Abstract
High secure forensic inpatient hospitals provide a wide range of interventions in a restricted environment. Patients referred to high security will have both a serious and enduring mental disorder and have committed an offence of interpersonal violence with significant impact. The task of these services is to restore mental health well-being and reduce risk to prevent further harm to others. Evidence to demonstrate whether this task is achieved is limited, which has a number of implications for those who deliver care, those who receive it and the wider public. To develop a clearer understanding of the effectiveness of high secure hospital treatment three different approaches were taken to investigate the evidence base for this setting. A systematic review of existing outcome research from high secure hospitals was undertaken to establish its scope and rigour. Patients who were preparing to move on from high security were interviewed to explore perceived values of care that contributed to reaching this stage. A consultation of professional experts was conducted to determine what essential elements of high secure care were required to improve patient outcomes. Clinical evidence from the best available outcome research demonstrates that a range of interventions can improve the clinical and social functioning of patients. Pharmacological practices can help symptom reduction in patients with enduring schizophrenia and reduce aggression where violence is associated with symptoms. Psychoeducation can improve insight in patients with schizophrenia and cognitive behavioural therapies enhance coping skills for managing intense emotions, lowering risk of violence and preventing re-offending. Patient and professional perspectives on the values of treatment aligned with some of these benefits and also identified additional key processes for rehabilitation. Developing safe relationships with peers and therapeutic alliances with professionals was seen as essential in gaining insight into personal difficulties and promoting change. The use of clinical evidence, practitioner’s experiences and patient’s values demonstrates the contribution each source of information can make to uncovering and understanding a system of care. To establish how the sum of the high secure treatment parts impact on rehabilitation, and identify which package of treatment is best for whom, ideographic investigations that closely and longitudinally monitor change are recommended.