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Forensics

Forensic services principally work with people who have a mental illness and or learning disability who have been involved with the police, court and/or prison. The majority of service users in are sectioned under the Mental Health Act. Forensic services incorporate high secure, medium secure and low secure hospitals and there are also some community Forensic services.
People in Forensic services are at high risk of nutrition related problems. It is well known that people with a mental illness and or learning disability are at higher risk of obesity, malnutrition and serious physical health problems than the general population (2, 3). People in Forensic services often remain in hospital for extended periods, might be on higher doses of antipsychotic medication and often have reduced access to food choice, self catering (cooking) and exercise (restrictions are based on individual services users risks). It is also recognised that poor motivation for healthy eating and exercise is common (4, 5). It is therefore unsurprising that there are higher rates of obesity in Forensic settings compared to the general population. One study in a secure psychiatric hospital in England shows 83.3% of females and 80.5% of males being overweight or obese (6) compared with 57% of females and 67% males in the general population (7).
“Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard”. (1) We understand nutrition, food and the people we work with, and are therefore perfectly placed to support the dietary needs of people with clinical conditions in the Forensic setting.
The role of Dietitians working in Forensic services include:
• ensuring that service users have equal access to Dietetic services
• ensuring that healthy eating opportunities available within the secure hospitals
• listening to what is important to our service users
• educating service users on nutrition and related health risks in both groups and 1:1s, making sure that information is given in a clear and relevant way
• providing education, training and support to the multidisciplinary team (MDT), enabling all staff to be able to support service users to make healthy food and lifestyle choices.
• working closely with food providers to ensure that nutritional needs are met. This includes comprehensive work with menus, chefs, onsite cafes, shops and vending machines
• working closely with the multidisciplinary team to provide expert advice on nutrition and health
• answering any questions from both service users and staff
• having a role in care pathway development and review which relate to nutrition and health
• work with individual service users to create and review nutritional care plans
• being involved in auditing obesity levels within Forensic services and advising on appropriate strategies for tackling obesity, both at individual and service level
• having a key role in auditing diabetes incidence within Forensic services and providing support and training to staff, patients and visitors on the management issues associated with diabetes( particularly as Forensic service users are less likely to want to attend local clinics)
• helping Forensic services to ensure they meet nutritional standard, including outcome 5 from Essential Standards or Quality and Safety standards from the care quality commission (8)
• using developed behavioural skills to help motivate and engage service users in managing their own health by addressing issues related to mental and physical health
• supporting service users as part of the MDT in their recovery, rehabilitation and reduce their risk of re-offending by addressing issues around self- care, finance/budgeting, confidence in choices and awareness of their own individual well- being for when they may be discharged back into the community
• keeping up to date with research and new information

1. The British Dietetic association (2014) Dietitian, Nutritionist, Nutritional Therapist or Diet Expert? A comprehensive guide to roles and functions. https://www.bda.uk.com/publications/dietitian_nutritionist
2. Public Health England (2013) Obesity and Disability, Adults. Accessed online at http://www.noo.org.uk/uploads/doc/vid_18474_obesity_dis.pdf
3. Disability Rights Commission (2006), Equal Treatment: Closing the gap. A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems. DRC, London
4. Oakley et al (2013) The right to be fat? A survey of weight management in medium secure units. Journal of Forensic Psychiatry and Psychology Vol24(2)p205-214
5. Haw and Stubbs (2011) what are we doing about weight management in Forensic psychiatry? A survey of Forensic Psychiatrists. The British Journal of Forensic Practice Vol 3(3) pp183
6. Haw and Rowell (2011) Obesity and its complications: a survey of inpatients at a secure psychiatric hospital. The British journal of Forensic Practice Vol 13(4) pp 270-277
7. Health Survey for England (2011) Chapter 10 Adult Anthropometric measures, overweight and obesity accessed online :
http://www.hscic.gov.uk/catalogue/PUB13218/HSE2012-Ch10-Adult-BMI.pdf
8. Care Quality Commission (2011) Essential Standards of Quality and Safety. Accessed online at http://www.cqc.org.uk/sites/default/files/documents/gac_-_dec_2011_update.pdf

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