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Forensic mental health services play a key role in the diversion, treatment, rehabilitation, and supervision of offenders with mental health problems in Europe. Private sector providers are increasingly commissioned to provide secure care for service users. Questions have been raised about the effectiveness of the private sector providers. A sample of 229 patients from low, and medium secure psychiatric services in the United Kingdom was analyzed to determine differences in restrictive practices, adverse service user incidents, and service user characteristics between service users admitted to private sector or publicly funded hospitals. Service users with a diagnosis of a personality disorder, and those who had multiple psychiatric diagnoses were disproportionately placed in the private sector. Greater prevalence of seclusion, physical restraint, verbal aggression toward staff, physical violence toward staff and other service users, property damage, and self-harm were observed in private sector service users. Further attention is warranted around the decision-making processes that allocate people to private versus publicly funded care, potential sources of bias in admission characteristics should be taken into account when interpreting poorer clinical outcomes in the private sector. [ABSTRACT FROM AUTHOR]

People in secure psychiatric services experience high levels of exposure to early psychological trauma, are often diagnosed with severe mental illness (SMI) and have increased risk for obesity. Developmental trauma, SMI and obesity are associated with poor physical health outcomes and early death. This study aimed to assess the predictive power of Adverse Childhood Experiences (ACEs), self-harm and psychiatric diagnosis for secure inpatient weight gain and obesity. Data for 248 Welsh patients accommodated in low, medium, and high secure hospitals throughout England and Wales was analyzed. Patient admission bodyweight (in kilograms), bodyweight at the time of audit, and patient BMI at the time of audit was collected. Sex, psychiatric diagnosis, length of current admission, number of ACEs, and frequency of self-harm were also examined. Patients gained significant amounts of weight between admission until the time of the audit (median period = 1 – 2 years) and showed high levels of obesity. Self-harm frequency significantly predicted weight difference. Number of ACEs and diagnosis of schizophrenia significantly predicted patient BMI at the time of audit. The study findings indicate that psychological trauma and the nature of mental illness are important factors driving weight gain and excess morbidity in this vulnerable group. [ABSTRACT FROM AUTHOR]

Many people treated in secure inpatient services have a serious mental illness and are obese. This study aimed to assess the predictive power of demographic, clinical and pharmacological factors on secure inpatient weight gain during the initial stages of treatment. Retrospective data pertaining to body weight, sex, diagnosis, and prescribed medication was collected for 209 secure psychiatric inpatients. Lower admission bodyweight and non-antipsychotic medication with a low risk of inducing weight gain were the only significant predictors of weight gain (R2 =.050). Clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]