Physical health and activity management in forensic mental healthcare: hospital practices and staff insights from an Australian national study

BACKGROUND: There is currently no national approach to physical health and activity management for individuals under forensic mental healthcare. AIMS: This study aims to document the physical health and activity management of in-patients under forensic mental healthcare across Australia, physical activity opportunities and how data are recorded. It also explores staff perspectives on physical health and activity needs of forensic in-patients. METHOD: Forensic hospital staff with expertise in managing the physical health and activity of in-patients were invited to participate in a mixed-methods study. RESULTS: Twenty-two surveys were completed and 64 staff members participated in 17 focus groups. Eight themes were identified: (a) lack of a standardised approach to physical health and activity; (b) inconsistent monitoring and documentation; (c) importance of general practitioners and multidisciplinary teams; (d) need for structured, adaptable programmes and engaged staff; (e) challenges related to patients, staff, ethics and infrastructure; (f) gaps in education, engagement and awareness; (g) need to balance nutrition and eating autonomy; and (h) importance of developing and implementing interventions. CONCLUSIONS: Forensic hospitals in Australia lack a standardised approach to physical health and activity management, with inconsistent monitoring. Physical activity interventions require engaged staff, resources and flexibility, yet ethical and logistical barriers complicate implementation. Solutions include investing in specialised staff, scheduling physical activity into patients' routines and integrating information technology systems. Comprehensive policies for assessment, monitoring, nutrition, physical activity and interventions are important for improving in-patient forensic mental healthcare, and key performance indicators should be developed.