bluuebunny/crossref_metadata_2025 huggingface dataset:
From discharge to follow‐up: a small‐scale study of medium secure provision in the independent sector
Authors: Castro Maria , Cockerton Tracey , Birke Simon
Published: August 2011

Established following the Reed Report (1991) recommendations, Redford Lodge is an independent psychiatric hospital offering medium secure provision for mentally ill patients and offenders. For this study social and behavioural data were collected on admission and discharge for the 166 patients admitted over the three years 1995‐1998 and 49 discharged patients were reassessed at six‐month follow‐up. Predictors of length of stay, discharge and success at follow‐up were examined in relation to social and demographic factors and engagement in therapy programmes.Patients' socio‐demographic variables were not significantly related to their length of stay, place of discharge or success at follow‐up. One predictor of progress after discharge was employment. Contact with family was identified as a significant factor associated with shorter stay and positive place of discharge but not associated with success at follow‐up. Engagement in psychological therapies and/or group activities was directly related to length of stay, general progress and improvement in mental state but not to subsequent involvement in community services or general success in independent living at follow‐up.Although the findings suggest treatment is successful, further research is needed to identify specific treatment variables that have a positive long‐term effect.
Self‐inflicted deaths of prisoners serving life sentences 1988‐2001
Authors: Borrill Jo
Published: August 2011

Prisoners serving life sentences are known to be at a higher risk of suicide. This paper reports findings from a review of self‐inflicted deaths of life sentence prisoners over the years 1988‐2001 and an indepth analysis of 20 recent cases (1998‐2001) to identify the individual motivations and environmental triggers for self‐inflicted death in this population. There were 80 (9.5% of total prison suicides) self‐inflicted deaths among lifers in the study period. The prisoners were older and more likely to kill themselves a year or more into their sentence than were other prison suicides. Analysis of the 20 case studies showed that lifers who killed themselves less than a year into their sentence tended to be overtly suicidal from the start of their time in custody, to have committed domestic murders and to have killed themselves when faced with the reality of their sentence or tariff. Lifers who killed themselves more than a year into their sentence tended to have a previous history of self‐harm or suicide attempts but fewer signs of immediate risk. Problems in progressing through the lifer system seemed to be significant, including reduced status or a failed appeal, and inability to adjust following transfer. Other triggers included disrupted relationships in or out of prison. Among both early and late groups there was evidence of mental health problems contributing to the death. Warning signs immediately before the death included refusing food, work or medication. Mood and demeanour appear to be unreliable indicators of risk.
The challenge of nursing personality‐disordered patients
Authors: Murphy Naomi , McVey Denis
Published: August 2011

ABSTRACT Providing nursing care for patients with personality disorders is seen by many nursing staff as a highly undesirable job. This paper reviews the available literature and attempts to explore why the task of providing nursing care to these clients is so unpopular. Five core areas of difficulty are identified in the literature and each of these will be elaborated upon within the paper: i) these patients are perceived as less reinforcing and more demanding than mentally ill patients, ii) nurse training is inadequate preparation for this type of work, iii) the role of nursing personality‐disordered patients is high in conflict, iv) this type of nursing is traumatising and v) this type of nursing requires specific skills and qualities.The paper will then outline the implications that these challenges have for a nursing service that provides care for personality‐disordered patients. These include the impact upon i) the retention of staff, ii) the recruitment of staff, iii) the patients and iii) an organisation. The paper will also suggest some potential solutions to these challenges.
The use of the PCL‐R in forensic populations with learning disability
Authors: Morrissey Catrin
Published: August 2011

Although the PCL‐R is used widely for assessing forensic populations in general, there has been no published research on the reliability and validity of such assessments with offenders with a learning disability. The problems with applying the PCL‐R with this population are discussed. The results of a pilot study analysing data collected for clinical purposes on a high‐security hospital LD admission ward are described, and recommendations for further development and research are made.
Neologism in forensic practice
Authors: Dalton Rita
Published: August 2011

A neologism (new word) has crept into forensic practice: the word ‘absconsion’, which is used instead of the correct form of ‘abscondment’ to mean the act of running away or escaping. The author speculates that forensic practitioners' reliance on previous reports has led to its appearing in current usage.
Cyberstalking: a case study of serial harassment in the UK
Authors: Bocij Paul , Bocij Helen , McFarlane Leroy
Published: August 2011

This paper presents the first academic case study of a UK cyberstalking incident that involved an individual known to have harassed at least four victims. The case study describes how the harasser selected victims, his use of technology to gather confidential information about them and his use of multiple personalities as part of the process of harassment. The discussion section of the paper raises a broad range of issues, including whether the case represents a genuine cyberstalking incident, how technology was used to assist the harasser's activities and how the harasser attempted to avoid detection.
A review of clinical risk and related assessments in forensic psychiatric units
Authors: Kettles Alyson , Robinson David , Moody Ellenor
Published: August 2011

The level of service provision for people suffering from a mental disorder is an area of debate that has always presented clinicians with numerous difficult decisions. The decision‐making process is perhaps at its most contentious with reference to the type and degree of risk individuals may present, either to themselves or to the general public.
The use of a repertory grid as an aid to assessment and formulation in a sex offender with a learning disability
Authors: Mason Jonathan
Published: August 2011

Whereas a number of standardised psychological measures exist for the assessment of sex offenders (eg Beckett, 1994), very few such measures are appropriate for use with those with learning disabilities. Measures often use complicated language and concepts, fail to include people with learning disabilities in their standardisation samples and use notions of sex and sexuality that, in many cases, are of little relevance to the lives of people with learning disabilities. In order to help in the psychological formulation of Paul (a sex offender with learning disabilities), a Kelly Repertory Grid (Kelly, 1955) was used. The analysis of the grid provided important information about Paul's sense of self, his attitude towards women and his attitude towards relationships in general. This allowed for a systematic approach to assessment and formulation that might not otherwise have been available. It is proposed as a novel starting point in the process of assessment and formulation in this client group, which fits in well with existing cognitive‐behavioural (CBT) approaches to treatment.
Limitations in actuarial risk assessment of sexual offenders: a methodological note
Authors: Craig Leam , Browne Kevin , Stringer Ian , Beech Anthony
Published: August 2011

The assessment of risk of recidivism in sexual offenders is fundamental to clinical practice. It is widely accepted that, compared with actuarial measures of risk, unaided clinical judgment has generally been found to be of low reliability. Consequently, the literature has shown a surge in actuarial measures. However, a major difficulty in assessing risk in sex offenders is the low base rate, leading to an increased likelihood of making a false positive predictive error. To overcome this, risk assessment studies are increasingly using the receiver operating characteristic (ROC), which displays the relationship between level of risk and decision choice. This note summarises the methodological issues in measuring predictive accuracy in assessing risk of re‐offending in sexual offenders, and identifies from the literature both static and dynamic risk factors associated with sexual offence recidivism.
Mental health in‐reach services at HMP Usk/Prescoed
Authors: Salathial Tracey
Published: August 2011

This paper aims to capture some of the issues raised by those working on the development of mental health services in the prison environment. Each establishment in England and Wales will be different in terms of prison category and prisoner status, but its principle aim will be the same: to follow the strategic plans for the development of mental health services outlined in the National Service Framework. The purpose of the paper is to begin to facilitate and promote further open discussion of the development of services in prisons in order to improve clinical care.
The therapy seesaw: achieving therapeutically balanced approaches to working with emotional distress
Authors: Talkes Kirsty , Tennant Allison
Published: August 2011

This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can get in the way of providing a structured therapeutic approach are discussed. The paper focuses on dialectical behaviour therapy as a treatment model, and discusses how the concept of ‘dialectics’ provide an over‐riding context for case conceptualisation (Linehan, 1993). The dialectical dilemmas and powerful dynamics that can be enacted between individuals, teams and patients in their endeavours to cope with distress will be illustrated. The dialectical philosophy is described and elaborated upon, providing a framework for the synthesis of clinical interpersonal encounters and metaphorical concepts of a therapy seesaw. The paper discusses how these ideas can guide us in our work with emotionally distressed individuals.
High‐dose antipsychotic prescriptions at a forensic psychiatric hospital: is there a need for implementation of a monitoring form?
Authors: Acosta‐Armas Alexis , Cooper Mike , Jacob Caroline , Churchward Sam
Published: August 2011

The use of pharmacological interventions in the treatment of forensic psychiatric patients constitutes an important part of the day‐to‐day practice of mental health professionals working in this important psychiatric sub‐speciality. It involves not just the prescription of specific drugs, but also the regular monitoring of their effects and possible side effects. Such monitoring involves the collaboration of professionals working in very different fields such as medicine, nursing, occupational therapy, physiotherapy and pharmacy.
Leadership of applied psychological services in prisons and probation
Authors: Towl Graham
Published: August 2011

This paper presents a case study of the leadership of applied psychological services in prisons and probation services. The history and process of achieving management change with this professional group in the context of broader public sector reforms are considered in detail.
Developing models and a framework for multi‐professional clinical supervision
Authors: Davies E , Tennant Allison , Ferguson Esme , Jones Lawrence
Published: August 2011

The UK government proposals for services for individuals considered to be dangerous with a severe personality disorder (DSPD) are developing. The complex task of balancing safety and therapeutic change in DSPD services will rest largely upon the skills, knowledge and practice of the staff group. As a result, one challenge for DSPD services is to provide sufficient training and support to staff, in order to ensure that adequate resources are available to assist them in processing their emotional reactions to their work. As part of this, clinical supervision systems need to be developed to offer professional support and learning, enabling individual practitioners to develop knowledge and competence and assume responsibility for their own practice (DoH, 1993). Among the service developments at Rampton Hospital an innovative multi‐professional supervision strategy has been introduced for all staff working in the unit. This paper describes the evolving supervision framework, including a new tool, the ‘Supervision Matrix’, and implementation guidelines, and describes how this supervision framework will be evaluated.
Development of a specialised forensic service for women with learning disability: the first three years
Authors: Berber Elizabeth , Boer Harm
Published: August 2011

In recent years there has been growing interest in the fate of those women with mental disorder who come into contact with the criminal justice system. This interest has stemmed from growing recognition that traditional forensic services could not offer the appropriate care required by this group in a conventional mixed‐gender environment. Women‐only services have begun to be developed in generic psychiatric settings, spurred on by the national service framework (NSF) which set a time limit for the development of segregated in‐patient facilities. Forensic services for those with learning disability have been slower to take up the challenge of how best to place women with learning disability who offend and require an in‐patient secure environment. This article describes how one such service attempted to rise to this challenge and build a service for this often neglected group
Crime and the family: like grandfather, like father, like son?
Authors: Gregory Nathan
Published: August 2011

The phenomenon of criminal behaviour has interested scholars from academic disciplines building on centuries of philosophical debate developed from emerging biological, psychological and social sciences. Criminological theories of causation are embedded in conceptual networks that link political ideology classified by philosophical underpinnings. For example, the late 18th and early 19th century utilitarianism consensus classical theory supported the notion of free will, suggesting that individuals were likely to commit crime if the pay‐off were greater than the retribution. In contrast, conflict marxist and radical criminology regarded crime as a function of poverty, reflecting a power imbalance in society. The late 19th century saw the emergence of the positivist school, which argued that factors including genetics, poverty, personality and the family were important in determining criminality. This article concentrates on the transmission of crime through families by reviewing a selection of the main studies in the area.
The management of aggression care plans: implementation and efficacy in a forensic learning disability service
Authors: Thomas Cathy , Kitchen Dave , Smith Adam
Published: August 2011

This article describes the design and implementation of the management of aggression care plans (MOACAP) in a secure service for people with learning disability and severe challenging behaviour. The MOACAP is a five‐part document, which has sections for descriptions of challenging behaviour, escalation patterns of the behaviour, non‐physical interventions, physical interventions and post‐incident briefing.Preliminary evaluations suggest that use of MOACAP leads to a reduction in aggressive incidents in the service. The approach should also be relevant to other forensic, mental health and challenging behaviour services and brain injury units. The MOACAP may also be relevant to services that will be affected by the National Institute for Clinical Excellence (NICE) and the National Institute for Mental Health in England (NIMHE) guidelines on the short‐term management of disturbed (violent) behaviour.
Audit of the referrals to the psychology section of a mentally disordered offenders team
Authors: Harman Rachel , Dalton Rita
Published: August 2011

There is increasing recognition that, wherever clinically appropriate, the needs of mentally disordered offenders should be met by health and social services rather than the criminal justice system (Cohen & Eastman, 1997). Many trusts now make separate service provision for this client group, but there has been little research into the role of applied psychology in these services. This study consists of an exploratory audit of the referrals to applied psychology in a multidisciplinary mentally disordered offenders team. Client characteristics as well as referral characteristics were explored. One of the main results of the audit was that clients referred for outpatient groups (who were not normally known to the team prior to referral) had significantly higher rates of non‐attendance and drop‐out than clients referred for other reasons. Outpatients in general also had higher rates of non‐attendance and dropout than inpatients. The main conclusion of this study is that applied psychology resources may be best used in the provision of services to clients known to the team and that, as inpatient work may be more productive, it should perhaps be the priority for psychologists working with this client group.
Characteristics of need and risk among women prisoners referred to inreach mental health services
Authors: Loughran Michael , Seewoonarain Kishane
Published: August 2011

High levels of need and complexity were identified in women referred to and accepted by the inreach team in HMP & YOI Bullwood Hall during the first two years of operation. They included mental health problems, personality disorder, substance misuse and social factors. During the first and second years of operation, there were 124 and 194 referrals respectively. Prevalence of substance misuse was high, and a large proportion of women were involved in multi‐drug use. Low mood was the most common reason for referral. The prevalence of intentional self‐injury was high, and was significantly associated with previous suicide attempts, history of abuse and personality disorder traits. A number of factors were identified that compromised effective through‐care to the community, including lack of accommodation and primary care access on release, and that disrupted the connectivity of care. These factors contributed to the social exclusion of this vulnerable group.
Offender profiling: a review of the literature
Authors: Gregory Nathan
Published: August 2011

All societies in the modern world are troubled by crime, and the general public is equally fascinated by criminals and fearful of criminal behaviour. In the United Kingdom, events such as the murders of Jack the Ripper, the Yorkshire Ripper and Harold Shipman, and the Soham tragedy, coupled with film and television programmes including Silence of the Lambs, Cracker and Crime Scene Investigation, have fuelled the public's consciousness of the criminal mind.In the fight against crime, the development of offender profiling by the FBI in the USA has further captured people's imagination. The technique was introduced to help law enforcement agencies solve serious crimes such as serial rape or murder, and to a lesser extent arson and property crime. At the heart of profiling lies the belief that by combining psychological principles with crime scene analysis, it is possible to identify the likely characteristics of a perpetrator.Although advances in crime detection are welcomed, the profiling field appears riddled with contradiction and disagreement. Social scientists argue that the discipline is unscientific due to methodologically weak research, while police officers appear sceptical about its benefits for solving crime. In Britain, profiling has witnessed both notable successes, for example Canter's profile of the serial rapist and murderer John Duffy, and dramatic failures, such as the Colin Stagg profile in the Rachel Nickell inquiry. This article reviews the offender profiling literature, examines its applicability in the legal system and identifies areas for future research.
What health partnerships should seek to provide for offenders
Authors: Lane‐Morton Tish
Published: August 2011

The quality and relevance of what happens in prisons are measurably improved once prisons are seen, and have to act, as an integral part of society and the community. The provision of health care has benefited a great deal from the involvement of national and local agencies whose professional expertise is in health and education. HM Inspectorate of Prisons (HMIP) has developed the World Health Organisation's concept of a ‘healthy prison’ (WHO, 1998) to judge the treatment of prisoners and the conditions in which they are held against four core criteria. Partnership working between the Prison Service and NHS was formalised in April 2000, and the majority of prisons have transferred the commissioning of health care to the NHS. This paper considers the challenges and developments of partnership working in improving health outcomes for prisoners, and identifies future improvements.
High secure services
Authors: Campbell Andrea
Published: August 2011

Abstract High secure services treat patients who may have very complex clinical needs under conditions of security. Until very recently such services were run and managed on the periphery of the structures and accountability arrangements put in place for the rest of the NHS, becoming isolated from modern thinking and evidence‐based therapeutic practice. A high percentage of patients in the high secure system were assessed as no longer requiring that level of security.Following an inquiry at Ashworth hospital which reported in 1999, steps were taken to bring these services into the mainstream of the NHS, to decentralise further the commissioning and performance management and to develop the capacity and capability to enable discharge of patients to lower levels of security. New partnerships and new relationships have resulted in an NHS Plan target of 400 patients discharged from high security.The inclusion of high security services within Health & Offender Partnerships creates a framework for managing proposed and ongoing changes. High security services are a necessary part of our mental health system and should be valued and developed. This paper outlines how quality improvements will be enabled and embedded.
Applied psychological services
Authors: Crighton David
Published: August 2011

Applied psychology interventions have an important role to play in mental and physical health services with offenders and in reducing re‐offending. There has been a significant growth of the evidence on the effectiveness of specific interventions. Barriers still exist to delivering effective psychological interventions.Psychological interventions also have a key role in comprehensive, accessible services with offenders in relation to long‐term disorders as well as co‐morbid problems. Until 2000 offenders were largely excluded from mainstream health and social care provision. Very significant progress has been made in this respect. The provision of mainstream psychological therapies had until recently lagged behind other areas of health care. As a result, Applied Psychology Group (APG) has developed a new strategy, with a shift of emphasis towards strategic development of psychological interventions ‐ away from a primary focus on psychologists, to psychology and its applications.This paper outlines recent developments designed to ensure delivery of high‐quality psychological interventions in Health and Offender Partnerships.
Conditional discharge: the role of the social supervisor ‐ a preliminary study
Authors: Riordan Sharon , Lewis Keith , Humphreys Martin
Published: August 2011

The process of statutory community aftercare for restricted hospital order service users is acknowledged as successful. Previous research examining the attitudes of forensic psychiatrists to the use of restriction orders has indicated that they view them as a useful clinical tool in some circumstances, particularly where there is evidence of previous breakdown of follow‐up. This study, as part of a larger project examining the effectiveness of statutory community aftercare, focused on the attitudes of social supervisors to the process of conditional discharge and their role within it. The findings showed that social supervisors agree that there are positive and negative aspects to the process. They overwhelmingly agreed that the legal framework ensured that service users continued engagement with psychiatric services, leading to enhanced compliance with treatment and follow‐up, but recognised that, at times, the role, because of its control aspect, created tension in the social worker‐service user relationship. Social supervisors suggested that investment should be made into providing appropriate accommodation for this group of people and, where appropriate, access to drug and alcohol misuse services.
A descriptive analysis of the nature and extent of bullying at a category C prison
Authors: Nagi Claire , Browne Kevin , Blake Johanna
Published: August 2011

The main aim of the study reported was to explore the nature and extent of bullying at a category C prison. The sample consisted of 51 adult male prisoners, who were asked to complete a questionnaire designed to assess their experiences of victimisation and witnessing bullying in the prison during their time there. The results indicate that more than half (51%) of the prisoners report being victimised and more than three‐quarters (76%) report witnessing bullying. The most common forms of bullying were less direct forms of aggression (for example namecalling and teasing). No significant associations were found between being a victim of bullying and the type of prisoner, or whether the prisoner was new to the prison system.
Threats against health care workers, part I: a review; classification, prevalence and management
Authors: Dalton Rita , Eracleous Helen
Published: August 2011

This article considers the literature on threats made by individuals, with particular reference to threats made by patients against health care workers. It is in two parts. The first part considers the definitions and classification of threats, the prevalence of threat‐making and suggestions for assessment and management. The second part concerns the characteristics of those who threaten and the impact of the threats on the victims, and considers threats as predictors of, and part of, the escalating process which leads to further violence.
Threats against health care workers, part II: the characteristics of those who makes threats, threats as predictors of violence and effects on the victims
Authors: Dalton Rita , Eracleous Helen
Published: August 2011

This article considers the literature on threats made by individuals, with particular reference to threats made by patients against health care workers. This is the second of two parts, and concerns the characteristics of those who threaten and the impact of the threats on the victims. It considers threats as predictors of, and part of, the escalating process which leads to further violence.
Informing policies in forensic settings: a review of research investigating the effects of exposure to media violence on challenging/offending behaviour
Authors: Steward Joanne , Follina Franco
Published: August 2011

This review collates the empirical evidence on the behavioural effects of media violence. It assesses the content of different forms of media to which patients in secure services could be exposed. Numerous explanations for behaving aggressively are examined, using a variety of theoretical backgrounds. The effect of viewing different forms of violence on individuals' behaviour is also examined. The review includes positive influences of exposure to media violence, though the main findings are that exposure to aggressive and violent material increases aggressive thoughts, feelings and behaviour. The review presents research on violence depicted in films, video games, comic books and song lyrics, and assesses its impact on aggressive and inappropriate behaviour; it also addresses exposure to weapons. We conclude by outlining how this research could influence policy on the resources made available to forensic populations, advocating assessment of the suitability of presenting a particular piece of media violence to the individual rather than a whole population, and the possibility that individual responses to media violence can be a useful assessment tool.
DSPD: origins and progress to date
Authors: Maden Tony
Published: August 2011

The article reviews briefly the main factors behind the development of new DSPD services. Weaknesses in the design of the services are pointed out, and the article outlines the characteristics of patients and institutions that should be considered carefully if intentions are to be realised. It concludes by suggesting that the long‐term future of DSPD may depend on its perceived cost‐effectiveness compared with that of other services.
An evaluation of the PCL‐R in assessing prisoners with low intellectual functioning
Authors: Spiers Laura
Published: August 2011

The Psychopathy Checklist‐Revised is used in forensic and clinical settings to give an indication of the level of psychopathy an individual presents. The use of the PCL‐R with offenders with a learning disability (LD) is understudied. The current study aims to replicate a study by Morrissey (2003) which focused on the problems arising from assessing an LD service sample from Rampton Hospital. The results may suggest that the PCL‐R may be used reliably with offenders with low intellectual functioning.
‘I consider myself sadistic’: a qualitative analysis of sadistic endorsement in a group of Irish undergraduates
Authors: Davies Jason , O'Meara Aisling
Published: August 2011

Sadistic behaviour is not uncommon in offender populations, especially in some groups of violent and sexual offenders. However, little research has been conducted on sadism in a non‐offender group who are not part of a sadomasochistic culture or club. Twelve undergraduates, six of whom considered themselves sadistic and six who did not, completed an open‐ended questionnaire exploring individuals' experiences and views of themselves and others. Questionnaire responses were analysed using a thematic analysis approach and substantial differences were found between the two groups. Further research should be conducted with general population groups to further our understanding of sadistic behaviour and attitudes.
Personality assessment in offenders with mild and moderate intellectual disabilities
Authors: Mason Jonathan
Published: August 2011

Personality assessments are a clinically useful tool for offenders from the general population, and assessments of personality disorder can be used to predict future risk, as well as the likely trajectory and outcome of psychological interventions. There has been very little research examining the clinical utility of personality assessment in offenders with intellectual disabilities, both from the perspective of normal personality and from the perspective of personality disorder. After discussing the small amount of relevant research available, this article uses a clinical case example to demonstrate how a clinician might go about assessing different personality characteristics in offenders with mild and moderate intellectual disabilities, and interpreting the results. A model is presented to guide the clinician through the process of test selection, and details of the main tests under consideration are summarised in an appendix, including some of their strengths and weaknesses.
Staff attitudes towards patient‐to‐patient bullying in a secure learning disability population: a study of sex differences
Authors: Ireland Jane , Clarkson Rachel
Published: August 2011

The current study explored staff attitudes towards patient‐to‐patient bullying in a forensic learning disability service housing male clients, and the potential role of empathy. One hundred staff took part (51 men and 49 women). All completed the Attitudes towards Bullying scale ‐ Secure version (AB‐S) and the Interpersonal Reactivity Index (IRI). It was predicted that women would report more positive attitudes towards victims of bullying than men, and that increased empathy would be associated with decreased negative attitudes. It was also anticipated that increased length of service would be related to an increase in negative attitude towards victims. The results are discussed with regard to the environment in which bullying is taking place with suggestions for interventions.
Referrals for anger management groups: identifying suitability
Authors: Dalton R
Published: August 2011

An audit of 100 referrals made to anger management groups provided by a forensic community mental health team over a four‐year period was carried out to help identify the characteristics of those who benefit from the group programme. It was hypothesised that certain factors might predominate in unsuitable referrals. Only 43 individuals actually attended the initial assessment, and 17 completed the group. Chisquare tests of association established no association between attendance and any of the variables identified. Clinical assessment suggested some differences between those who completed the groups and those who did not, but the numbers were small. Given the low completion rate and the fact that variables which characterise unsuitable referrals have not been identified, it is concluded that it may be more useful to use resources in other ways.
Sexual offending and antisocial personality: exploring the link
Authors: Greenall Paul
Published: August 2011

This paper explores the link between sexual offending and antisocial personality. Drawing on previous research, it illustrates that sex offenders with an antisocial personality are a heterogeneous group, differentiated by several factors. They victimise children, adults or both, those who victimise adults or adults and children are more psychopathic. They are motivated primarily by non‐sexual factors like opportunistic impulsivity or generalised anger, and violence is a source of erotic pleasure in some cases. A small group of men, however, are driven to offend by sadistic sexual fantasies of a serious nature, which develop over time and later form the basis of their violent predatory assaults. Varying definitions of antisocial personality confuse the research, and diagnostic co‐morbidity means that pure psychopathic types are probably rare.
Audit of the NICE Guidelines for Schizophrenia in an NHS forensic psychiatric service
Authors: Gough Karen , Churchward Samantha , Dorkins Eluned , Fee Jason , Oxborrow Susan , Parker John , Smith Helen
Published: August 2011

The NICE Guidelines for Schizophrenia are designed to give guidance on the best practice in treatment and management of schizophrenia. These guidelines have 13 standards which services can use for the purpose of audit. As schizophrenia is our service's most common diagnosis, an audit against the guidelines was undertaken. The results indicated that we met three of the standards. Recommendations have been implemented to improve practice on standards that were not met, and this has led to some creative practice development. Despite the labour‐intensive nature of the audit, the results gave a clear indication of areas where there was a need for improvement and will act as a good baseline for re‐audit.
Can massage and aromatherapy benefit the users of forensic psychiatric services?
Authors: Brownsword Alessandra , Baker Elina
Published: August 2011

This article reports on the contribution that complementary therapies can make to the well‐being of service users who are recovering from mental distress. As part of a wider strategy to promote awareness of a range of self‐management techniques at a forensic psychiatric hospital, complementary therapies (massage and aromatherapy) were provided. This article reports on a review of the evidence of the mental health benefits of the regular provision of these therapies. Further research is needed to establish the effectiveness of massage and aromatherapy for the forensic psychiatric population.
The impact of low secure unit care on patient outcomes
Authors: Jones Steven , Lobban Fiona , Evershed Kate , Taylor Lee , Wittkowski Anja
Published: August 2011

A significant number of people with psychosis require inpatient admission under the Mental Health Act. Department of Health documents have highlighted the importance of delivering effective care to individuals with psychosis treated in low secure conditions. Research into patient outcomes in these settings has so far been neglected. The aim of the research reported here was to assess outcomes for patients tested at three six‐monthly assessments during their residence at a new community low secure facility for people with psychosis and challenging behaviour. Although there were numerical reductions on many of the outcome measures over time, few were statistically significant. The main significant improvements were in Positive and Negative Syndrome Scale total and delusions scores over time. Initial evidence indicates that this type of care may have promise, but further research is needed to extend these findings.
Breaking the Chain: a prison‐based participatory action research project
Authors: Sullivan Elizabeth , Hassal Paul , Rowlands Darren
Published: August 2011

This paper describes how a group of prisoners at HMP Grendon Therapeutic Community undertook to survey staff and prisoners about unmet needs relating to abstinence from substance misuse. Participatory action research (PAR) principles helped to focus the energy and enthusiasm of the group, who sought to test their hypothesis that therapy could not meet the needs of everyone in relation to relapse prevention. With help, the group developed and analysed a survey, wrote or contributed to interim and final reports, evaluated the Relapse Prevention Taster Course that was commissioned as a result and contributed to this paper. The group processes are described, and two of the members describe what they got from participating.
Forensic mental health services: facts and figures on current provision
Authors: Rutherford Max , Duggan Sean
Published: August 2011

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.
Injuries to staff from implementation of physical interventions: could poor manual handling be at fault?
Authors: Stubbs Brendon
Published: August 2011

This paper addresses increasing concern about the physical consequences for both staff and patients following implementation of physical interventions (PI), with particular attention to injuries to staff and patients. The literature to date suggests that staff have consistently been injured more than patients. Future research is needed to establish clearly what proportion of staff injuries can be attributed to the potential causes outlined in this article.
Measuring psychological change in offenders with intellectual disabilities and alcohol misuse using repertory grids: two case examples
Authors: Mason Jonathan
Published: August 2011

Measuring psychological change in offenders with intellectual disabilities undergoing psychological therapy presents the clinician with a variety of challenges. They include finding measures sensitive enough to measure the often modest cognitive changes that take place over the course of psychological therapy and finding measures appropriate to use with this client group. Little is known about the use of alcohol in offenders with intellectual disabilities. Repertory grids, based on Kelly's (1955) theory of personality, have been shown to be an adaptable, sensitive, reliable and valid measure of psychological change. Two case examples are used to show how repertory grids can be used to assess the treatment gains made by patients undergoing different (though similar) psychological interventions aimed at reducing alcohol misuse.
Mental disorder and adverse life events in a forensic intellectual disability service
Authors: Gore Nick , Dawson David
Published: August 2011

The study investigated the frequency of adverse life events and prevalence of MD recorded for clients with intellectual disabilities (ID) in a medium secure unit, using data from an electronic patient record (EPR) system. Prevalence of MD was calculated on the basis of ICD‐10 diagnoses and a 38‐item checklist was developed to investigate adverse/traumatic life events for sub‐samples with and without MD. High rates of MD were reported overall, particularly of schizotypal and delusional disorders and disorders of personality. Adverse life events including abuse, bereavement and relationship difficulties had been documented by clinicians. The overall number of recorded events was significantly higher for clients diagnosed with a MD. Associations between MD and life events have been reported previously, but not in a forensic ID population. The study contributes to a growing body of literature highlighting the relationship between life events and mental health in people with ID, offering further information for service development and clinical practice.
A retrospective study of historical risk factors for pathological arson in adults with mild learning disabilities
Authors: Kelly Julia , Goodwill Alasdair , Keene Nick , Thrift Su
Published: August 2011

This pilot study investigated three historical risk factors for pathological arson identified in Jackson's Only Viable Option theory (Jackson, 1994), which views the act as an adaptive response to circumstances that are difficult to tolerate and which the individual does not have the necessary skills to resolve by appropriate means. Twenty men with mild learning disabilities were recruited from inpatient forensic services. It was hypothesised that there would be a greater incidence of risk factors among individuals with an index offence of arson than those without, and that risk factors would significantly predict an index offence of arson. Significant differences were found between the groups for perceived inability to effect social change and childhood experiences of fire, but not for the family problems under investigation. However, the sample size was too small to draw reliable conclusions on the predictive ability of the risk factors. The findings suggest that perceived inability to effect social change and childhood experiences of fire are risk factors characteristic of men with learning disabilities who have set fires, lending support to elements of Jackson's theory and providing opportunities to develop evidence‐based practice. However, the underlying causes of these risk‐factor characteristics remain unclear. It is hoped that the present study will help inform the choice of risk factors under investigation and improve the design of a larger study.
Treatment need and provision in medium secure care
Authors: Davies Jason , Oldfield Kate
Published: August 2011

Individuals being treated in medium secure hospitals have typically engaged in some form of offending in other service settings or while in the community. Although psychological treatment for addressing such behaviour in medium secure hospitals is beginning to be developed, at present there is a lack of evidence of ‘what works’. This paper reports a review of the type and level of offending behaviour engaged in by those in a single medium secure service, including the conviction histories for such behaviours and the psychological approaches to risk reduction and offending behaviour taken in medium secure hospitals in England and Wales. The need to develop an evidence base for psychological treatment in medium secure services including at the individual level is clearly indicated.
Assessing high risk offenders with personality disorder
Authors: Greenall Paul
Published: August 2011

Personality disorder was once a ‘diagnosis of exclusion’ and consequently many people, including offenders, were unable to access appropriate care. Some offenders therefore slipped through the net, with devastating consequences. However, recent developments in the health and criminal justice fields have sought to address this problem. One such initiative was the establishment in the Northwest of England of three specialist multi‐disciplinary Forensic Personality Disorder Assessment and Liaison Teams. Their task is to assess high‐risk offenders with personality disorder and provide a gate keeping and monitoring function to agencies involved in their care and management. This practice‐based paper outlines the work of the Greater Manchester team. It describes the team's approach to the assessment of these individuals and outlines some of the professional and ethical challenges encountered so far.
Experience of collaborative research practice in forensic mental health
Authors: Adams Jean , Steele Sandra , Kettles Alyson , Walker Helen , Brown Ian , Collins Mick , Sookoo Susan , Woods Phil
Published: August 2011

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.
The benefit of hair for the construction of facial composite images
Authors: Frowd Charlie , Hepton Gemma
Published: August 2011

The police often ask witnesses and victims to construct a facial composite of people they have seen committing a crime. Research has suggested, however, that these images are of poor quality due to memory decay, the face construction method used and the presence of the external facial features (hair, ears, face shape). In the current work, the role of the most important external feature, hair, was explored. Participants were shown an unfamiliar target face and constructed a composite of it 24 hours later using a modern recognition‐based system and one of three types of hair: exact, similar or poor match to the target. Better‐matching hair was found to help participants construct a more identifiable central region of the face (eyes, brows, nose, mouth). The results highlight the importance of accurate hair at the start of the construction session. Implications for police practice are discussed.