Where do forensic dietitians work?
A forensic dietitian can work in the following areas:
- Secure hospitals with a range of low, medium, and high-secure wards
- Community forensic services
- Prison services
A dietitian working in these services must be aware of varying levels of security risk - ranging from low, medium, and high-security settings to rehabilitation and community patients. Various security measures are in place to ensure the safety of service users, staff, and the broader community.
An obesogenic environment is common across forensic settings, particularly in forensic secure services and community placements. This is largely due to the nature of these services, where there is limited physical activity and restricted access to healthier food options. Service users often cannot go to the shops to choose healthier foods, and many are prescribed medications, such as antipsychotics, which can increase cravings for carbohydrates, leading to overeating and weight gain.
Additionally, service users may enter these facilities with addictions to alcohol, drugs, or cigarettes, and once these addictions are addressed, they may replace them with food. Restrictions imposed by the Ministry of Justice (MOJ) can further limit opportunities for exercise and other activities that service users were accustomed to before entering care.
Food choices are also limited, particularly in secure hospitals where service users may stay for months or even years. The repetitive nature of catered meals, including desserts, often leads to boredom, causing some users to turn to convenience foods or takeaways.
Dietitians working within forensic settings will need to be aware of what diet / food items are culturally appropriate for a range of service users within their care, and how the nutritional needs can affect or be affected by a variety of physical health conditions including but not limited to:
- Overweight and obesity
- Type 1 and 2 diabetes mellitus
- Coeliac disease
- IBS
- IBD
- Dyslipidaemia
- Refeeding syndrome
- Malnutrition
- COPD
- Disordered eating: looking at extreme calorie restriction (hunger strike) or looking at restrictions due to mental health condition or learning disability or autism e.g. ARFID, sensory issues surrounding food, paranoid ideation or intrusive thoughts and beliefs around food.
- Dysphagia: ensuring adequate nutritional status whilst on modified texture diets
Forensic dietitians often support service users who experienced Nutrition-related trauma which refers to the psychological and emotional impact that food and eating patterns can have due to past experiences.
For example
- Emotional or comfort eating
- The use of food as a substance in the absence of substances like alcohol or drugs
- Food insecurity
- Under- and overeating with resulting malnutrition or obesity as a form of self-harm
- Using obesity as a protective measure to prevent service users from being sexually assaulted again
- The role of shame & other negative emotions in binge eating & obesity
- How to best communicate diet-related concerns with service users
Nutrition-related trauma can affect a person’s ability to make healthy food choices and maintain a balanced relationship with nutrition.
Dietitians in forensic settings address a range of health needs in an obesogenic environment:
- Oral health: Reduce sugar intake, often collaborating with SLT, OT, and dentists
- Healthy eating: Promote healthy eating by reviewing purposeful leave, shopping lists, and takeaway options
- Catering liaison: Ensure catering meets the cultural and nutritional needs of service users
- Therapeutic/texture-modified meals: Work with speech therapists to provide appropriate meals for those needing texture modification
- Education and supervision: Offer education to service users, students, and colleagues
- Clinical governance: Influence research, policy, and service development for optimal care
- Collaboration: Assist with risk assessments and best-interest decisions
- Specialist advice: Manage dietary effects of antipsychotic medications
- Communication and co-production: Develop accessible nutrition materials tailored to various communication needs
How do forensic dietitians work?
Dietitians within a forensic setting can work in a range of ways to ensure that information is accessible for the service user such as:
- One-to-one consultations
- Group education sessions
- Treatment groups
- Cooking sessions
In forensic settings, dietitians will usually work very closely with a wide MDT, including:
- Consultant psychiatrists and responsible clinicians
- Psychologists
- Occupational therapy
- Speech and language therapists
- Physiotherapists and gym teams
- Activity coordinators
- Physical health teams
- Social workers
- Nursing and HCA teams
- Recovery and co-creation teams