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Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non-existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point-in-time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described.

The provision of psycho-educational groups for people diagnosed with schizophrenia is an important part of successful treatment. The value of such interventions is less clearly established in secure settings with no reports on women. Gender differences in the manifestation of schizophrenia highlight the importance of a gender-specific intervention. A 'Living with Mental Illness' group programme for women in a secure psychiatric setting is described and evaluated. Those who completed group treatments (n = 20; 63%) showed improved knowledge of schizophrenia, decreased fear of schizophrenia, greater insight and increased optimism and perceived control of the illness. They also showed increased hope and greater self-compassion. Pre-post group findings reflected improved ratings of compliance with drug treatments, appropriate behaviour and insight into risk. This was reflected in a decrease in risk behaviours, improved attendance at treatment sessions and a reduction in symptomatology. Group members also reported a positive group therapeutic alliance. FINDINGS are discussed in the context of gender-specific treatment, research, methodological issues characteristic of a real-world evaluations and the need to assess the long-term benefits of such treatment. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Psycho-educational groups for secure inpatients with schizophrenia need to address gender-specific differences in the manifestation of the condition. Such interventions as part of a broader treatment initiative can be associated with clinical improvement that is both illness specific and leads to improved engagement with care initiatives. The needs of patients who do not complete treatments needs to be regularly reassessed. Language: en

People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.

Background Engaging patients in treatment in secure settings is a major challenge. Engagement is associated with a shorter length of stay, whereas treatment non-completion is associated with an increased risk of recidivism. Aims The aims of this study were to assess differences between high and low treatment attendees in a women's medium secure unit and to compare progress over the course of their stay. Methods Sixty consecutive admissions to a women's medium secure unit were classified into high and low treatment attendee groups. The two groups were compared in terms of risk behaviours and psychometric measures of symptomatology, impulsivity and personality. Results High treatment attendees had a shortened length of stay, showed less disturbed behaviour and made more progress in terms of a reduction in symptoms overall and traumatic stress symptoms specifically. Low treatment attendees were more likely to have a diagnosis of schizophrenia/schizotypal illness than personality disorder, less likely to be impulsive and more likely to have scores indicative of severe disorder on the personality subscales of the Millon Clinical Multiaxial Inventory—III. Conclusion Attendance at groups in this medium security unit had clear advantages for patients and potential cost savings for services and the community, but we found a subgroup of women who found it difficult to attend. Given the small sample size, we advocate replication, but our findings suggest the following: Implications for practice development of motivational interventions to help patients make a therapeutic alliance more accurate assessment of treatment readiness, to avoid mistimed interventions that are counterproductive more effective deployment of milieu therapeutic approaches to stabilise behaviour at an early stage of hospitalisation abandonment of a ‘one size fits all’ approach to groups for mixed patient populations. More ‘customised’ approaches would allow more appropriate ‘pacing’ of treatment and adaptations of interventions according to need during the treatment course. Copyright © 2012 John Wiley & Sons, Ltd.

Accessible summary • Factors predicting length of stay in a women's secure service were analyzed. • Patients were divided into short- and long-stay groups. • Longer stay patients differed in terms of symptomatology, personality scale scores and need. Shorter stay patients engaged more in treatment. Abstract Attempts to understand determinates of length of stay in secure settings has been given increased impetus by minimum standard setting and payment by results initiatives. Factors predictive of length of stay in the extant literature include, index offence, previous engagement in therapy, symptomatology, personality pathology and need. These factors were assessed for their predictive validity in a sample of 70 consecutive admissions to a women's medium secure service. Patients were divided into short- and long-stay groups A loglinear analysis of intake variables indicated that the highest order interaction (duration of stay × diagnosis × index offence/previous engagement in therapy) was significant. Analysis of dynamic variables indicated that longer stays were associated with total symptomatology, paranoid pathological personality scale scores and Camberwell Assessment of Need Forensic Version need items of psychotic symptoms and psychological distress. Short-stay patients showed higher levels of therapy engagement. Findings are confirmatory of some of the key variables to be considered when estimating length of stay and when planning treatment.

Accessible summary This article addresses the need for more appropriate sexual health assessment materials for use with women with a learning disability. It gives a summary of other assessment measures that have been developed and why they are not suitable for women with a learning disability. It describes the development of a new assessment measure that can be used to assess the sexual knowledge needs of women in secure settings, with a learning disability. This research is important because it acknowledges that people with a learning disability have the same rights as others with regard to information about sexual health matters. As such people with a learning disability should be asked the questions about the sexual knowledge in an easy and straightforward way that allows them to discuss concerns. Summary Little research has been published on the need for sexual education for women in secure psychiatric facilities when patients present with a combination of learning disability, mental illness and personality disorder. The development of a brief, feasible, gender-specific sexual knowledge questionnaire is described, which has validity and reliability and which is comprehensible by 95% of adults. Results of a pilot study show significant sexual knowledge deficits in learning disability and mentally ill women along with risk and vulnerability factors. Ways of addressing these issues are discussed.

Nutrition screening is the first-line approach to addressing the nutritional needs of service users and has been recommended as best practice by several authoritative and regulatory bodies. A simple and comprehensive screening tool, the St Andrew's Nutrition Screening Instrument (SANSI), was developed for use in an inpatient secure psychiatric setting. The aim of this study was to test the screening tool for reliability and validity. This study identified SANSI as reliable and valid for use in secure psychiatric settings for adolescents and adults. This should give confidence to regulatory and commissioning organizations, that the nutritional risk for patients in an organization which serves a diverse mental health population is being correctly identified, raising staff awareness and allowing appropriate action to be planned.

Accessible summary • Progress in treatment for women in medium secure conditions is dependent on reducing patients risk to self and others. • A method of managing and reducing risk behaviours is described. • In this study risk reduction has been paralleled by increased engagement in treatment activities. • The implications for treatment and further research are discussed. Abstract The treatment and risk management programmes in a women's medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research.

Background The short form of the forensic version of the Camberwell Assessment of Needs (CANFOR-S) (Thomas et al., 2003) is of potential value in all clinical forensic settings, but so far reported mainly with high security hospital patients. Aims To conduct a pilot study of the feasibility of using the CANFOR-S in medium and low security hospital units and to report preliminary findings there. Methods Thirty-six of 38 patients on one medium secure ward for women, one low secure ward for women and one low secure ward for men, all in the same hospital, agreed to participate in the study. Staff and patients completed the CANFOR-S as part of a larger formal assessment package. Results All the women and 18 of the 20 men completed the CANFOR-S. It was found to be easy and quick (25 minutes) to use, and acceptable. Staff and patient ratings were similar on all but one item: needs with regard to safety to others, with staff consistently rating more. Men and women were similar in number of needs, but had different needs profiles. Those in medium security were generally more needy than those in low security. Conclusions and implications for practice The CANFOR-S is feasible for clinical practice, with results perceived as useful in treatment planning by patients and staff. More widespread use could improve service planning. Copyright © 2008 John Wiley & Sons, Ltd.

The development and evaluation of an evidence-based treatment for problem drinking is described. In addition to a clear description of the treatment programme, emphasis is placed on the management of change within mental health settings, treatment integrity and an ongoing process of audit and evaluation. Implications for future service development are discussed. Copyright © 2001 John Wiley & Sons, Ltd.

The scientist‐practitioner philosophy of clinical practice is first placed in its historical context. The history of the scientist‐practitioner stance is marked by an enduring struggle between advocates and opponents of a research-based profession of clinical psychology. The criticisms of the scientist‐practitioner stance are discussed alongside counterarguments in support of that position. Making the conceptual distinction between theoretical preference and philosophical position, three philosophies to underpin clinical psychology are outlined. It is concluded that the fundamental research to decide on the optimum stance for effective practice, and hence to inform training, is sadly lacking. # 1997 by John Wiley & Sons, Ltd.

Following a brief discussion of the history of the development and use of single cases studies, an overview of the single case design in contemporary outcome research is offered. This overview encompasses varieties of single case design, methods of data analysis, and pitfalls and problems with single case methodology. An analysis of current trends in single case design, based on publications in two leading behavioural journals, highlights a move toward alternating treatment designs and the growth of cognitive measures in single case studies. It is concluded that while single case designs are not necessarily the design of choice in all circumstances they are a fundamental research strategy in outcome research.

The Work Environment Scale was used to assess staff perceptions of a change in a treatment programme for problem drinkers. A more cost-effective 2-week research-based day-patient programme, which included the concept of matching, replaced a 5-week cognitive behavioural in-patient programme. The maintenance of a positive work environment was attributed to the meeting of staff expectations, a cognitive behavioural ideology, and the establishment of a research culture. The study highlights the importance of the thorough preparation of staff for change, and their active involvement in the process in settings where work satisfaction is already above the average level for mental health facilities.

The specificity of the retardation effect on the Stroop Naming task with eating disorder clients was examined by comparing anorexic patients and normal weight controls with obese restrained eaters. Although the expected differences between normal weight controls and anorexics were found for color naming of food and body size words, obese restrained eaters were not differentiated from the clinical sample. It is suggested, therefore, that the Stroop phenomena do not have a precise relationship to the extent of psychopathology and that factors such as the ability to “fake” the test and poor concentration leading to general slowing, may explain the results. © 1994 by John Wiley & Sons, Inc.

This study reports a comparison of a single ward versus a two-ward system of acute in-patient care in a general hospital psychiatric unit. It focuses on staff and patient perceptions and attitudes towards the two types of ward. A continuous care ward system was preferred by the majority of staff who described an improvement in 'ward atmosphere'. Patients who had experienced both ward systems also preferred the continuous care system. Both patients and staff felt that the continuous care system still needed to place greater emphasis on 'ward atmosphere' dimensions of involvement, support and spontaneity. The implications of these findings for improving the functioning of the preferred ward are discussed.

Thirty-one inpatient and 67 expatient problem drinkers' use of low alcohol drinks and their attitudes towards them were assessed using questionnaire measures. Self ratings of craving for alcohol were made before and after exposure to and optional tasting of low alcohol drinks. Problem drinkers were found to have a generally favourable view of low alcohol drinks, and they claimed that use of these drinks did not contribute to relapse. However, craving for alcohol was found to be significantly raised over baseline after exposure to low alcohol drinks. A significant correlation was found between this increase in craving and severity of dependence as assessed by the SADQ.