Virtual reality-based intervention in forensic mental health services: a feasibility study of implementation, acceptability, and clinical outcomes

This study evaluated the feasibility, acceptability, and preliminary clinical outcomes of an immersive virtual reality (VR)-based relaxation program implemented as part of routine care in adult and juvenile forensic mental healthcare settings.

A feasibility study was conducted in two forensic mental healthcare services: an adult prison-based rehabilitation unit (UHRPI; n = 21) and a juvenile justice treatment unit (UTJJ; n = 8). The 12-week study comprised a four-week pre-intervention phase, a four-week intervention phase including eight VR sessions, and a four-week post-intervention phase. Feasibility, comprising service-user acceptability and professional usability, was the primary outcome. Secondary exploratory outcomes included physiological measures (blood pressure and heart rate), state anxiety (STAI-State), and subjective emotional states assessed immediately before and after each VR session using visual analog scales (VAS). Participant-level behavioral indicators extracted from institutional clinical records were summarized descriptively. Linear mixed-effects models were used to analyze repeated physiological and VAS measures, whereas state anxiety was analyzed using paired-samples t-tests.

Acceptability and usability were high in both settings, and the intervention was generally well tolerated. In the UHRPI, significant reductions were observed in systolic blood pressure, heart rate, and state anxiety; no significant physiological or anxiety changes were observed in the UTJJ. In both settings, stress and anxiety decreased and relaxation and perceived connection with nature increased immediately following VR sessions, whereas changes in happiness and craving reached significance in only one setting. Participant-level behavioral indicators showed descriptive reductions in several indicators across study phases, with patterns differing between settings.

The VR-based relaxation program was feasible, acceptable, and well integrated into routine forensic mental healthcare. The intervention was associated with improvements in immediate emotional responses across both settings and with favorable physiological changes in adults. Descriptive behavioral findings suggest potential benefits that warrant further investigation. Larger controlled studies with predefined clinical and safety outcomes are needed to determine effectiveness, establish causal effects, and evaluate long-term implementation.