Many studies have identified high levels of mental health problems among adolescents in custody and there is increasing evidence that mental health problems in this population are associated with further offending and mental health problems into adulthood. Despite recent improvements in mental health provision within custodial settings there is little evidence of structured interventions being offered or of their effectiveness being evaluated. A cognitively based intervention was developed and offered to adolescents with a variety of mental health problems in different secure settings, and the outcomes compared with a control group. Although this small‐scale study did not identify significant differences in outcomes for the two groups, both recruitment and retention in therapy were good, and potential candidates were not excluded on the basis of learning difficulties or co‐morbidity. The study demonstrated the viability of a delivering cognitively based intervention for common mental health problems within secure settings.

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In the UK and other western countries, child and adolescent care is increasingly understood as a distinct speciality. Internationally, inpatient units are the most widely used element of acute adolescent mental health services. Child and adolescent mental health inpatient nursing has been identified as unique, and yet there is dearth of research investigating the role of nursing in adolescent mental health inpatient units and its impact. This is the second of a two papers presenting findings from a first of its kind, qualitative study investigating into the nature of mental health nursing within a child and adolescent mental health service psychiatric intensive care unit (CAMHS PICU). A qualitative conceptual analysis design was used. Findings relating to understanding of staff experience of their work and their support needs are presented. Results indicate there is significant emotional labour generated from the detailed and intense relationally-focused work with young people; responsible for both a sense of value and job satisfaction, and corrosion of staff capacity to sustain these interventions over the longer term. The central role of projective identification and the specific support requirements that emerge from these intrapersonal dynamics are explored. A conceptual model of CAMHS PICU nursing is proposed, synthesised from findings in the two parts of this series.

Research within the area of paranoid thinking has focused primarily on adults and has only recently looked at the effects during the critical life stage of adolescence, with even less research in the context of the juvenile justice system. This article aims to explore the relationship between antisocial behaviour in adolescence and the development of paranoid thinking, set within wider contexts that surround the juvenile justice system. The information presented is drawn from both the current research and the clinical experiences of those working in adolescent forensic psychiatry services. The relationships with other disorders such as conduct disorder, ADHD, PTSD, and depression are also explored.