A review of clinical staff attitudes, perceptions and knowledge regarding substance use and its treatment in the forensic setting

Purpose Forensic mental health services care for individuals with mental disorders involved in the criminal justice system. Rates of co-occurring substance-use disorders (dual diagnosis) in this population is high, and addressing substance use in treatment is vital, but limited staff knowledge and negative staff attitudes can hinder care. This study, a systematic review, aims to understand the attitudes, perceptions and knowledge of clinical staff regarding substance use as well as its treatment within the forensic setting. Design/methodology/approach A comprehensive database search of PubMed (containing Medical Literature Analysis and Retrieval System Online), PsycINFO and Cumulative Index to Nursing and Allied Health Literature was conducted in February 2025 using keywords associated with the topic question. Studies were selected based on inclusion and exclusion criteria. The quality of included studies was assessed using the Joanne Briggs Institute critical appraisal tool. Findings A total of 12 studies were included in the final review. Findings showed that substance use and dual diagnosis work remains a significant challenge in forensic settings due to security constraints, staff training gaps and persistent stigmatising attitudes. Addressing these issues is essential for better treatment provision. Originality/value This is the first systematic review exclusively and comprehensively exploring clinical staff attitudes, perspectives and knowledge regarding substance use and its treatment in the forensic setting. Findings will help to guide the implementation of future substance-use and dual diagnosis treatment and training programmes in forensic settings.