Relationships between residents in secure psychiatric units cause clinicians a great deal of concern (Reference Dein and WilliamsDein & Williams, 2008). The effective management of such liaisons pre- and post-discharge also needs to be considered.

Relationships in secure settings can and will happen. Robust plans need to be made while individuals are in-patients and in anticipation of their wish to move on together. Strict boundaries need to be maintained, although joint participation in various therapeutic activities can be facilitative and could be a positive rehabilitative endeavour. With the evolution of gender specificity in secure care, separation of units or wards may reduce the instances of relationships. Clinical decision-making needs to be at the fore, especially when relationships end, as all mental disorders are at risk of relapse, thereby increasing risks.

Those in relationships are unlikely to leave a unit (sometimes after being together for years) at the same time, for example where one individual is much further down the treatment and rehabilitation pathway, and they may not reside at the same post-discharge location. Decisions on harmonising care pathways can be difficult, requiring a comprehensive assessment of risk and management. The involvement of the Ministry of Justice in restricted cases can make decision-making more complex. Guidance from the Ministry of Justice at an early stage would be particularly advantageous, possibly inviting case-workers to care programme approach meetings.

Finally, we would like to note that relationships may not only be partnerships, but also include friendships.