The findings indicate clinical and operational issues, which will need careful consideration in the future planning of services. The high number of ARMS cases highlights the importance of clear treatment pathways and targeted interventions and may suggest a need to commission distinct ARMS services. The number of people who met the extended age and service acceptance criteria may suggest a need to adapt or redesign clinical services to meet the age-specific needs of over 35 year olds and those with an ARMS. It is unclear how changes to the remit of EIP services will impact upon future clinical outcomes.

The mental health needs of prisoners are significant with a high incidence of common mental health problems including anxiety and depression. Extending national initiatives such as the National Health Service Improving Access of Psychological Therapies programme to people in prison offers a valuable opportunity to address these mental health problems and improve continuity of care from prison to the community. This study adopts an observational, prospective cohort design and evaluates an IAPT for offenders service over the first three years of operation within a male Category B prison holding remand/convicted prisoners. The evaluation found large effect sizes for changes in anxiety and depression with clinical recovery being achieved in 55% of depression and 52% of anxiety cases. On average, prisoners were treated in less than five sessions employing a low-intensity cognitive-behavioural approach. The lack of established formal diagnoses and a control group limits the findings.

Purpose -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.Design/methodology/approach -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.Findings -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.Research limitations/implications -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.Practical implications -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.Originality/value -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.

In-patient nurses working with people with learning disabilities and challenging behaviours may not have sufficient knowledge/skills in functional assessment methods to adopt a ‘Person Focused Training’ approach to service delivery. Recommendations for supporting staff to use functional assessments are made.

Aim: Following the introduction of an access and waiting time standard for Early Intervention in Psychosis (EIP) services, the identification and treatment of people experiencing an At-Risk Mental State (ARMS) for psychosis has become a national priority. However, there is a dearth of literature concerning what is offered to and accepted by ARMS service users within routine services. Methods: This descriptive evaluation reports upon the assessment and treatment of people with an at-risk mental state identified during the first year of a routine service operating in line with the EIP standard. The paper details referral sources, referral to treatment times, socio-demographic characteristics, ARMS subgroups and the interventions accepted by these service users. Results: A total of 138 ARMS cases were identified over the evaluation period, with 73% (n=101) aged between 18-34 years and 86% (n=118) meeting attenuated psychotic symptoms criteria. The majority (64%) of service users engaged in multiple interventions; 54% (n=75) accepted psychoeducation and coping skills enhancement work, 42% (n=58) participated in a sleep programme, 33% (n=45) undertook coping with voices and visions work and 28% (n=39) engaged in individual psychological therapy. Conclusion: The findings indicate that the majority of ARMS service users presenting to the EIP service were aged 18-34 and experienced attenuated psychotic symptoms. A range of NICE and CBT informed interventions as well as individual psychological therapies appear to be acceptable to ARMS service users and many engaged in multiple interventions offered.