Assessment of need for inpatient treatment for mental disorder among female prisoners: a cross-sectional study of provincially detained women in Ontario.

Background: International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. Most will be treated within the prison however the most severely ill require transfer to a hospital facility. The primary aim of our study was to survey the total provincial female prison population in Ontario, Canada, to determine the proportion that require treatment in a psychiatric hospital, and the security level required.

Integrated care in mental health: next steps after the NHS Long Term Plan.

Health and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better 'integrated' care. We describe key aspects of integration that need addressing.

The psychiatric management of prisoners on hunger strike: developing a management algorithm using the Delphi technique.

Purpose: The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.

Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems?

: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. : We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. : A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour.

A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder.

Background: Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the significant cognitive deficits frequently present within this group.

Methods: Sixty-five patients with schizophrenia or schizoaffective disorder were enrolled in a single blind randomized controlled trial of CRT versus treatment as usual (TAU); representing 94% of those eligible within a national forensic cohort.

Tick, tock, lock: night-time confinement in high security - history, practice, ethics and practicalities.

SummaryNight-time confinement, locking patients in their bedrooms overnight, is practiced within high-secure hospitals in the UK. This article provides context, sets out the history and reviews the ethical and pragmatic issues at stake. Thought is given to the future, where we appear to be moving toward a different approach.

Combination long-acting injectable (LAI) antipsychotic medication in adolescents with severe psychosis and aggression: a case series.

Objectives: We examine the use of combination long-acting injectable (LAI) antipsychotic medication for adolescents with severe psychosis and aggression. We discuss benefits and risks with this approach, for a highly challenging small group of young people.

Methods: A clinical summary is given of three adolescents admitted to a secure adolescent forensic inpatient unit, and the literature is reviewed.

Offending behaviour, health and wellbeing of military veterans in the criminal justice system.

Background: A small but significant proportion of military veterans become involved in the criminal justice system (CJS) after leaving service. Liaison and Diversion (L&D) services aim to identify vulnerable offenders in order to provide them with the health/welfare support they need, and (where possible) divert them away from custody. An administrative database of L&D service-users was utilised to compare the needs of veterans with those of non-veteran L&D service-users.

The crucible of early career psychiatry.

Objective: To capture the voices of psychiatrists as they reflect on challenges at the early stages of the career trajectory.

Method: Early career psychiatrists contributed reflections that identified various challenges in the transition from trainee to consultant psychiatrist.

Results: Common difficulties included negotiating role transition and conflict.

Diversion of Mentally Ill Offenders from the Criminal Justice System in Ireland: Comparison with England and Wales.

Aim: It is generally accepted that certain people who are mentally ill and have contact with the criminal justice system should be diverted to psychiatric care rather than imprisoned. We sought to comment on priorities relating to the development of diversion services in Ireland through comparison with developments in a neighbouring jurisdiction.

Methods: A comparative review was undertaken in relation to the provision for psychiatric diversion across the offender pathway in Ireland and England and Wales.

The Barriers and Benefits to Developing Forensic Rotations for Psychiatry Residents.

Psychiatry residents' experiences in forensic psychiatry vary greatly across the country, and many psychiatry programs meet the Accreditation Council for Graduate Medical Education requirements for a forensic experience through general psychiatry rotations (e.g., on a consult-liaison service) or classroom-based activities.

Montgomery and shared decision-making: implications for good psychiatric practice.

The 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.Declaration of interestNone.

Animal maltreatment: Implications for behavioral science professionals.

Despite the widespread belief among the public and an increasing number of law enforcement personnel that individuals who harm animals often harm other people, the subject of animal maltreatment has received little attention from behavioral scientists. Advances in comparative neuroanatomy have highlighted the ability of animals to feel physical and emotional pain, including complex psychological reactions to traumatic events. These advances, and recent studies (however sparse) that support the notion that perpetrators of crimes against animals often commit other crimes, have arguably created an ethical and practical imperative for behavioral scientists to undertake a serious examination of animal maltreatment and potential mechanisms for responding to it.

Management of psychogenic non-epileptic seizures: a multidisciplinary approach.

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management.

The feasibility of following up prisoners, with mental health problems, after release: a pilot trial employing an innovative system, for engagement and retention in research, with a harder-to-engage population.

Background: Following up released prisoners is demanding, particularly for those prisoners with mental health problems, for whom stigma and chaotic lifestyles are problematic. Measurement of mental health outcomes after release is challenging. To evaluate mental healthcare for offender populations, using high-quality randomised controlled trials, evidenced-based methods must be developed to engage them while in custody, to locate and re-interview them after release, and to collect potentially stigmatising mental health outcomes data.

The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review.

Background: The effectiveness of psychostimulants, primarily methylphenidate (MPH), in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in the general population of typically growing children and adolescents is well established through many Randomised Controlled Trials (RCTs).

Aims And Methods: We carried out a systematic review of all the RCTs in people with intellectual disabilities (ID) that assessed effectiveness of MPH on the core ADHD symptoms.

Outcomes And Results: We included 15 papers from 13 studies that were all on children and adolescents with ID (315 participants were on MPH and placebo respectively), 12 of which used a cross over design, and one used a parallel design.

The assertive approach to clozapine: nasogastric administration.

Aims and methodAn 'assertive approach' to clozapine, where nasogastric administration is approved, is assessed through a case-load analysis to provide the first systematic description of its use and outcomes worldwide. RESULTS: Five of the most extremely ill patients with treatment-resistant schizophrenia were established and/or maintained on clozapine, resulting in improvements to their mental state; incidents were reduced, segregation was terminated and progression to less restrictive environments was achieved.Clinical implicationsDespite being underutilised and rarely enforced, in extreme circumstances, an assertive approach to clozapine can be justified.

Security of mind: 20 years of attachment theory and its relevance to psychiatry.

In this editorial, I suggest that no psychiatrist should be without a working knowledge of attachment theory, and it is a capability that all trainees should cover in the proposed new curriculum. I have focused on three domains of research to argue that attachment theory is relevant to practicing psychiatrists.Declaration of interestNone.

Emergency department provider perspectives on elder abuse and development of a novel ED-based multidisciplinary intervention team.

Background: An ED visit provides a unique opportunity to identify elder abuse, which is common and has serious medical consequences. Despite this, emergency providers rarely recognise or report it. We have begun the design of an ED-based multidisciplinary consultation service to improve identification and provide comprehensive medical and forensic assessment and treatment for potential victims.

Tackling obesity in mental health secure units: a mixed method synthesis of available evidence.

Background: The prevalence and incidence of obesity are high in people with severe mental illness (SMI). In England, around 6000 people with SMI access care from secure mental health units. There is currently no specific guidance on how to reduce the risk of obesity-related morbidity and mortality in this population.

Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs.

Background: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.

Aims: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.

Method: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England.

Correctional psychiatry in Nigeria: dynamics of mental healthcare in the most restrictive alternative.

Nigeria has poorly structured services for correctional mental health driven by a mix of socioeconomic and legal factors. The archaic asylum systems established in the early part of the 20th century under the Lunacy ordinance of 1916 are no longer fit for purpose. The present strategy is to provide mental healthcare for mentally abnormal offenders within some prisons in the country.