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Lookup NU author(s): Professor Eileen KanerORCiD, Professor Sheena Ramsay, Dr Iain McKinnonORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Objectives Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients’ physical and mental health. This study sought to identify the key influences and challenges around weight management in United Kingdom (UK) adult secure mental health settings. Design Qualitative focussed ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. Setting Low secure male mental health ward and associated patient activities and events, in a National Health Service (NHS) Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. Participants Twelve males (primarily White British) on the low secure ward; other male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a six-month period from April 2022. Results Secure mental healthcare delivered an overall ‘obesogenic’ environment, predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and understaffing. Ward culture was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. Conclusions Weight management in secure services is a complex challenge. In future, whole settingbased interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.
Author(s): Mills S, Kaner E, Ramsay S, McKinnon I
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2024
Volume: 14
Issue: 3
Online publication date: 29/03/2024
Acceptance date: 12/03/2024
Date deposited: 03/04/2024
ISSN (electronic): 2044-6055
Publisher: BMJ Group
URL: https://doi.org/10.1136/bmjopen-2023-079406
DOI: 10.1136/bmjopen-2023-079406
ePrints DOI: 10.57711/k7vx-aj03
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