The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kingdom and abroad. The Trust is based at the Tavistock Centre in Swiss Cottage. The founding organisation was the Tavistock institute of medical psychology founded in 1920 by Dr. Hugh Crichton-Miller.The Tavistock and Portman NHS Trust was formed in 1994, when the Tavistock Clinic merged with the neighbouring Portman Clinic in Fitzjohn's Avenue. The Portman specialises in areas of forensic psychiatry, including the treatment of addictive, sociopathic and criminal behaviours and tendencies.It has developed as a centre of excellence for psychoanalysis within the NHS since being included at its founding in 1948. The Trust and predecessor organisations have been influential beyond medicine, including in the British Army, management consultancy, prison and probation services.
This review evaluates the performance, feasibility, and acceptability of Artificial Intelligence (AI) and machine learning (ML)–enabled wrist- and ankle-worn wearables for monitoring physiological and behavioral states that help predict difficulties in arousal regulation, emotion modulation, and behavioral control—often manifesting as aggression or self-injury in autistic children and adolescents. A systematic search of peer-reviewed literature was conducted to May 2025 following PRISMA 2020 guidelines and a preregistered PROSPERO protocol (CRD420251068317). Participant characteristics, sensor modalities, study settings, AI/ML approaches, outcome definitions, and feasibility and acceptability measures were examined. Findings were synthesized narratively due to study heterogeneity. Preliminary proof-of-concept data (n = 246; 170 autistic) suggest that AI-enabled models have the potential to anticipate aggression 1–3 min before onset (AUC 0.80–0.87) in specialized psychiatric settings. Under controlled conditions, self-injury and motor stereotypies were detected with 86–96
ABOUT THE BOOK: Relating to Self-Harm and Suicide presents original studies and research from contemporary psychoanalysts, therapists and academics focusing on the psychoanalytic understanding of suicide and self-harm, and how this can be applied to clinical work and policy. This powerful critique of current thinking suggests that suicide and self-harm must be understood as having meaning within interpersonal and intrapsychic relationships, offering a new and more hopeful dimension for prevention and recovery. Divided into three sections, the book includes: a theoretical overview examples of psychoanalytic practice with self-harming and suicidal patients applications of psychoanalytic thinking to suicide and self-harm prevention. Relating to Self-Harm and Suicide will be helpful to psychoanalytic therapists, analysts and mental health professionals wanting to integrate psychoanalytic ideas into their work with self-harmers and the suicidal. This text will also be of use to academics and professionals involved in suicidal prevention.
Background Mental health problems among children in England are rising, with significant wait times and barriers preventing many from accessing timely support. Watch Me Play! (WMP) is a caregiver–child interaction intervention designed to enhance child development and promote mental health resilience through child-led play. Aims To assess the feasibility of delivering WMP remotely to parents and carers of children aged 0–8 years referred to UK early years and children’s services. Method A non-randomised, single-group feasibility design with a mixed-methods process evaluation aimed to recruit 40 families. The study evaluated recruitment, retention, adherence, fidelity and acceptability. Outcomes were collected at baseline and 3 months; we conducted qualitative interviews to examine barriers and facilitators, and we used health economic data estimated intervention costs. Results WMP was well-regarded and acceptable to families and service providers. Recruitment involved seven sites and 21 families, with 67% retention at 3 months. Self-reported adherence was 80%. Facilitators included the simplicity of the approach and quick access to support. Barriers included limited staff capacity and practitioner perceptions of readiness in families with complex needs. Hybrid delivery (online and face-to-face sessions) was feasible and acceptable. The average intervention cost was £209 per family. Conclusions Findings indicate core feasibility parameters – including acceptability, fidelity, data-collection procedures and delivery across diverse contexts – were met. WMP is a low-cost intervention suited for early years services. Although a full-scale effectiveness trial is not yet warranted, a future randomised feasibility trial is recommended to investigate the acceptability of randomisation and recruitment across a broader range of services.
Randomized controlled trials (RCTs) are the gold standard for evaluating interventions, yet their use in criminal justice settings remains limited and challenging. This qualitative study examined barriers encountered during a multi-site RCT of mentalization-based treatment for men with antisocial personality disorder (ASPD) under probation community supervision in the United Kingdom. Sixteen focus groups were conducted with mentalization-based treatment therapists, offender managers, psychologists, and research staff across 13 sites. Thematic analysis identified five primary challenges: Staff emotional burden, Participant attrition, Systemic constraints within the justice system, Trial design challenges, and Intervention-specific implementation problems. Staff emotional burden emerged as a substantial and under-recognized barrier, associated with systemic instability, professional isolation, and the demands of sustained clinical work with resistant participants. In response, the trial introduced adaptive strategies intended to mitigate these barriers, including strengthened leadership structures, enhanced supervision, improved engagement with probation services, involvement of peer researchers to support trust and participation, and increased procedural flexibility to accommodate participants’ circumstances. These findings underscore the value of embedding qualitative evaluation within RCTs to support timely, targeted adaptations that enhance feasibility, staff well-being, and retention. Despite the inherent complexity of conducting trials in criminal justice contexts, responsive and reflexive trial design can support ethical and rigorous evaluation of psychological interventions for high-risk populations.
This study addresses a critical gap in the evidence base for cost-effective psychological interventions for antisocial personality disorder (ASPD) in forensic settings by presenting a full trial-based economic evaluation of mentalisation-based treatment plus probation as usual (MBT-ASPD + PAU), compared to PAU alone, for males with ASPD convicted of an offence in England and Wales. The economic evaluation adopted a societal perspective, incorporating costs to health care, the criminal justice system, and the wider societal impact of offending. Outcomes were assessed 24 months post-randomisation. The primary cost-utility analysis compared costs with quality-adjusted life years (QALYs) derived from the EQ-5D-5L, while a secondary cost-effectiveness analysis compared costs with aggression outcomes measured by the Overt Aggression Scale - Modified (OAS-M). Although missing data limited definitive conclusions regarding service use, available data suggest that participants in the PAU group spent more time in custody than those in the MBT-ASPD + PAU group. Utility scores and quality of life showed minimal variation over follow-up, with no significant differences between groups. Overall costs were lower in the MBT-ASPD + PAU group, though not statistically significant. Over the 24-month period, MBT-ASPD + PAU was associated with both reduced costs and lower aggression (as reflected in OAS-M scores), indicating that each unit reduction in aggression yielded a cost saving of approximately £93. For QALYs, MBT-ASPD + PAU appeared cost-effective compared to PAU across all values a decision-maker may be willing to pay for improvements in outcome. These findings provide preliminary evidence for the potential economic value of MBT-ASPD + PAU in a forensic ASPD population, particularly in relation to aggression reduction and the associated cost savings. Trial registrationThis trial is registered with ISRCTN (ISRCTN 32309003).
