1 A critical analysis of clinical evidence from high secure forensic inpatient services

Taylor (PT) for advice in the protocol formulation stages. We also thank the MSc Forensic Psychology course leaders along with high secure service professionals who assisted in identifying fugitive literature and to Dr Linda Morison and Dr Gwen Adshead for comments on a completed version of the review. Abstract High secure forensic inpatient hospitals serve important functions in the detention and rehabilitation of people with serious mental health needs who present as a risk to society. Establishing whether services are effective in restoring mental health and reducing risk is an important task, but one that has not been systematically undertaken. A systematic review of outcome evidence from this setting was therefore conducted to establish its scope and quality. Evidence was found from twenty-two studies for nine different interventions targeting multiple and overlapping outcomes, which included recidivism, mental health, aggression, social functioning and quality of life. Studies were commonly assessed as being at a potentially high risk of bias from validity threats. The 'best' available evidence was for medication, psychoeducation and third-wave cognitive-behavioural interventions. Clinical implications are tentatively offered given the narrow focus of the review on high security. Directions for the high secure services research agenda are more definitively proposed.