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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]

There is a relative lack of research focused on people with intellectual disabilities within forensic settings and limited information describing models of care. This article describes the process of enquiry and information gathering that was synthesized to develop a specific model of care for a specialist forensic intellectual disability secure care unit within a forensic mental health service in Aotearoa (New Zealand). The obligations to address the over representation of tāngata whenua (Māori; Indigenous people of Aotearoa) and to resist the dominant Western and mental health paradigms being ineffectively imposed within this specialist service, were acknowledged as central challenges. A literature review, consultation with tāngata whaikaha hinengaro (service users) and Māori cultural input provided a platform to synthesize diverse perspectives. This resulted in the weaving together of the important elements necessary in a model of care, to optimize specialist forensic intellectual disability care and rehabilitation in Aotearoa. This article has an emphasis on the research literature, but is not a research project, rather it is a description of the process leading to a negotiated model of care to achieve equity. [ABSTRACT FROM AUTHOR]

There is growing evidence that culturally adapted, evidence-based, violence prevention programmes can have benefits for people in correctional and forensic mental health services. Adding to this evidence is crucial, given the over-representation of Indigenous people and ethnic minorities in such services. This qualitative descriptive study describes Tū Tahanga, which combines the ManAlive violence prevention programme, with Māori (Indigenous people of Aotearoa/New Zealand) cultural concepts. This was developed for Māori service users in a forensic mental health service. Content analysis was undertaken through interviews with participants in the group (N = 11). Core aspects of ManAlive were maintained. These aspects coexist with cultural concepts of a specific healing space, a holistic Māori model of health, and the creation of family like supportive relationships reinforced by living in the same facility. This description lays a platform for future evaluative research to determine the impact of the programme on reducing violent offending. [ABSTRACT FROM AUTHOR]

Objectives: Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS. Method: A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks. Results: Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service. Conclusions: Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks. [ABSTRACT FROM AUTHOR]

Introduction: Violence is a major public health problem worldwide. Emergency nurses are often in a unique position to identify, assess, evaluate, and treat these patients, but there is limited forensic knowledge and skills to enable emergency nurses to feel confident to guide their practice in New Zealand. The purpose of this study was to establish the level of forensic knowledge and skills currently known and used by nurses in clinical practice working in New Zealand District Health Boards (DHB)'s emergency departments. The study aimed to develop a tertiary education course based on the needs and the knowledge required, to enable nurses to practice confidently and safely with Forensic patients in the emergency department setting., Methods: A descriptive approach using online questionnaires including both quantitative and qualitative components was sent to all emergency departments in New Zealand DHB's as well as the New Zealand Nurses Organisation (NZNO) emergency nurses' section. Open-ended questions were analysed by thematic analysis. Closed questions were analysed by SPSS version 15 data analysis software (SPSS Inc, Chicago, IL). Themes identified focused on the knowledge and skills emergency nurses currently possess and the level of specialist education required to ensure patients receive the best medicolegal care., Results: Results of the questionnaire revealed limited knowledge in being able to correctly identify all forensic patients, insufficient knowledge around evidence preservation and collection and limited knowledge around legislation or legal processes governing clinical care were discovered. However, 84% of all participants felt that having forensic knowledge was important for their practice, indicating a need for increased forensic education. Practice implications indicate that forensic education is warranted, needed and desired among ED nurses within the clinical setting., Discussion: As forensic patients generally require emergency medical attention, it is important that nurses as part of the front-line first responders have forensic knowledge around preservation and collection of evidence during the provision of medical care. It was found that, emergency nurses do not have enough knowledge around forensic issues indicating that forensic education is warranted, needed and desired among ED nurses within the clinical setting. The study also provides support for the implementation of tertiary forensic science nursing postgraduate study in New Zealand., (Copyright © 2020 Elsevier Ltd. All rights reserved.)