Clinical and organisational aspects of work seemed separate in the minds of staff, with the latter reported to be more stressful; staff support came in the form of close relationships with colleagues, who saw themselves as isolated in the context of the wider environment. Promotion of the well-being and effectiveness of FMH staff should therefore take account of clinical, organisational and societal aspects of their situation.

Although findings appear promising, this was a naturalistic study. The sample size was small, but represented all men accepted into the two pilot services. Further evaluation of the role of supported housing and perhaps other details of community supervision should follow.

BackgroundCase formulation plays a key role in effective management of offenders' needs, particularly on the Offender Personality Disorder Pathway (OPDP).AimsTo validate a method of investigating formulations with offenders still in prison but in the OPD Pathway and investigate agreement over the content of formulations between each of the main dyadic pairs: offender‐clinician, offender‐key worker and clinician‐key worker.MethodsWe developed a checklist of the main features of a formulation from a review of initial formulations in the files of prisoners in two prisons which operate within the OPD Pathway system. We then recruited 30 violent offenders in each OPD wing of two prisons, and asked each of them, their clinically qualified worker (usually a psychologist) and the criminal justice system key worker to complete a formulation summary according to a card‐sort process based on this checklist. We calculated the level of agreement between pairs of raters (e.g. offender and key worker) about the importance of aspects of each domain to the case using intraclass correlation coefficients.ResultsThe rating tool showed good internal validity. Analysis of inter‐rater ratings showed agreement among teams on aspects relating to prisoners' observable actions, experiences and external support domains, but little agreement on cognitions, feelings, risky situations or staff/self‐support, mainly affecting the prisoner‐key worker dyad. There were, however, significant differences in agreement rates between the two sites.ConclusionsAgreement within teams about formulations is strong where content relates to overt behaviours and points of fact, but weaker on risk, cognitions and support. The appropriateness of this approach to formulation across cultural groups may need further evaluation as the main measured difference between the prisons was in distribution of ethnic and cultural groups.

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Substance misuse has been associated with an increased risk of violence and offending in those with severe mental illness. The current study explored the relationship between attitudes regarding substance use and the attribution of blame for a criminal offence in a sample of male mentally disordered offenders with a history of substance misuse. Participants completed measures that examined general beliefs about substance use and blame attributions for an offence they had committed, and identified substances previously used. Cannabis and alcohol were the most frequently used substances, and polysubstance use was common. Results indicated a significant correlation between substance-related beliefs and the attribution of blame for offending; in particular, greater maladaptive substance-related beliefs were correlated with higher externalisation of blame for the index offence (p50.001). The need for appropriate interventions that address the relationship between substance use, offending and mental health in forensic populations to be developed is considered.