Identified risk factors and clinical experience suggest that self‐harm is a common and very significant problem in forensic psychiatric settings. Sparse training on self‐harm given to staff throughout professional development is a concern for staff who can be left feeling dissatisfied and powerless as how to manage the patient who self‐harms. Consequently, staff often have to rely on idiosyncratic beliefs about self‐harm and its management to guide their practice. This survey investigated staff attitudes towards self‐harm in a forensic psychiatric service. The results highlight much variation in attitudes and a sub‐population of staff holding relatively more punitive/negative beliefs. In addition, the survey drew attention to the difficulty of managing self‐harm in forensic settings‐especially in relation to issues around facilitating safe self‐harm.

Purpose – At present, there are significant limitations to the criminal justice system’s (CJS) ability to respond appropriately to detainees or defendant with learning disabilities (LD). The development of Liaison and Diversion Services has provided the opportunity to more easily identify people with LD in the CJS through the use of screening assessments. Therefore, the purpose of this paper is to consider why there is a need for screening assessments and review the literature on existing measures, in order to consider the next steps to develop a more effective pathway from the CJS to LD services. Design/methodology/approach – This paper takes the form of a literature review. Findings – The review found that there is a significant body of research defending the need for LD screening in the CJS across the UK. The aim of a screening process would be to identify individuals who possibly have LD and ensure that the correct measures are in place to assess and manage these individuals, including appropriate diversion to specialist LD services. The learning disability screening questionnaire (LDSQ) is an instrument that could be utilised in these instances and could be carried out by Liaison and Diversion Services. Research limitations/implications – Neither of the tools reviewed in this paper have been vigorously field tested within forensic settings in the UK. It is recommended that there should be trials of the LDSQ as a screening tool within Liaison and Diversion Services with comparison against outcomes of full diagnostic assessments for LD. Originality/value – Screening for LD is being discussed across the UK as part of Liaison and Diversion Services. This paper highlights the need for a reliable and valid screening tool and provides support for the use of the LDSQ.

The HCR-20 is the most widely used structured professional judgement instrument for assessing risk of violence. Recent developments in secure settings have addressed service user involvement in risk assessment to empower service users, and encourage them to take responsibility for their pathway through hospital. This audit aimed to examine the quality of, and service-user involvement in, the HCR-20 assessments completed on two wards (a low secure and a psychiatric rehabilitation ward) within Somerset Partnership NHS Foundation Trust. Data from the current RiO (electronic patient record system) Risk Screen and Risk Information sections and the most up-to date HCR-20 report (if there was one) was reviewed across a number of domains. The in-house HCR-20 training programme appeared to be effective, with most assessors following the appropriate data collection process. The quality of the risk assessments was mixed with the historical section being more consistently completed than the clinical and risk sections. The results of the audit facilitated the development of standards for the completion of HCR-20 risk assessments on the two wards reviewed. Limitations of the audit in terms of generalisation are noted. Nonetheless, this audit serves to give an early impression on the extent of collaboration with service users on risk assessments.

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a forensic psychiatric setting. In the preparation of these guidelines, a literature search was conducted to examine the evidence on clinical effectiveness for managing self‐harm. Overall, the evidence for defining a definitive treatment approach to self‐harm is extremely limited. However, a number of studies/reviews have identified aspects of treatment and care that are considered to be effective. Guidelines have been produced that capitalise on this information and provide front‐line staff (such as nurses) with advice that can be used on a daily basis when working with a service user who self‐harms.

Disordered gambling is characterized by persistent and problematic gambling, leading to impairment or distress, which may be exacerbated by vigilance to gambling cues in the environment. Yet, questions regarding the specific attentional biases present in gamblers remain unresolved. In the current study, we used a rapid serial visual presentation paradigm to examine attentional orienting and maintenance/ disengagement for gambling stimuli, relative to emotional and neutral stimuli, in high-and low-risk gamblers (N = 57). High-risk gamblers showed attentional biases for gambling stimuli, relative to other distractors, and these biases were observed at the level of attentional maintenance/disengagement. Low-risk gamblers showed some evidence of non-specific attentional biases (to negative and gambling pictures). Low-risk, but not high-risk, gamblers demonstrated sustained biases for negative items and facilitated disengagement from positive items. Findings highlight differences in attentional processes between high-and low-risk gamblers and point to sustained biases as worthy targets for clinical interventions. Future work should assess the malleability of gambling biases in high-risk gamblers and determine whether altering attention to gambling items influences gambling behaviour. Résumé Le jeu compulsif est caractérisé par des comportements liés au jeu qui sont problé-matiques et persistants, et qui entraînent une détresse ou une incapacité à fonctionner pouvant être exacerbées par l'attention accordée aux signaux associés au jeu dans

Outcome expectancies (OEs), or beliefs about the consequences of engaging in a particular behaviour, are important predictors of addictive behaviours. In Study 1 of the present work, we assessed whether memory associations between gambling and positive outcomes are related to excessive and problem gambling. The Gambling Behaviour Outcome Association Task (G-BOAT) was administered to a sample of 96 community-recruited gamblers. On the G-BOAT, participants responded to a list of positive outcome phrases with the first two behaviours that came to mind. Those with more problematic gambling (as measured on the Problem Gambling Severity Index) and greater gambling involvement (as measured by time and money spent gambling on the Gambling Timeline Followback) responded to positive outcome phrases on the G-BOAT with more gambling-related responses. In Study 2, we administered G-BOAT to a community-recruited sample of 61 gamblers, who also completed a computerized reaction time measure of implicit gambling OEs, an explicit self-report measure of gambling OEs, and a measure of gambling frequency. Consistent with Strack and Deutch’s (2004) reflective-impulsive model, memory associations on the G-BOAT and positive OE scores on the explicit Gambling Expectancy Questionnaire each predicted unique variance in frequency of gambling behaviour. These studies are among the first to demonstrate the important role of memory associations in excessive and problem gambling.Les résultats escomptés (RE), c’est-à-dire la croyance dans les conséquences d’un comportement donné, constituent une importante variable explicative des comportements liés à la dépendance. L’étude 1 a évalué si des associations mémorielles entre le jeu et des résultats positifs sont reliées aux problèmes de jeu compulsif. La tâche d’association de résultats découlant de comportements liés au jeu (Gambling Behaviour Outcome Association Task [G-BOAT]) a été administrée à un échantillon de 96 joueurs recrutés au sein de la collectivité. Dans le cadre de la G-BOAT, une liste de locutions exprimant un résultat positif était présentée aux participants et ceux-ci devaient répondre en indiquant pour chacune des locutions les deux premiers comportements qui leur venaient à l’esprit. Ceux qui présentaient un problème de jeu plus grave (selon l’indice de jeu problématique) et qui s’adonnaient davantage au jeu (selon le suivi du temps passé à jouer et de l’argent dépensé effectué à l’aide de l’outil Gambling Timeline Followback) ont donné des réponses liées au jeu plus fréquemment que les autres. Dans le cadre de l’étude 2, la G-BOAT a été administrée à un échantillon de 61 joueurs recrutés au sein de la collectivité. Ceux-ci ont en outre fait l’objet d’une mesure informatisée du temps de réponse (TR) pour les RE liés au jeu implicites, d’une autoévaluation des RE liés au jeu explicites et d’une mesure de la fréquence des comportements liés au jeu. Conformément au modèle de réflexion et impulsion de Strack et Deutch (2004), les associations mémorielles obtenues dans le cadre de la G-BOAT et les résultats relatifs aux RE positifs obtenus dans le cadre du questionnaire sur les attentes quant au jeu ont dans les deux cas permis de prévoir une variance unique concernant la fréquence des comportements liés au jeu. Ces études fournissent ainsi un premier ensemble de données probantes relativement à l’importance des associations mémorielles dans l’apparition des problèmes de jeu compulsif.

The purpose of the study discussed here was to review the experience and management of bullying on an open forensic borderline learning disability unit. Semi‐structured interviews were used to gather the perceptions, experiences and recommendations of service users about current and future management of bullying. Staff completed a questionnaire seeking information on the incidence and characteristics of bullying, management techniques and training requirements. Service users' results highlighted the importance of the level and predictability of staff presence on the ward, difficulties in reporting episodes for fear of retribution, and improving availability of information about bullying. Staff results highlighted a consistent response to bullying but reluctance to rate highly the strategies used or their confidence in assessing bullying, and a desire for bullying‐specific training. Both groups were interested in unitwide interventions to promote greater openness and wider involvement in dealing with bullying and to reduce the impact of negative factors such as fear and secrecy.

The NICE Guidelines for Schizophrenia are designed to give guidance on the best practice in treatment and management of schizophrenia. These guidelines have 13 standards which services can use for the purpose of audit. As schizophrenia is our service's most common diagnosis, an audit against the guidelines was undertaken. The results indicated that we met three of the standards. Recommendations have been implemented to improve practice on standards that were not met, and this has led to some creative practice development. Despite the labour‐intensive nature of the audit, the results gave a clear indication of areas where there was a need for improvement and will act as a good baseline for re‐audit.