Psychological and psychosocial interventions offered to forensic mental health inpatients: a systematic review

Abstract

ObjectiveTo examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health inpatients.DesignCINAHL, MEDLINE, PsycINFO, ScienceDirect and Web of Science databases were searched for research published in English between 1 January 1990 and 31 May 2018.Outcome measuresDisturbance, mental well-being, quality of life, recovery, violence/risk, satisfaction, seclusion, symptoms, therapeutic relationship and ward environment. There were no limits on the length of follow-up.Eligibility criteriaWe included randomised controlled trial (RCT) studies of any psychological or psychosocial intervention in an inpatient forensic setting. Pilot or feasibility studies were included if an RCT design was used.We restricted our search criteria to inpatients in low, medium and high secure units aged over 18. We focused on interventions considered applicable to most patients residing in forensic mental health settings.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias.Results17 232 citations were identified with 195 full manuscripts examined in detail. Nine papers were included in the review. The heterogeneity of the identified studies meant that meta-analysis was inappropriate. The results were presented in table form together with a narrative synthesis. Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings. The most frequently reported outcomes were violence/risk and symptoms. 61% of the violence/risk comparisons and 79% of the symptom comparisons reported improvements in the intervention groups compared with the control groups.ConclusionsCurrent practice is based on limited evidence with no consistent significant findings. This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk, but there is tentative support they may improve symptoms. More RCTs are required with: larger sample sizes, representative populations, standardised outcomes and control group interventions similar in treatment intensity to the intervention.PROSPERO registration numberCRD42017067099.

Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research

“…If the opportunity to participate in research is an ethical right (4), it seems FMHS patients are seldom granted this right. Research pertaining to core interventions is lacking on a broad scale (22,23). In an analysis of available systematic reviews, Howner et al (22) concluded that none of the broad range of intervention categories they investigated had a sufficient evidence base in FMHS settings.…”

A randomised controlled feasibility study of interpersonal art psychotherapy for the treatment of aggression in people with intellectual disabilities in secure care

“…A systematic review (2019) of randomised controlled trials (RCT) of psychological interventions offered to forensic/secure mental health inpatients (n = 9 studies including 523 participants) reported that current practice is based on limited evidence with no consistent significant findings [17]. Study sample sizes ranged from 14 to 112.…”

“…Economic evaluations were not included in the studies. The review concluded that further studies are needed to clarify the evidence base [17].…”

Offense-Related Issues in Forensic Psychiatric Treatment: A Thematic Analysis

“…Furthermore, to achieve the necessary balance between risk management and strength enhancement as prescribed by GLM, both internal capabilities and external conditions must be developed throughout the rehabilitative process. In terms of internal capabilities, various interventions already in established use in forensic psychiatry can be used in a targeted and individual manner (47)(48)(49). CBT based approaches, group and individual, focusing on problem-solving and interpersonal skills, have the best evidence base for the treatment of forensic patients and should be preferred to other models (1).…”