Forensic mental health inpatients in medium secure settings have a limited capacity for sexual expression during their stay in hospital, due to a number of factors, including a lack of willingness on behalf of staff to engage with sexual issues, as a result of safety fears and ambiguity regarding the ability of the patient to consent. Furthermore, UK forensic medium secure units do not provide conjugal suites for patients to have sexual relations, with their spouse or other patients. To date, there is no empirical research on how forensic psychiatric patients (or service users) manage their sexuality, whilst in hospital and when released into the community. Here, we present an analysis of semistructured interviews with patients at a UK medium forensic unit, in order to explore these issues further. More specifically, we examine how the public exclusion of sexuality from these units results in sexuality being experienced as sectioned off or amputated, such that a new form of sexuality emerges; one that has been cultivated by the psychologically informed practices operating within the unit. This process, we argue produces a Psychologically Modified Experience (PME), a new form of self-relation that continues to modify when released into the broader ecology of the community. IntroductionForensic mental health services in the UK are based around secure hospital units, varying from low to high security, that are embedded in local health services. Persons diagnosed with severe or enduring mental health issues who have entered the criminal justice system after committing a criminal offenceknown as an 'index offence' -may be detained or 'sectioned' under the Mental Health Act (1983) and subsequently transferred to a secure unit for a significant, open-ended period of time. Two-thirds of forensic mental health service users spend over two years on a section, with twenty percent detained between five and ten years and eighteen percent between ten and twenty years (Rutherford & Duggan, 2007). This period of detention can occur at a critical period in the individual's development of adult sexuality and personal relationships, with over half of all patients being within an age range of twenty to forty years of age (Rutherford & Duggan, 2007). Sexuality and personal relationships are therefore significant issues for service users (Lowson, 2005). However, we have found in previous studies 2 ( AUTHORS, 2007) that staff working in secure forensic mental health units express significant concerns around service-user sexuality.When patients engage in sexual activity with one another, this raises a significant number of dilemmas for staff. This includes the impact of such activity on the health and wellbeing of the patients concerned, given their current state and the timing of the events concerned in relation to the duration of the stay on the unit. It also raises a concern for patient's rights and whether sexual activity has been consensual for all who are involved. We found (AUTHORS, 2007) that staff reported extensive...

Very little is known about the sexual activities of psychiatric patients during their stay in hospital and beyond. In this article, we have explored how mental health professionals working within a forensic psychiatric unit construct the issue of patient sexuality in order to ascertain the range of sexual possibilities open to patients. Drawing on interviews with twenty four participants--psychiatrists and clinical psychologists (clinical staff), we examined how participants made sense of patient sexuality and their clinical judgments in relation to them. Using a thematic analysis, we were able to identify a number of relevant themes emerging, including a) what the limits of acceptable sexual behaviour were judged to be, b) discrimination against transgender and same sex relationships, c) vulnerability among female patients and therapeutic efficacy, and d) an abject fear of patient pregnancy. Furthermore, a general concern throughout was the putative professional conflict between the clinical and ward staff. Further discussion regarding the potential for clearer policy on patient sexuality and further training for professionals is developed in the final section.

Medium secure forensic psychiatric units are unique environments within the broader 'post asylum' landscape of mental health services. Length of stay is much greater, a recovery-focused care system is much more difficult to implement, and there is a paucity of suitable "step-down" services. The aim of this study was to examine how forensic psychiatric environments contribute to the shaping of recovery, by examining key features such as social interactions and agency. Here, we report on the findings from patients participating in a qualitative-visual study. This analysis forms part of larger study on staff and patient experiences of secure hospital space. In this paper, the analytical focus is directed towards two key elements of recovery -agency and relationality, using the concept of 'topology' and 'life-space', developed by the social psychologist Kurt Lewin. First, we explore how patients have relative freedom to move within institutional spaces, yet lack relational space. Secondly, we explore how life-space is expanded or compressed by the manner in which the patient's present life in hospital is connected or disconnected from their past or pending future. Finally, we discuss the implications of these findings for a recovery model within secure forensic settings, focussed on personalisation and expanded life-space.2

The climate or atmosphere of a ward in secure psychiatric care is typically studied by examining the relationship between social and environmental factors. However the experiences of patients are irreducible to a set of discrete dimensions or factors. Drawing on recent work in affect theory and architectural studies, we argue for an approach to atmosphere that places it 'in between' persons and space, as a 'spatially extended quality of feeling' (cf. Böhme, 2017a) of which patients are intimately aware. The paper discusses empirical material drawn from a broader study of inpatient medium-secure forensic care in a large hospital in the South of England. We show how the process of becoming attuned to the fluctuations and shifts in the atmosphere of the ward is a critical aspect of everyday life for patients. Attunement cuts across existing notions of power and resistance in these settings. We also demonstrate how attachments to a range of objects, some created by patients, can either expand or punctualize attunement, enabling change in the overall atmosphere. We conclude by speculating on how we might rethink spaces of recovery on an ethospheric basis.

How sexual consent should be discussed with young people is the subject of current policy debates and contestations in the UK. While the current Westminster government Violence Against Women and Girls (VAWG) strategy (Home Office, 2011) and subsequent action plans recognise the importance of addressing consent, with no statutory relationships and sex education there are few contexts in which these conversations with young people routinely take place. Organisations that work with young people as victim-survivors of violence and through school-based primary prevention programmes have long identified sexual consent as an issue which requires specialist attention and intervention (see e.g. Coy et al, 2010; EVAW, 2011).