The HCR-20 and the VRAG have excellent predictive efficacy in offenders with an ID. A structured clinical judgement based on the HCR-20 was especially predictive.

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PurposeThe aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.Design/methodology/approachRetrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.FindingsAttachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.Research limitations/implicationsThe sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.Practical implicationsAttachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.Social implicationsMental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.Originality/valueThis study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.

Aims and methodStructured clinical judgement tools provide scope for the standardisation of forensic service gatekeeping and also allow identification of heuristics in this decision process. The DUNDRUM-1 triage tool was completed retrospectively for 121 first-time referrals to forensic services in South Wales. Fifty were admitted to medium security, 49 to low security and 22 remained in open conditions.ResultsDUNDRUM-1 total scores differed appropriately between different levels of security. However, regression revealed heuristic anchoring on the ‘legal process’ and ‘immediacy of risk due to mental disorder’ items.Clinical implicationsPatient placement was broadly aligned with DUNDRUM-1 recommendations. However, not all triage items informed gatekeeping decisions. It remains to be seen whether decisions anchored in this way are effective.Declaration of interestDr Mark Freestone gave permission for AUC values from Freestone et al. (2015) to be presented here for comparison.

Background and aim Reducing alcohol misuse by male prisoners is an important global issue. Control of drinking behaviour could be a useful target for intervention in this population, and locus of control could be a causal factor in this. We aimed to assess the effect of a clinical psychologist‐facilitated group intervention on male prisoners’ locus of control of drinking behaviour. Design A two‐arm, single‐site, open, randomized controlled trial. Setting A category B local training prison in South Wales, housing about 770 mainly sentenced men. Participants Prisoners serving less than 2 years who met inclusion criteria for pre‐imprisonment alcohol misuse, alone or with drug misuse. A total of 119 were allocated to the intervention arm and 119 to the control arm; 104 and 87, respectively, completed the post‐randomization baseline interview and 68 and 60 completed a second interview approximately 4 weeks later, respectively, after intervention or treatment as usual (TAU) alone. Intervention Nine clinical psychologist‐facilitated groups in the prison over 3 weeks. Range of participants per session was one to seven, with three to five most usual. Measures The primary outcome was locus of control of behaviour (LCB); secondary outcomes included mental state generally (comprehensive psychiatric rating scale/CPRS) and specifically (Beck Depression Inventory/BDI). An integral process evaluation was conducted. Findings LCB scores decreased during the study, but without significant intervention effect [−1.7, 95% confidence interval (CI) = –5.1 to 1.6, P = 0.329]. Change among completers in the control group was from a mean score of 37.4 [standard deviation (SD) = 10.0] to 33.7[SD = 11.7] and in the intervention group from 37.4 (SD = 11.6) to 31.9 (SD = 11.8). Secondary outcomes, including change in mental state, did not differ between arms, but 686 (64%) sessions were lost, most because of ‘prison issues’. Conclusions A clinical psychologist‐facilitated group intervention did not have a statistically significant effect on sense of control of drinking behaviour among men with pre‐imprisonment alcohol misuse serving less than 2 years in a South Wales prison. The study proved coterminous, however, with 40% prison staff cuts which seem likely to have contributed to the high loss of group sessions and possibly overwhelmed any treatment effect. Intervention completion failures, previously cited as harmful, had no effect here, so the trial should be repeated when the prison climate improves.

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Purpose This study aims to understand the perceived causes and consequences of weight gain within a secure psychiatric inpatient service in South Wales. Design/methodology/approach A purposive sample of 12 staff members were interviewed. These interviews were transcribed verbatim and analysed using thematic analysis. Findings Three themes were identified, these were increasing demand for integrated physical health care, unhealthy lifestyles and weight gain viewed as a symptom of poor mental health. Originality/value It is a unique insight into the factors that contribute to obesity in a Welsh secure unit and adds to current understanding of the challenges of improving weight management services within this sector.