The psychological and psychosocial interventions offered to forensic mental health in-patients: a systematic review

Objective: To examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health in-patients.

Design: CINAHL, MedLine, PsycINFO, ScienceDirect, and Web of Science databases were searched for research published in English between 1 January 1990 and 31 May 2018.

Outcome measures: Disturbance, mental well-being, quality of life, recovery, violence/risk, satisfaction, seclusion, symptoms, therapeutic relationship and ward environment. There were no limits on the length of follow up.

Eligibility criteria: We included randomised controlled trial (RCT) studies of any psychological or psychosocial intervention in an in-patient forensic setting. Pilot or feasibility studies were included if a RCT design was used.
We restricted our search criteria to in-patients in low, medium, and high secure units aged over 18. We focused on interventions considered applicable to most patients residing in forensic mental health settings.

Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias.

Results: 17,232 citations were identified with 195 full manuscripts examined in detail. Nine papers were included in the review. The heterogeneity of the identified studies meant that meta-analysis was inappropriate. The results were presented in table form together with a narrative synthesis. Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings. The most frequently reported outcomes were violence/risk and symptoms. 61% of the violence/risk comparisons and 79% of the symptom comparisons reported improvements in the intervention groups compared to the control groups.

Conclusions: Current practice is based on limited evidence with no consistent significant findings. This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk but there is tentative support they may improve symptoms. More RCTs are required with: larger sample sizes, representative populations, standardised outcomes and control group interventions similar in treatment intensity to the intervention.