Prisoners constitute a high-risk group for suicide. As an early stage in the pathway leading to suicide, suicidal ideation represents an important target for prevention, yet research on this topic is scarce in general prison populations. Using a cross-sectional survey design, correlates of suicidal ideation while incarcerated were examined in a sample of 1203 male prisoners, randomly selected from 15 Flemish prisons. Overall, a lifetime history of suicidal ideation and attempts was endorsed by 43.1% and 20.3% of respondents, respectively. Approximately a quarter of all prisoners (23.7%) reported past-year suicidal ideation during their current incarceration, which was significantly associated with both imported vulnerabilities (psychiatric diagnoses and a history of attempted suicide) and variables unique to the prison experience (lack of working activity, exposure to suicidal behaviour by peers, and low levels of perceived autonomy, safety and social support) in the multivariate regression analysis. A first-ever period of imprisonment and a shorter length of incarceration (≤12months) were also associated with increased odds of recent suicidal ideation. Collectively, the current findings underscore the importance of both vulnerability factors and prison-specific stressors for suicidal ideation in prisoners, and hence the need for a multi-faceted approach to suicide prevention in custodial settings. In addition to the provision of appropriate mental health care, environmental interventions that target modifiable aspects of the prison regime could provide a substantial buffer for the onset and persistence of suicidal ideation in this at-risk population.

While there has been a growth in recent years in recovery research, much of this has been from the US and there is very little comparative research in this area. This paper describes the rationale, conceptual foundations and methods for a prospective, multi-country, cohort study aimed to map pathways to recovery from problematic illicit drug use, with a specific focus on gender differences in recovery pathways. Our study combines qualitative and quantitative components and examines the impact of recovery policy on the accessibility and viability of recovery pathways in England, Scotland, Belgium, and the Netherlands. Additionally, the paper describes five processes through which mechanisms for behaviour change for recovery may be triggered. This study will provide opportunities for linking recovery outcome research with analyses of national recovery policies, while also addressing the gap in literature around female pathways to recovery.

Aims: Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients' perspectives and personal experiences. This study aims to assess opiate users' satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods: The study sample consisted of 77 opiatedependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients' subjective experiences, in addition to some quantitative measures. Findings: About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions: Compared with other stakeholders' perspectives or traditional outcome indicators, service users' subjective experiences shed an alternative light on the impact of opiate dependence and OST on individuals' daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services.

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.

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