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Background: FACTS is a Wales‐wide mental health service for 10–17‐year‐olds with needs beyond the remit of mainstream child and adolescent mental health services (CAMHS). As a purely consultation‐liaison service, it differs from other UK services in the field. Aims: To describe a complete cohort of referrals to FACTS 2013–2017 with service exit by June 2018. Methods: Clinical, social and offending data were extracted from FACTS records. Results: 80 young people completed a FACTS episode, averaging nearly a year (309 days; range 13–859 days). Mostly boys (65, 81%) of mean age 15.4 years (range 9–18), two‐thirds (n = 53) had three or more referral reasons, one invariably being threatened/actual harm to others; only half were criminal‐justice involved. Half (41, 51%) were committing sexually harmful acts. Half were self‐harming (41, 51%). All but seven had had at least one adverse childhood experience (ACE), nearly half (35, 44%) four or more. Nevertheless, post‐traumatic stress disorder (PTSD) was rarely diagnosed (7, 9%); just over one‐quarter (23, 29%) had no diagnosis at all. Correspondence analyses endorsed two distinct Attention deficit hyperactivity disorder groups, distinguished by presence/absence of evidenced brain damage or dysfunction. Suicide‐related behaviours clustered with the other diagnoses, flashbacks and psychotic symptoms with no diagnosis. Change in home circumstances during a FACTS episode was slight. Conclusions: The complexity of presenting problems and service involvement evidences need for FACTS. The extent of persistently harmful sexual behaviours is a novel finding, suggesting need for more expert input for this at other service levels. Rarity of PTSD diagnoses was surprising given the extent of ACEs. This raises concerns that services focus on disorder signs rather than the child's inner life. Given the extent of problems, minimal change may be a positive outcome – especially when remaining in the community. Further development of this service should include explicit case‐by‐case goals and indicative outcome markers. [ABSTRACT FROM AUTHOR]

Background: Imprisonment impacts on lives beyond the prisoner's. In particular, family and intimate relationships are affected. Only some countries permit private conjugal visits in prison between a prisoner and community living partner. Aims: Our aim was to find evidence from published international literature on the safety, benefits or harms of such visits. Methods: A systematic literature review was conducted using broad search terms, including words like 'private' and 'family', to maximise search sensitivity but strict criteria for inclusion – of visits unobserved by prison staff and away from other prisoners. All included papers were quality assessed. Two of us independently extracted data from included papers, according to a prepared checklist. Meta‐analysis was considered. Results: Seventeen papers were identified from 12 independent studies, all but three of them from North America. The only study of health benefits found a positive association with maintaining sexual relationships. The three before‐and‐after study of partnership qualities suggested benefit, but conjugal visiting was within a wider family‐support programme. Studies with in‐prison behaviour as a possible outcome suggest small, if any, association, although one US‐wide study found significantly fewer in‐prison sexual assaults in states allowing conjugal visiting than those not. Other studies were of prisoner, staff or partner attitudes. There is little evidence of adverse effects, although two qualitative studies raise concerns about the visiting partner's sense of institutionalisation or coercion. Conclusions: The balance of evidence about conjugal visiting is positive, but there is little of it. As stable family relationships have, elsewhere, been associated with desistance from crime, the contribution of conjugal visiting to these should be better researched. [ABSTRACT FROM AUTHOR]

Expressing remorse - or not - appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected - or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions. [ABSTRACT FROM AUTHOR]