BackgroundThere is a lack of research in forensic settings examining therapeutic relationships. A structured communication approach, placing patients’ perspectives at the heart of discussions about their care, was used to improve patients’ quality of life in secure settings.The objectives were to:• Establish the feasibility of the trial design• Determine the variability of the outcomes of interest• Estimate the costs of the intervention• If necessary, refine the interventionMethodsA pilot cluster randomised controlled trial was conducted. Data was collected from July 2012 to January 2015 from participants in 6 medium secure in–patient services in London and Southern England. 55 patients and 47 nurses were in the intervention group with 57 patients and 45 nurses in the control group. The intervention comprised 6 nurse-patient meetings over a 6 month period. Patients rated their satisfaction with a range of domains followed by discussions on improving patient identified problems. Assessments took place at baseline, 6 months, and 12 months. Participants were not blind to their allocated group. The primary outcome was self-reported quality of life collected by a researcher blind to participants’ allocation status.ResultsThe randomisation procedures and intervention approach functioned well. The measures used were understood by the participants and gave relevant outcome information. The response rates were good with low patient withdrawal rates. The quality of life estimated treatment effect was 0.2 (95 % CI: −0.4 to 0.8) at 6 months and 0.4 (95 % CI: −0.3 to 1.1) indicating the likely extreme boundaries of effect in the main trial. The estimated treatment effect of the primary outcome is clinically important, and a positive effect of the intervention is not ruled out. The estimate of the ICC for the primary outcome at 6 and 12 months was 0.04 (0.00 to 0.17) and 0.05 (0.00 to 0.18). The cost of the intervention was £529 per patient.ConclusionsThe trial design was viable as the basis for a full-scale trial. A full trial is justified to estimate the effect of the intervention with greater certainty. The variability of the outcomes could be used to calculate numbers needed for a full-scale trial. Ratings of need for therapeutic security may be useful in any future study.Trial registrationCurrent Controlled Trials ISRCTN34145189. Retrospectively registered 22 June 2012.

This study aimed to evaluate the validity of the Short-Term Assessment of Risk and Treatability (START) within a UK medium-secure hospital (665 STARTs derived from N = 80 individuals). Findings showed that START Total Vulnerability and Mean Risk Rating Scores were significantly predictive of Total Aversive incidents at one month, decreasing over time to a nonsignificant small/medium effect at six months. START Total Strength Scores were not predictive at any time point. START scores could discriminate between mentally disordered offenders at different stages of their care-pathway. Females were rated as having significantly less strengths and more risks than males. The START correlates with the HCR-20 and HoNOS Secure, and a crude cost analysis was undertaken. These results suggest that the START is a valid tool in this population.

BackgroundForensic mental health services have largely ignored examining patients’ views on the nature of the services offered to them. A structured communication approach (DIALOG) has been developed with the aim of placing the patient’s perspective on their care at the heart of the discussions between patients and clinicians. The effectiveness of the structured communication approach in community mental health services has been demonstrated, but no trial has taken place in a secure psychiatric setting. This pilot study is evaluating a 6-month intervention combining DIALOG with principles of solution-focused therapy on quality of life in medium-secure settings.Methods and designA cluster randomized controlled trial design is being employed to conduct a 36-month pilot study. Participants are recruited from six medium-secure inpatient services, with 48 patients in the intervention group and 48 in the control group. The intervention uses a structured communication approach. It comprises six meetings between patient and nurse held monthly over a 6-month period. During each meeting, patients rate their satisfaction with a range of life and treatment domains with responses displayed on a tablet. The rating is followed by a discussion of how to improve the current situation in those domains identified by the patient. Assessments take place prior to the intervention (baseline), at 6 months (postintervention) and at 12 months (follow-up). The primary outcome is the patient’s self-reported quality of life.DiscussionThis study aims to (1) establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial, (2) determine the variability of the outcomes of interest (quality of life, levels of satisfaction, disturbance, ward climate and engagement with services), (3) estimate the costs of the intervention and (4) refine the intervention following the outcome of the study based upon the experiences of the nurses and patients. The intervention allows patients to have a greater say in how they are treated and targets care in areas that patients identify as important to them. It is intended to establish systems that support meaningful patient and caregiver involvement and participation.Trial registrationCurrent Controlled Trials, ISRCTN34145189

Carer satisfaction with forensic mental health services is likely to be higher with services that address carers' information needs. New ways of providing this information may offer greater opportunities for working with carers.

Aims and MethodThis study describes residents in seven care homes, reviews their usage of mental health services and evaluates cost implications of psychiatric health care provision.ResultsThe patients are predominantly male with multiple diagnoses who are receiving psychiatric health care, but in general lack structured rehabilitation services. Forty-seven per cent of the residents moved into the trust catchment area in order to occupy the placement.The cost associated with the provision of differing models of out-patients care varies considerably.Clinical ImplicationsThese vulnerable residents are costing the mental health service relatively little, although the total cost to society is higher.This study points to the necessity of multiagency planning for 'new long-stay' patients.