'A ward full of emotional, aggressive people': Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder.

Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing.

Using a trauma-informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings.

Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma-informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.

The Use of Pupillometry in Autobiographical Implicit Association Test.

The Autobiographical Implicit Association Test (aIAT) is a reaction time-based methodology to assess one's recognition of the truth value of propositions about an autobiographical episode. This study introduced pupillometry to examine its utility as an additional measure of aIAT. Participants blindly chose one of two cards and memorized it. They then underwent the aIAT to assess the cards they chose. The pupil diameter was larger in the block in which sentences related to the chosen card shared the same response key with sentences describing false events than the block in which sentences related to the chosen card shared the same response key with true-event sentences. Although preliminary, pupil measurement also yielded high efficiency in discriminating the chosen card. These results indicate that pupillometry can be used as a measure of aIAT.

A Systematic Review of Non-pharmacological Strategies to Reduce the Risk of Violence in Patients With Schizophrenia Spectrum Disorders in Forensic Settings.

Background: The purpose of this systematic review is to systematically investigate which non-pharmacological interventions are effective in reducing violence risk among patients with schizophrenia spectrum disorders (SSD) in forensic settings. Methods: Six electronic data bases were searched. Two researchers independently screened 6,003 abstracts resulting in 143 potential papers. These were analyzed in detail by two independent researchers yielding 10 articles that could be used. Results: Of the 10 articles, four were non-randomized controlled trials, three were pre-post studies without controls, and one was observational. Only two studies applied a randomized controlled trial design. Cognitive behavioral treatment programs were investigated in three studies. A broad range of other interventions were studied. Often outcome measures were specific to each study and sample sizes were small. Frequently, important methodological information was missing from the papers. It was not possible to carry out a meta-analysis due to the heterogeneity of the study designs and outcome measures. Conclusion: Because of methodological limitations it is difficult to draw firm conclusions about the effectiveness of non-pharmacological interventions to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying better methods in terms of study design, sample sizes and outcome measures are urgently needed.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards / Ser e fazer centrado na ocupação em ambientes desafiadores: reflexões sobre estratégias de implementação e recompensas profissionais

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards / Ser e fazer centrado na ocupação em ambientes desafiadores: reflexões sobre estratégias de implementação e recompensas profissionais

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.

Preventing Suicide in Forensic Settings: Assessment and Intervention for Inmates With Serious Mental Illness.

Suicide is one of the leading causes of inmate deaths in correctional settings. Furthermore, there is heightened risk for suicide among individuals diagnosed with serious mental illness (SMI) who present in jails and prisons. In the present article, the authors review suicide risk factors associated with SMI, with emphasis on incarcerated individuals, and discuss the best practices in assessing risk for suicide. The authors review interventions designed to prevent suicide among individuals with SMI in forensic settings. The article also points to the need for continued research to inform the development of assessment tools and intervention strategies for this population.