect the programme aims which is a valuable indicator of treatment effectiveness. Participants advocated the value of completing an introductory group to broaden their insight into the structure and delivery of psychological group interventions.

Given the limited amount of research involving service users within secure settings, it is specifically the service user's experiences and suggestions for programme development that are considered within this paper. This highlights the value of service user involvement for those interested in conducting research within secure settings.

Night confinement (NC) has been proposed as an appropriate and safe way to make cost improvements in a high secure NHS hospital. Given potential controversy, evaluating the impact of this change is vital. This paper aims to focus on the issue.

The study used a mixed methods design to assess the impact of a three month night confinement pilot on four high secure admission wards. In total, 158 staff and 42 patients were approached to complete questionnaires and interview prior to and following the pilot. Questionnaires were analysed using T tests, ANOVA and Mann Whitney‐U to asses perceived changes in ward climate, working environment and quality of life. Thematic and saliency analysis was used to explore themes arising from semi structured interviews. Hospital data were collected to identify behavioural changes.

The study found that NC had no adverse effects and incidents of self harm, other incidents and seclusion hours dropped by a third during this period. This was contrary to staff expectations.

Limitations include: a large number of researchers involved; average response rate and a disproportionate number of patients on Tilt restrictions on the pilot wards. Further evaluation is necessary if NC is to be adopted more widely.

This evaluation suggests that NC can contribute to providing an efficient and effective secure mental health service.

This study provides a unique opportunity to assess the impact of NC on patients and is of value to other secure units seeking effective cost improvements.

A significant number of people held within the secure forensic hospital estate in this country suffer from neuropsychological deficits (e.g. Lowings, 2010; Williams et al., 2010). These deficits, many of them cognitive, have a detrimental impact on patient's abilities to benefit from psycho-educational materials thereby slowing the progress of their rehabilitation. Understanding these difficulties enables interventions to be more effectively targeted and facilitated to the patients’ cognitive strengths. It was against the backdrop of the evidence that a review was commissioned into neuropsychological activity at Rampton Hospital.

The review of the neuropsychological assessment activity was confined to the male patients residing within Mental Health Services (MHS) and the National High Secure Learning Disability Service (NHSLDS) of the hospital. With regards to the MHS, 129 patient files were examined in order to identify the volume of neuropsychological assessment previously undertaken and the make up of the neuropsychological test batteries administered with the current patient group. With regard to the NHSLDS 48 files were similarly examined. In addition, MHS psychologists were surveyed to assess their knowledge of patients within that service who to their knowledge had previously suffered an acquired brain injury (ABI) or had suffered a significant neurological illness likely to have resulted in cognitive impairment.

A scoping exercise identified that a significant amount of neuropsychological assessment was being undertaken, albeit in an unstructured way. This led to a number of patients being subjected to a significant delay before the need for neuropsychological testing and rehabilitation possibilities became apparent. There was a huge variance on when a patient was tested ranging from one month to 14 years and the size of the test battery used, with the number of tests conducted per patient ranging between one single test to 16 tests during a patients stay at the hospital.

Opportunities to more appropriately place patients based upon their abilities could be achieved if the hospital were to adopt a policy of conducting neuropsychological assessments, including cognitive functioning, for all patients upon admission to the hospital. A proportion of patients were known to have had a ABI or a significant illness likely to have resulted in cognitive impairment. This was considered to be an underrepresentation and the taking of a thorough history specifically covering ABI and specific illnesses known to have an impact on cognitive ability and behaviour was also recommended.

In light of this review, services are to take a more systematic approach to assessing neuropsychological difficulties. Consideration is being given to neuropsychological screening becoming part of the admission process.

There is a dearth of research exploring pathways to episodes of deliberate self‐harm (DSH) within mentally ill men in high‐secure hospitals. This study aims to explore pathway(s) to episodes of self‐harm experienced by this group over the course of their life.

A total of seven men with a history of repetitive DSH participated in audio‐taped semi‐structured interviews. Transcribed interviews were analysed using grounded theory methods.

Two pathways to episodes of DSH emerged and were termed: the relief, and the response to mental health problems pathways. Participation within a dyadic suicide pact emerged as an unexpected theme.

There were a number of limitations within this study. Participants did not describe DSH episodes, which occurred within the high‐secure hospital and it was unclear as to the stage of their illness or whether co‐morbid difficulties were present during the episodes of DSH. Further research is required to substantiate the two pathways to episodes of DSH found within this study.

The present study offers a theoretical framework for clinicians working with mentally ill men within high‐secure hospitals, who have a history of DSH and identifies the need to carefully assess each individual episode of DSH.

This study is the first to explore pathways to episodes of self‐harm as experienced by mentally ill men within a high‐secure hospital by interviewing patients directly.