A Systematic Review of the Efficacy of Harmful Behaviour Programmes for patients in Forensic Mental Health Settings

This systematic review guided by Wakefield’s (2014, 2015) seven step approach aims to assess the efficacy of harmful behaviour programmes for forensic mental health patients within secure environments. Forensic mental health... [ view full abstract ]

This systematic review guided by Wakefield’s (2014, 2015) seven step approach aims to assess the efficacy of harmful behaviour programmes for forensic mental health patients within secure environments. Forensic mental health care is an emerging speciality that crosses boundaries between health and judicial systems. The rationale for this review was based on the growing concerns and needs of patients and service providers as the unique and individual challenges for patients have been unmet in the past. Therapeutic modalities based on cognitive, behaviour and social learning theories have application within this context for forensic mental health nursing. Such interventions include the Reasoning and Rehabilitation Programme R&R (Ross, Fabriano & Ewels 1988) and Enhanced Thinking Skills (ETS) (Tapp et al 2009) aiming to reduce the incidence of harmful behaviours.

The data for this study was gathered through in-depth systematic searches of electronic database, from 2005-2015, to answer the question: What is the efficacy of harmful behaviour programmes for patients in forensic mental health settings? The databases Medline, Academic Search Complete, AMED, Biomedical Reference Collection, Cinhal, PsychArticles, Social Sciences, Embase and The Cochrane Library yielded 189 articles. Limiters and examination through inclusion and exclusion, in addition to quality appraisal tool CASP identified seven studies as appropriate to meet the aim of the review.

Findings; Data extraction identifies seven studies were undertaken in United Kingdom. All studies used a quantitative approach with various sample sizes ranging from 35 to 121. Three study utilised the ‘R&R’; three R&R2’MHP and another ETS. Findings provide an increasing evidence base for cognitive behavioural therapeutic approaches in reducing harmful behaviours. Benefits of specific intervention programmes in reducing harmful behaviour within forensic settings were detailed. Furthermore engagement in these programmes enhances well-being and impacts on symptoms. In addressing the question regarding the efficacy of harmful behaviour programmes for patients in forensic mental health or settings this review demonstrates the complexity of providing a nursing service within custodial and legal constraints.

To conclude these specific intervention programmes contribute to reducing harmful behaviour and increase wellness for patient’s in forensic mental health settings.