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Sexuality is a central part of being human, however, talking about sexual health is generally avoided in forensic psychiatry. The aim of this qualitative study was to explore how healthcare professionals experience talking about sexuality and sexual health with patients cared for in forensic psychiatry. Individual interviews were conducted with eighteen healthcare professionals from ten different forensic psychiatry care units in Sweden. The interviews were semi-structured, and the data was analyzed with qualitative content analysis. The findings showed the overarching theme "Balancing on a slack line". The conversations the healthcare professionals have about sexuality and sexual health with patients in this setting are affected by forensic psychiatry's dual mission; to provide care and at the same time protect patients and society. These conversations can be about opening up for having responsive conversations, but also closing conversations since the field of sexuality and sexual health is fraught with norms and preconceptions. To be able to conduct these conversations can be a challenge since the professionals can experience uncertainty due to a lack of competence, indicating that knowledge and resources are needed to facilitate conversations. In conclusion, the study indicates that there is a lack of support and structure for performing conversations about sexuality and sexual health in forensic psychiatry care, and there is a need for increased knowledge among healthcare professionals. In order to support staff, the forensic psychiatry services need to acknowledge the national guidelines for sexual and reproductive health and rights and to develop and adapt the local guidelines. [ABSTRACT FROM AUTHOR]

Aims: To describe a reflexive account of a mental health nurse as researcher undertaking a mixed methods study as part of a doctoral degree, with women in a secure forensic hospital. Design: A discursive paper that draws upon the primary author's experience of dual roles as a mental health nurse and a novice researcher, and relevant literature pertaining to positionality and reflexivity in the context of conducting mixed methods research. Methods: A mixed methods study was conducted within a secure forensic hospital in Australia, to identify factors associated with the frequency and duration of seclusion for women and, to explore their experiences of seclusion. Notes and a reflective diary were used to demonstrate the reflexive approach and strategies used throughout the study design and data collection stages of the research. Results: Women in the secure forensic hospital setting often have complex histories and experiences and are considered a vulnerable group, which can add additional challenges when undertaking research with this population. As a doctoral student with clinical experience in mental health undertaking research in the forensic hospital setting with women, positionality and the connection with reflexivity requires exploration to understand self and the influence on research. This understanding along with identified strategies to enhance reflexivity, supports the management of the dual nurse as researcher roles to enhance all stages of the research process. Conclusion: Doctoral nursing candidates undertaking clinical research in their area of clinical practice and at the location of previous employment, may experience challenges in relation to identity and the dichotomy of roles. Further challenges can be posed when research involves complex populations and/or controversial practices. Support to balance role conflict and maintain reflexivity is critical to understanding the role of self in research and to enhance credibility. Implications for the Profession and/or Clinical Practice: Women are a complex, yet minority population in forensic mental health settings, however the numbers of women being admitted to services is increasing. Future research may consider the use of the strategies explored here to enhance the reflexive process, and support future researchers in this field to conduct research that aims to support an often‐misheard population to better support health outcomes. Patient or Public Involvement: There was no patient or public contribution to this paper, however the study in which this paper is based on, is grounded in the experience of patients (women). [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatric patients require specialized care due to the unique challenges in forensic settings. Negative attitudes and beliefs towards mentally disordered offenders can lead to discrimination against patients and are related to worse outcomes. Forensic psychiatric nurses play a crucial role in the treatment of these patients. Aim: This study aimed to investigate the perceptions, attitudes, and beliefs of forensic psychiatric nurses and general medicine nurses towards psychiatric patients and to compare them between nurse groups. Method: The study was conducted with 46 nurses working in the High-Security Forensic Psychiatry Clinic (Mean age: 35.46, SD= 7.16) and 58 nurses working in other inpatient settings (Mean age:36.28, SD=8.78) aged between 18-65 between December 2020 and April 2021 in Turkey. Nurses in the forensic psychiatry clinic were required to have at least 6 months of experience in the clinic. Results: Forensic psychiatric nurses exhibited more positive attitudes towards patients (p<.0001), showing lower tendency to be socially distant (p=.009), higher trust (p<.0001), higher willingness to treat (p<.0001), lower tendency to perceive patients as threatening (p=.004), and more general positive attitudes. Significant relationships were found between some of the stigma-related scales we used and certain factors. For forensic nurses, being male (p=0.043) and single (p=,025), working long hours (p=.047), and having fewer children (p=.005) were related to more negative perceptions about delinquents. Insufficient knowledge about forensic psychiatry was linked to negative beliefs about mental disorders (p=0.017) and specifically the curability of mental disorders (p=0.008). Having more siblings was related to higher embarrassment about mental disorders (p=.043). For general nurses, having first-degree relatives who receive psychiatric treatment was related to perceiving patients as threatening (p=.021)) and negative perceptions about delinquents (p=.007). Being older was related to more positive beliefs about mental patients' dangerousness (p=.026). Having more siblings was associated with higher trust toward patients (p=0.002). Conclusions: These findings emphasize the importance of addressing stigmatization among healthcare professionals, particularly forensic psychiatry nurses and general nurses. Providing comprehensive training about mental disorders and forensic psychiatry and promoting empathy and understanding can enhance the quality of care for patients with mental illnesses and contribute to better mental health outcomes for society. [ABSTRACT FROM AUTHOR]

Background: Forensic nursing, which merges healthcare and legal expertise to address trauma and violence, is vital yet often underrepresented in nursing education. Many nursing students lack knowledge in this field, underscoring the need for enhanced education to improve patient care and legal outcomes. This study aimed to assess university nursing students' knowledge and attitudes towards forensic nursing, as well as identify factors influencing their knowledge. A mixed-methods design was conducted at a Saudi nursing college with a convenience sample of 250 students. The data were collected using a structured questionnaire comprising two parts. The quantitative part included demographic and academic characteristics, knowledge and opinions on forensic nursing, knowledge of forensic evidence, and attitudes towards forensic nursing. The qualitative part consisted of four open-ended questions about factors affecting forensic knowledge. Data analysis involved inferential statistics and content analysis. Results: The study revealed that 80.4% of nursing students lacked prior knowledge of forensic nursing, and only 59.76% had some awareness of forensic evidence. A strong positive relationship was found between attitudes towards forensic nursing and knowledge of forensic evidence (r = 0.817, p < 0.001), indicating that positive attitudes could predict 66.8% of the variance in forensic evidence knowledge. Key barriers included lack of support from upper management, insufficient resources, and concerns about faculty qualifications. Students recommended integrating forensic nursing into the curriculum, offering specialized programs, and promoting research and social media awareness campaigns. Conclusions: These findings underscore significant gaps in knowledge and misconceptions about forensic nursing among participants, emphasizing the critical need for education and awareness in this field. The study highlights the potential implications for integrating forensic nursing concepts into undergraduate curricula, enhancing faculty training, and utilizing diverse teaching modalities. Addressing these gaps will not only improve future nurses' competency in forensic nursing, but also contribute to better patient care. [ABSTRACT FROM AUTHOR]

Abstract Background Forensic nursing, which merges healthcare and legal expertise to address trauma and violence, is vital yet often underrepresented in nursing education. Many nursing students lack knowledge in this field, underscoring the need for enhanced education to improve patient care and legal outcomes. This study aimed to assess university nursing students’ knowledge and attitudes towards forensic nursing, as well as identify factors influencing their knowledge. A mixed-methods design was conducted at a Saudi nursing college with a convenience sample of 250 students. The data were collected using a structured questionnaire comprising two parts. The quantitative part included demographic and academic characteristics, knowledge and opinions on forensic nursing, knowledge of forensic evidence, and attitudes towards forensic nursing. The qualitative part consisted of four open-ended questions about factors affecting forensic knowledge. Data analysis involved inferential statistics and content analysis. Results The study revealed that 80.4% of nursing students lacked prior knowledge of forensic nursing, and only 59.76% had some awareness of forensic evidence. A strong positive relationship was found between attitudes towards forensic nursing and knowledge of forensic evidence (r = 0.817, p

There is a growing body of international research investigating the impact of patient suicide on mental health professionals. The experience of losing a patient to suicide can have a significant and, in some cases, long-lasting (negative) impact on mental health professionals. However, the nature and extent of the impact on prison staff or forensic mental health professionals in particular is less clear. This narrative review summarises both quantitative and qualitative studies and key findings in this area, focusing on the above professions. A literature search was conducted using PsychInfo and Google Scholar, covering the period from 2000 onwards. The vast majority of findings relate to mental health professionals in general. We were unable to identify any published reports on the responses of forensic psychiatric staff. The majority of identified studies in the prison context are qualitative. Studies fromGerman-speaking countries are particularly scarce in both the prison and mental health contexts. We conclude that there is a profound lack of knowledge about the impact of client/patient suicide on the subgroups of (German) prison and forensic psychiatric staff. Clearly, more research is needed on both the nature and extent of the impact, as well as on the specific organisational and supportive factors that help to mitigate the negative effects of suicide. [ABSTRACT FROM AUTHOR]

The Croatian Academy of Sciences and Arts has developed an Applied Genomics Development Strategy to promote the use of genomics in Croatia. The strategy focuses on areas such as biomedicine, biosafety, and forensic genomics, and emphasizes the need for ethical guidelines and a legal framework. It also highlights the importance of interdisciplinary collaboration, education, and international cooperation. The document also includes a list of scientific articles covering various topics in genetics and genomics, providing valuable insights into the field and its applications in medicine and research. [Extracted from the article]

Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units. [ABSTRACT FROM AUTHOR]

This document is a corrigendum for an article titled "The totalising nature of secure and forensic mental health services in England and Wales." The corrigendum acknowledges errors in the original article and provides corrected sentences for those errors. The errors include instances of text overlap without appropriate acknowledgement of the original source. The corrigendum does not change the scientific conclusions of the article. [Extracted from the article]

Forensic nursing is a specialized area of nursing that combines nursing knowledge with legal and forensic aspects. Forensic nurses play a crucial role at the intersection of healthcare and the legal system. Discussing violence has become a major topic, especially in the health context, due to the global growth of violence, making it a priority for discussion in public health. Therefore, it is essential that the nursing professional is qualified to work in this area, offering their respective contributions to know how to intervene and recognize these situations, knowing which steps to follow and how to proceed in the most varied contexts presented, in addition to a thorough look and a rich in details paying attention to quality service, the environment, exposure, safety and reliability. The objective is to analyze the topic regarding forensic nursing with regard to violence against women, aiming at health promotion. This study highlighted opinions about forensic nursing, reflecting on thoughts and perspectives of the specialty, covering everything from the concepts that are pillars on the subject to other aspects. In this article, the authors had the opportunity to explore the topic a little more and bring knowledge to future readers, since one of the limitations of the study is the lack of knowledge of this specialty, and also of its professional performance. [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology: A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results: A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion: High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research. [ABSTRACT FROM AUTHOR]

Aim: To investigate the current status of experience and support of nurses as second victims and explore its related factors in nurses. Design: A sequential, explanatory, mixed-method study was applied. Methods: A total of 406 nurses from seven tertiary hospitals in China were chosen as participants between September to October 2023. The Chinese version of the Second Victim Experience and Support Questionnaire (SVEST), Somatic Complaints of Sub-health Status Questionnaire (SCSSQ) and Generalized Anxiety Disorder (GAD-7) were applied to collect quantitative data. Eight nurses were selected for a qualitative study through in-depth interviews. Through interpretive phenomenological analysis, the interview data were analysed to explore the experience and support of nurses as second victims. Results: Practice distress (15.74 ±  4.97) and psychological distress (15.48 ±  3.74) were the highest dimensions, indicating Chinese nurses experienced second victim-related practice and psychological distress. Nurses with different gender, age, education, marital status, income, working hours, professional titles, and unit types have different levels of second victim-related experience and support (p <  0.05). In addition, the score of SVEST was positively associated with SCSSQ (r =  0.444) and GAD-7 (r =  0.490) (p <  0.05). This qualitative study found that the experience and support of nurses as second victims included nurses' perceptions and needs for patient safety events; psychological, physical and practice distress of nurses; and nurses and hospitals coping style after patient safety events. Discussion: Our findings suggest that nurses who are second victims of patient safety events experience severe practice and psychological distress, indicating that nursing managers should pay attention to psychological and practice distress of nurses after patient safety events and provide effective preventive measures. [ABSTRACT FROM AUTHOR]

Abstract Background Emergency department nurses often deal with victims of violence and trauma. In the emergency department, the main focus is on saving lives and stabilizing patients' conditions. The next important task is to preserve any valuable evidence that could potentially help identify a crime. It is important to describe how nurses currently practice in the emergency department and perceive their role in caring for forensic patients. This study aimed to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among emergency department nurses as well as the correlation between mean scores of performance and perception. Methods This is a cross-sectional correlational descriptive study. This non-observational survey study used a questionnaire to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among 274 emergency department nurses. Results The total mean scores for frequency of performed behaviors and their perceived importance were 2.36±0.65 and 4.23±0.64 respectively. The overall mean scores of importance were significantly higher than frequency. There was a significant correlation between the frequency of performance and perception of the importance of twenty-eight items (twenty-four positive correlations and 4 negative correlations) (p

Background: Emergency department nurses often deal with victims of violence and trauma. In the emergency department, the main focus is on saving lives and stabilizing patients' conditions. The next important task is to preserve any valuable evidence that could potentially help identify a crime. It is important to describe how nurses currently practice in the emergency department and perceive their role in caring for forensic patients. This study aimed to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among emergency department nurses as well as the correlation between mean scores of performance and perception. Methods: This is a cross-sectional correlational descriptive study. This non-observational survey study used a questionnaire to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among 274 emergency department nurses. Results: The total mean scores for frequency of performed behaviors and their perceived importance were 2.36±0.65 and 4.23±0.64 respectively. The overall mean scores of importance were significantly higher than frequency. There was a significant correlation between the frequency of performance and perception of the importance of twenty-eight items (twenty-four positive correlations and 4 negative correlations) (p<0.05). The frequency of performed behaviors positively correlated with participants' type of shift worked and their personal experiences of legal and judicial claims. The female gender of respondents positively correlated with behaviors' perceived importance. Conclusion: The study revealed a significant discrepancy between the frequency of forensic nursing role behaviors performed and their perceived importance in the emergency department. This gap emphasizes the pressing requirement for forensic nursing subjects to be incorporated into graduate and undergraduate nursing curricula, as well as ongoing training programs and courses. It is crucial to establish and implement forensic nursing protocols for the care of trauma victims, and to foster collaboration between healthcare systems, law enforcement, and forensic investigators to streamline the process. [ABSTRACT FROM AUTHOR]

Background: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. Methods: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. Results: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. Conclusions: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives. Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care. Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants. Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis ('giving the voices something to feed on'). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future. Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235. Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), This study canvases the lived experiences of forensic patients receiving EMDR for PTSD – people whose views are seldom captured. They described being profoundly impacted by trauma, developing debilitating and enduring PTSD symptoms which variably contribute to offending and psychosis. Participants did not have favourable first impressions when they first heard about EMDR, thinking it 'quackery'. However, they were surprised and delighted by results, with the majority describing marked symptom reduction and personal transformation. Having targeted some of the underlying drivers of maladaptive behaviour, people reported hope for a better future. EMDR was well suited to a forensic setting and was seen as an empowering therapy. [ABSTRACT FROM AUTHOR]

Sexual assault (SA) can induce a negative impact on victims' mental health. Specialised SA services generally offer medical care and a forensic examination to SA victims. However, there is a large variation in how these services provide mental health support. This study aims to assess mental health problems of SA victims attending the Belgian Sexual Assault Care Centres (SACCs) and identify predictors for victims' use of support from in-house psychologists. Health records of victims ≥ 16 years who presented within one week post-SA to one of the three Belgian SACCs between 25 October 2017 and 31 October 2019 were reviewed. An AIC-based stepwise backward binary logistic regression was used to analyse the association between victim, assault, service use and mental health characteristics and follow-up by a SACC-psychologist. Of the 555 victims, more than half had a history of mental health problems. Of those assessed, over 70% showed symptoms of posttraumatic stress disorder (PTSD), depression and/or anxiety disorder. One in two victims consulted a SACC-psychologist. Victims with a mental health history (OR 1.46, p =.04), victims accompanied by a support person during acute care (OR 1.51, p =.04), and victims who were assaulted by an acquaintance in comparison to those assaulted by a stranger (OR 1.60, p =.039) were more likely to attend their appointment with the SACC-psychologist. The study reaffirms the high mental health burden among victims attending specialised SA services, stressing the need to provide effective mental health interventions at these services and improve their longer-term use by victims. Prescheduling of appointments with an in-house psychologist in combination with phone reminders may improve the uptake of such services. Health care providers must be vigilant about potential barriers faced by victims without a mental health history or social support in attending appointments with mental health professionals. The mental health burden is high among victims attending Belgian Sexual Assault Care Centres. Half of the victims use the support of an in-house psychologist. Victims with a history of mental health problems, those accompanied by a support person during acute care, and those assaulted by an acquaintance in comparison to those assaulted by a stranger, are more likely to use this support. Effective mental health support should be recognised as an integral and essential part of care for SA victims. Uptake and longer-term engagement with this mental health support should be improved for those victims diagnosed with PTSD. [ABSTRACT FROM AUTHOR]

Objective: to analyze nurses’ role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. Method: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. Results: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals’ perceptions; 4) The professionals’ actions; and 5) Team structure. Conclusion: Nursing professionals’ skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

AbstractForensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.

AbstractAlthough numerous training options exist for sexual assault nurse examiner certification, most focus on specific certification-related content rather than on creating a holistic preparation for sexual assault nurse examiner (SANE) practice. Holistic preparation may be preferable for SANE trainees who are early in their nursing careers or who have practiced in limited clinical environments. This article describes a holistic training approach implemented at a SANE training site funded by the Advanced Nursing Education initiative of the Health Resources and Services Administration. Training covers hands-on pelvic and anal examinations, community education, underserved communities, self-care, and other topics that support newly trained SANEs in establishing and maintaining practice. This content has prepared trainees for a wide variety of patient encounters as well as for engaging with the community. With this approach, our trainees have the opportunity to enhance their ability to provide SANE care and to provide additional resources within their primary practice environments.

The emergency room is the most likely location where victims of violent crime would be encountered by the healthcare system, as the emergency staff is the first to evaluate the victim or culprit, exposing them to a range of forensic evidence. Forensic evidence can help exclude, identify, and prosecute a suspect and is classified as informational or physical evidence. Emergency staff must be proficient and knowledgeable in gathering, preserving, and documenting forensic evidence in their practice. To our knowledge, this is the first study that assesses the emergency staff's level of practice in managing forensic evidence. The aims of this study are to assess the level of practice of emergency staff in managing forensic evidence and observe an association between emergency experience and the level of practice in managing forensic evidence, study a connection between forensic education/training and the level of practice in the management of forensic evidence. This observational cross-sectional analytical study in Saudi Arabia was conducted from January 2022 to December 2022. Participants completed a self-administered online survey. Measuring the level of practice was implemented through a researcher-designed questionnaire based on a paper that provided guidelines for forensic evidence collection in the emergency department. Most emergency healthcare workers had a good level of practice in managing forensic evidence (64.7%). Those with excellent practice scored the lowest in documentation, whereas participants in the poor practice category scored the lowest in the trace evidence and clothes domains. Emergency workers who encountered less number of forensic cases per month, i.e. less than two or three to five cases, were found to be more likely to have poor management of forensic evidence. Emergency personnel with no prior education or training are more likely to engage in poor practice in forensic evidence collection. Furthermore, those who had acquired forensic education/training had higher percentages of excellent forensic practice (56.52%) compared to poor practice (7.14%). Those who claimed that their institution had issued guidelines were more likely to have excellent practice (75.36%), whilst those who did not receive guidelines were more likely to have poor forensic evidence management (85.71%). More research is required involving local hospitals and utilizing consistently validated methods in evaluating forensic evidence collection. Key points A national assessment of emergency staff level of practice in the management of forensic evidence was performed. Most emergency staff had a good level of practice in the management of forensic evidence. More training and education are needed for emergency staff in the field of forensics. National evidence-based guidelines for managing forensic evidence in the emergency setting should be established. [ABSTRACT FROM AUTHOR]

In recent years, there has been a global advancement in the offering of canine-assisted interventions (CAI) in prisons. However, these programs have focused primarily on the benefits to the dogs involved and not on the impact on the participants. The authors of this perspective study have been running a CAI programwith therapy dogs, called PAWSitive Support, in a Canadian federal prison since 2016. Thoughts fromthe programfacilitators and interviews with prison staff indicate that the program, and specifically the therapy dogs, provides a unique and integrated source of comfort, support, and love for participants. These benefits are consistent with those seen in CAI programs outside of prisons. Unique to the prison setting appears to be an improvement in participant-staff relations. The therapy dogs have helped participants to experience comfort and consequently express their emotions. This seems to contribute to their recognition of support within the prison system and specifically developing trust with staff. Additionally, the dogs have helped to create an experience of the feeling of love within the prison, interpreted as the feeling of being cared for, which is rare for this population. The authors suggest that the integration of a therapy dog intervention in prison could be a novel harm reduction strategy to address issues related to prisonization and associated mental health concerns, including substance use. This consideration can offer unique insight into the field of forensic psychiatry about providing compassionate care to patients. [ABSTRACT FROM AUTHOR]

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.

Objective: to analyze the association between sociodemographic aspects and functional capacity and physical violence in hospitalized elderly people. Methods: this was a multi-center, cross-sectional study of 323 elderly people treated at two university hospitals. The Conflict Tactics Scales, the scales for assessing basic and instrumental activities of daily living and a questionnaire adapted for assessing advanced activities of daily living were used. The data was analyzed using descriptive and inferential statistics. Results: individual activities of daily living were associated with major physical violence through the regression model, indicating an inversely proportional relationship between the variables, and independent elderly people for these activities are those who do not experience major physical violence (p=0.037). Conclusion: the functional independence for instrumental activities of elderly inpatients is related to a lower probability of being a victim of physical violence. Contributions to practice: the study points to unique findings in the relationship between physical violence and functional capacity, so that each type of activity of daily living can result in a different outcome for physical violence. It also confirms the importance of individual and contextualized assessments in the hospital environment, which can influence the conditioning factors for this condition.

Introduction: Mental health care provided to offenders with psychiatric problems in forensic settings mainly consists of verbal oriented treatments. In addition, experience-based therapies are used such as (creative) arts therapies: (visual) art therapy, music therapy, drama therapy and dance (movement) therapy. There are indications for effectiveness of arts therapies, but a systematic overview of effect studies of all arts therapies in forensic care is lacking. Methods: First, we performed a systematic review. Second, Thematic Analysis was used to synthesize the qualitative narrative results and define the hypothesized mechanisms of change. Third, we performed a meta-analysis to investigate the effects of arts therapies in reducing psychosocial problems of offenders. Twenty-three studies were included in the review. Quality and risk of bias was assessed using EPHPP (Effective Public Health Practice Project). Results: The included studies were heterogeneous in type of outcome measures and intervention characteristics. Synthesis of mechanisms of change involved in the methodical use of the arts in arts therapies resulted in a description of regulatory processes which are stimulated in arts therapies: perceptive awareness (interoceptive and exteroceptive), the regulation of emotions, stress, impulses, cognitions, social regulation, and self-expression. These processes play a role in developing prevention, coping and self-management skills. Eighteen studies were included in the meta-analyses (11 RCTs/CCTs; 7 pre-post studies). The meta-analyses indicated significant effects on both risk factors (psychiatric symptoms and addiction) and protective factors for criminal behavior (social functioning and psychological functioning). Effects on criminal and/or antisocial behavior were not significant, but this outcome measure was scarcely used among the studies. Discussion: The analyses in this study should be considered explorative. More research is needed to gain more solid conclusions about effectiveness and mechanisms of change of arts therapies in forensic institutions. However, the results of this first systematic review, synthesis of mechanisms and meta-analysis in this field are promising and show effects of arts therapies on risk and protective factors in individuals in forensic institutions. [ABSTRACT FROM AUTHOR]

Workplace violence on health workers in the workplace causes physical and psychological problems. Negative impacts on victims of workplace violence such as physical problems, anxiety, depression, stress, and risk of death or risk of suicide. This problem needs to be addressed immediately so as not to impact post-traumatic stress disorder and reduce the work performance of health workers. The purpose of this study is to explore interventions to reduce the negative impact of workplace violence on health workers. This study used scoping review design with a descriptive approach to data analysis. The CINAHL, PubMed, and Scopus databases were used in this investigation. This study used PCC's framework (Population, Content, Context). The keywords are workplace violence, healthcare personnel, interventions, and programs were used by the authors. Search strategy used PRISMA Extension for Scoping Reviews. The sample are health workers, original research used a randomized control trial or quasi-experiment design, and the publication time had to be within the previous ten years (2014– 2023). The JBI assessment was used to assess the quality of the article. We found 11 articles who discuss about interventions to reduce negative effects of workplace violence among health workers. This study shows that there is a decrease in psychological problems in victims of workplace violence such as anxiety, depression, and incidents of workplace violence. The range of sample in this study are 30– 440 respondents. The authors discovered three different types of interventions: training programs, cognitive behavior therapy, and workplace violence programs. Interventions must focus on both the physical and psychological needs of the victims of workplace violence, psychiatric nurses and psychologists carried out interventions in a thorough manner. Interventions carried out by psychiatric nurses and psychologists can reduce the negative impact of workplace violence on health workers such as anxiety, depression and other psychological problems. [ABSTRACT FROM AUTHOR]

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies show that both staff and patients describe patient participation as a challenge in forensic psychiatry. One reason may be that the forensic psychiatric process is difficult to understand and is experienced as being slow and complex. The proceedings in an administrative court are a core element in forensic psychiatric care as it constitutes the legal authority that legitimizes the deprivation of liberty. A better understanding about how patients experience these proceedings can contribute with important knowledge about how forensic psychiatric care can be understood from a patient perspective. The aim of the study was to describe patients' lived experiences of participating in oral hearings in an administrative court concerning the continuation of their forensic psychiatric care. Materials and methods: This is a phenomenological study performed in a Swedish context with a total of 20 interviews conducted with a Reflective Lifeworld Research (RLR) approach. Results: The results reveal three themes; A significant, correct but meaningless formality; An imbalance of power within the hearings; and Existential and practical disorientation. Conclusion: The findings show how these court proceedings concerning the continuation of forensic psychiatric care are often experienced as challenging. This is partly due to the care structure in forensic psychiatry and that the purpose of the hearings is difficult to comprehend and is perceived as unjust by patients. Another challenge is of a more existential dimension, where the main character in a hearing is most likely in a situation that would be stressful for anyone. However, the focus on danger can make this experience even more intense. An increased transparency on this legal process along with more discussion and education for both patients and staff is called for based on the results. [ABSTRACT FROM AUTHOR]

The practice of trauma-informed care (TIC) allows nurses in any setting to identify and intervene with traumatized individuals and to create a continuum of care when forensic nursing services are needed. The purpose of this article is to suggest ways to incorporate TIC content into baccalaureate nursing programs. We begin with an overview of baccalaureate nursing curricula and common types of traumatic experience important for students to understand. We then propose specific strategies for inclusion of TIC content in baccalaureate nursing education, using the American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice. With a solid foundation in TIC, baccalaureate-prepared nursing students can provide effective patient care and better support forensic nursing practice. This will increase the capacity of the nursing profession in general to meet the needs of those affected by trauma, violence, and abuse.

Abstract Background Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection. Main text This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection. Conclusions Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.

The document provides a list of upcoming events related to forensic science and related fields. The events include conferences, meetings, and symposiums taking place in various locations around the world. Some of the topics covered include diagnostics and laboratory medicine, forensic nursing science, toxicology, addiction medicine, and human identification. The events are organized by different associations and organizations, providing opportunities for professionals in the field to network and exchange knowledge. [Extracted from the article]

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to evaluate the internal consistency of instruments used in Brazil to measure situations of violence against the elderly in two states. Method: a cross-sectional study with 481 elderly people in two different samples, states, and time periods. Two instruments were used to measure violence against the elderly person. The data was analyzed and the internal consistency between the items was measured by the Cronbach's alpha coefficient. Results: the Hwalek-Sengstock Elder Abuse Screening Test showed a coefficient of α = 0.08 for the sample collected in Paraíba, while in Pernambuco it was α = 0.57. The Conflict Tactics Scale was highly accurate in defining violence, with a coefficient of α = 0.81 and α = 0.80 for the two samples. Conclusions: only the Conflict Tactics Scale turned out to be reliable and stable for determining physical and psychological violence among the elderly, thus contributing as a way of uncovering the phenomenon. [ABSTRACT FROM AUTHOR]

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rev Rene is the property of Rev Rene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD). Methods: Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis. Results: Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services. Conclusions: Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the "forensic" label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed. [ABSTRACT FROM AUTHOR]

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault. The Dutch Sexual Assault Centres established a national network that provides medical, forensic, and psychological services for victims, and despite of its strengths and opportunities, faces threats and weaknesses that underline the importance of further development. [ABSTRACT FROM AUTHOR]

The medico-legal care of victims of sexual assault is very challenging, and requires specific knowledge and skills. Professionals in the emergency departments of hospitals might not have specialised training in forensic science. Nurses have a very significant role in these settings, but they lack any formal forensic training. This study aims to develop a sexual assault nurse examiner-grounding program (SANE-GP) for Indian nurses to inculcate knowledge and skill regarding sexual assault examination. The study adopts a three-stage Delphi technique to develop the training module and uses a time-series design to evaluate the effectiveness of the program. A questionnaire on nurses’ knowledge on sexual assault examination (KQSANE-I) will be developed in phase-I and subsequently used in phase-II. The protocol of SANE-GP will help the medical community to implement the program across India. The implementation of SANE-GP can also help to start a sexual assault nurse examiner network.

The medico-legal care of victims of sexual assault is very challenging, and requires specific knowledge and skills. Professionals in the emergency departments of hospitals might not have specialised training in forensic science. Nurses have a very significant role in these settings, but they lack any formal forensic training. This study aims to develop a sexual assault nurse examiner-grounding program (SANE-GP) for Indian nurses to inculcate knowledge and skill regarding sexual assault examination. The study adopts a three-stage Delphi technique to develop the training module and uses a time-series design to evaluate the effectiveness of the program. A questionnaire on nurses’ knowledge on sexual assault examination (KQSANE-I) will be developed in phase-I and subsequently used in phase-II. The protocol of SANE-GP will help the medical community to implement the program across India. The implementation of SANE-GP can also help to start a sexual assault nurse examiner network.

Introduction: Sexuality is an integral aspect of the human experience that defines an individual. Robust research, substantiated by the World Health Organization, demonstrates that healthy sexuality improves mental health and quality of life. Despite this level of global advocacy and clinical evidence, sexuality and sexual health as determinants of health have been largely overlooked in the mental healthcare of patients being treated under the requirements of a forensic order (forensic patients). In this review, the authors have evaluated the literature related to the sexual development, sexual health, sexual knowledge and risks, sexual experiences, sexual behavior and sexual desires of forensic patients to inform policy and clinical practice. Furthermore, the review explored how forensic patients' sexual healthcare needs are managed within a forensicmental healthcare framework. The paper concludes with recommendations for service providers to ensure that sexual health and sexuality are components of mental health policy frameworks and clinical care. Methods: An integrative review was utilized to summarize empirical and theoretical literature to provide a greater comprehensive understanding of the sexuality and sexual experiences of forensic patients. This included identifying original qualitative, quantitative, ormixed-method research, case reports, case series and published doctoral thesis pertaining to the research topic. Results: Twenty-one articles were selected for review. We grouped the review findings into threemain themes: 1) Forensic patient themes, 2) Forensicmental health staff themes and 3) Forensic mental health organization themes. The review demonstrated scant information on the sexual healthcare needs of forensic patients or how health services manage these needs while the patient is in a hospital or reintegrating into the community. Conclusion: There is a dearth of evidence-based, individualized or group approaches which clinicians can utilize to assist forensic patients to achieve a healthy sexual life and it is recommended that such services be developed. Before that however, it is essential to have a clear understanding of the sexual healthcare needs of forensic patients to identify areas where this vulnerable population can be supported in achieving optimal sexual health. Urgent changes to clinical assessment are required to incorporate sexual healthcare as a component of routine mental healthcare. [ABSTRACT FROM AUTHOR]

Purpose Forensic nursing is a specialty in the nursing profession based on legal procedures. This study aimed to assess the effect of a forensic nursing virtual education course on knowledge and clinical decision-making among master’s nursing students. Methods In a quasi-experimental study with a pre- and post-test, 106 master’s nursing students at Guilan (n=65) and Mazandaran (n=41) Universities of Medical Sciences, Iran were enrolled. Data were collected using census sampling from March to April 2021. Participants in the intervention group received a forensic nursing virtual education course in three 90-minute sessions for 2 days. Results A total of 88 out of 106 master’s nursing students were enrolled in this study. The mean post-education score for knowledge in the intervention group was significantly higher than in the control group (12.52 vs. 7.67, P

Introduction: The Finnish forensic psychiatric service system lacks the standards and criteria guiding the quality and contents of patient care. Ensuring best recovery-oriented practices in forensic psychiatric services need to be developed at several levels. Objectives: The purpose of this research project is to develop safe, high-quality psychiatric care. The outcome of this project is the production of quality criteria for the forensic psychiatric care and service system. Methods: The study will be executed at the Department of Nursing Science of the University of Turku during 2023-2026. The research methods include a literature review, a survey based on validated measurement questionnaires (Downes Survey, QPC-FIP, QPC-FIPS), individual and group interviews as well as the Delphi method. The research will cover the multidisciplinary employees at adult psychiatric wards in Finland's larger hospital districts, employees of forensic psychiatric hospitals, and patients of forensic psychiatric hospitals. International specialists and specialists within Finland from various fields (nursing, medicine, psychology) will be invited to partake in the expert panel. Results: The research results will allow the development of the service system for forensic psychiatric patients in such a way that the identification of so-called risk patients can be improved already at the early stages of treatment, at the general psychiatric level. Moreover, the substance of care and participation during care can be created and the care following inpatient care and the patient's transfer out of forensic psychiatric care can be developed. The research may promote the effectiveness of treatment by highlighting areas in the care chains that, when reinforced, will allow patients to receive the right kind of treatment at the right time. A proposal of standardized operating methods and quality criteria will be created for the Finnish forensic psychiatric treatment system. The research project will also reveal previously unresearched information that can be utilized in national health policy. Conclusions: The project will promote equal prospects for wellbeing and a participatory society for citizens by exploring the views of forensic psychiatric patients and thus developing forensic psychiatric services. The project will promote sustainable employment by exploring the views of psychiatric personnel and increasing the quality and safety of psychiatric services. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

International variability and shifting trends in forensic psychiatry lead to gaps in national service provision and needs for service development. This study explores these needs through the subjective narratives of those involved in Finnish forensic services, either as forensic psychiatric patients, their parents, or service providers. Data was gathered by means of thematic interview and subjected to thematic analysis. Three main themes emerged: (1) pre-treatment challenges, (2) institutional/treatment-related concerns about therapeutic security and (3) adapting and recovery. The research highlights the need to develop forensic psychiatric services at three levels. First, it calls for increased risk awareness and risk assessment skills at the general psychiatric level. Second, it emphasizes the need for increased therapeutic engagement throughout the rehabilitative process. Third, it calls for structured and meaningful post-discharge aftercare. At all three levels, gradated security-aware standardization and patient triage in forensic services would help to develop and maintain an intact care pathway. This would decrease offending, marginalization, and suffering. Only then can we begin to meet the requirements of the WHO European Mental Health Action Plan. These findings can contribute to the development of international, standardized treatment models for clinical forensic psychiatric practices. [ABSTRACT FROM AUTHOR]

Background: Little is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS "prison-transfer" patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too "high risk" to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community. Aim: (a) To describe the characteristics of prison-transfers who receive an RMO directed discharge fromMSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge. Methods: Prospective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk--20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community. Results: Persons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending. Discussion: MSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered. [ABSTRACT FROM AUTHOR]

This systematic review was conducted to develop a broader understanding of the characteristics of older people who commit homicide. PubMed, Embase and PsycINFO were searched on 28 November 2018 for studies on homicides committed by people aged 55 years and over. Only articles published in English were included. Studies focusing on euthanasia and palliation were excluded. Fifteen articles met the inclusion criteria, with studies from the United States (n = 6), United Kingdom (n = 2), Australia, Canada, Finland, Italy, New Zealand, Switzerland and Turkey. The age range for 'older offenders' varied across the studies. Some studies examined the phenomena of sexual homicide and homicide-suicide. Offenders were more likely to be male, and the domestic setting for the offence was common. Social maladjustment, a care-giver role, personal physical and mental health problems and/or substance misuse issues were relevant to the offenders. Firearms-related homicides were common. Homicide committed by older people is rare but there may be a constellation of risk factors specific to this age group that needs further understanding. Our findings suggest that there is an increasing need for care of older offenders and a need for specialist forensic services for elderly offenders. [ABSTRACT FROM AUTHOR]