There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Non-systematic review of the literature.

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

No significant relationships.

Public Health England published a report in 2017 on Obesity in Secure Mental Health units. A key finding was that not only is obesity and overweight more prevalenr in the population detained within mental health secure units (reported rates of up to 80%) than in the general population (around 60%), patients appear to be more at risk of weight gain when they are detained.

1.To implement a traffic light system on food and confectionaries sold at the shop at a Medium secure hospital. 2. Provide healthier food options at the shop by using traffic light system as a visual aid 3. To achieve weight reduction and promote healthy life style choices in patients admitted to our medium secure Forensic unit

1.Buying a new till system which is able to quantify what type of food is sold 2.Labelling food sold using traffic light system 3. Calculate the types of food sold following a three- month period after implementation.

/Intended Outcome Traffic light system provides a visual aid to patients in choosing healthier food Patients in our medium secure unit achieve a reduction in their weight Traffic light system can be replicated/ adopted by other secure hospitals

The purpose of this research is to implement a traffic light system on food sold at a shop in our medium secure unit and that this will help improve food choices in the unit.

No significant relationships.

Little is known about factors that influence discharge decision-making for people admitted to medium-secure services from prison, particularly for those who are returned to prison following treatment.

To explore the organisational influences on care pathways through medium-secure services for those admitted from prison.

We recruited 24 clinicians via purposive and snowball sampling; 13 shared their experiences via a focus group, and 11 shared their experiences via individual semi-structured interviews. A thematic analysis was conducted, producing three overarching themes: maintenance of throughput and service provision, class of two systems, and desirable and undesirable patients.

Data indicated external factors that direct and, at times, limit clinicians’ pathway decisions, including commissioning criteria and legal status under the Mental Health Act 1983 and within the criminal courts system (i.e. whether on remand or sentenced). These factors also influence how clinicians view the role and function of medium-secure services within the wider forensic mental health system, and therefore the types of patients that are deemed ‘appropriate’ for continued treatment when making discretionary pathway decisions.

There remains a deficit in adequate resources to meet the mental health needs of prisoners who are admitted to medium-secure services. To meet the clinical need of all admissions, criteria for prolonged treatment in medium-secure services needs to be reconsidered, and it is likely that provision for the medium-secure hospital estate will need to increase substantially if effective rehabilitation of those who transfer from prison is to take place.

To assess physical health needs of adolescent in-patients by routine monitoring. A retrospective analysis of case notes was conducted on a 6-month intake to generic and secure adolescent mental health units in Greater Manchester, UK.

Fifty individuals were admitted (52% female, average age 15.84 years). Diagnoses varied and 66% were prescribed medications before admission. All had a physical health assessment, which identified various physical health risk factors. Average body mass index was 25.99 (range 15.8–44), and increased during in-patient treatment for 84% of individuals who had their body mass recorded more than once. A total of 28% of individuals smoked. Lipids and prolactin levels were elevated across the sample.

This evaluation strengthens the argument to optimise physical healthcare for adolescent in-patients and develop physical health interventions, particularly given that we observed elevated lipids and prolactin. Physical health and well-being may not be prioritised when assessing and managing young peoples' mental health, despite their increased vulnerability for comorbid conditions.

There is an abundant literature on the unfavourable attitudes held by staff working in mental health care settings towards patients with borderline personality disorder. The aim of this study was to assess whether attendance at a training session about the neurobiological underpinnings of borderline personality disorder could improve knowledge and produce positive attitudinal change within staff members working in a low secure inpatient setting.

Staff knowledge and attitudes (Mental Health Locus of Origin, Empathic Concern and Perspective Taking) were assessed at baseline, post-training attendance and at an eight-week follow up.

Attendance at the training session was associated with significant increases in theoretical knowledge, Perspective Taking and Locus of Origin scores. However, there were no changes observed in Empathic Concern scores.

This research suggests that a relatively brief training session, that utilises the neurobiological framework, can be effective in facilitating knowledge and attitudinal change for those working with borderline personality disorder. The implications of the findings are discussed along with suggestions for further research.