bluuebunny/crossref_metadata_2025 huggingface dataset:
Recording adverse drug reactions in a forensic psychiatry unit: how can we improve standards?
Authors: Gibbon Simon , Khalifa Najat
Published: August 2011

Adverse drug reactions (ADRs) are increasingly recognised as an important cause of morbidity and mortality. Psychiatric patients, and especially those in forensic units, may be at increased risk of ADRs. Detection and documentation of previous ADRs are essential in reducing the risk of future ADRs. A baseline audit was undertaken, and subsequently the recording of ADRs on the drug cards of patients in a forensic psychiatry unit was re‐audited. Poor levels of documentation of ADRs were found. Following the baseline audit, a number of simple measures were undertaken which improved performance at re‐audit.
Predicting violence in a medium secure setting: a study using the historical and clinical scales of the HCR‐20
Authors: McKenzie Brian , Curr Helen
Published: August 2011

This study examined the ability of the HCR‐20 Scale (version 2) to predict incidents of in‐patient violence during a stay on a medium secure ward. The study was carried out retrospectively on a sample of 94 admissions, using reports pre‐existing at the time of admission and nursing observations of behaviour in the two weeks that followed admission. The sample group was made up of mentally disordered offenders and patients with challenging behaviour. Their episodes of care averaged two years.The H and C scores, singly or combined, did not show powerful predictive capacity for the sample as a whole, which had a high base rate for violence. Insufficient variance and poor inter‐rater reliability precluded use of the R variable. For purposes of analysis, violent patients were also grouped on the number of incidents committed during their episode of care. Here the C Scale items showed strong predictive capacity for patients with more than 10 incidents during their stay. The paper argues that the latter finding supports a method of predicting admissions at risk of frequent incidents of violence.
Prison health in England
Authors: Cinamon Hannah , Bradshaw Richard
Published: August 2011

In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.
Safer Custody Group
Authors: Sedenu Anna
Published: August 2011

This paper describes the current levels of ‘self‐harm’, suicide and violence in prisons in England and Wales, outlines key high‐risk groups within the prison population and gives relevant national targets on self‐inflicted deaths and serious assaults ‐ now included in the National Offender Management Service (NOMS) national targets for 2005‐06. It outlines the case for Safer Custody Group to continue to provide on‐going services to tackle ‘self‐harm’, suicide and violence, as part of health and offender partnerships. The link with the ‘health agenda’ is explored, and concrete examples are given of successful collaborative work with the Department of Health and others. The delivery of services intended to promote and mainstream safety, health and well‐being in both public and private prisons is described, as are current and future projects aimed at delivering better services to prisoners, staff and bereaved families.
Mental Health Unit
Authors: Snow Penny , Moody Elizabeth
Published: August 2011

The paper sets out the work of the Mental Health Unit, part of the Health and Offender Partnerships Directorate. It explains the functions of the Unit in advising and taking decisions on behalf of the Home Secretary in exercising his powers in relation to dangerous mentally disordered offenders. It also sets out the work of the Unit in relation to the new Mental Health Bill. The Unit's role in developing Government policy in relation to mentally disordered offenders is not covered here.
Drug Strategy Unit
Authors: Lee Martin , George Simon
Published: August 2011

The paper covers:• nature of the drug problem ‐ drug dependence, prevalence of misuse, distribution of problematic drug‐users (PDUs) across NOMS and how drug‐related offending manifests itself• drug strategy in prisons ‐ demand reduction, supply reduction and establishing through‐care linkages, clinical services, counselling, assessment, referral, advice and through‐care services (CARATs), drug rehabilitation programmes, drug testing programmes, supply reduction initiatives, DIP linkages and wider resettlement agenda• assessing need and planning for the future ‐ needs analysis, development of the collaborative drug treatment vision, initiatives planned or under way to improve quality and amount of treatment available, and mainstreaming/integration of services to reduce re‐offending and make public environment safer.
Health & Offender Partnerships
Authors: Boyington John
Published: August 2011

This article introduces the rationale for bringing more closely together those parts of the Home Office and Department of Health that were concerned with policy for health and offenders. The experience of the Prison Health partnership, now entering its fifth year, has demonstrated the enormous potential for improved joint working. Information about the morbidity rates among offenders is included.The paper also introduces three main developmental projects being taken forward across the new organisation: improving the quality of health services for people in police custody (jointly with the Police Leadership and Powers Unit/Home Office), court diversion and care, and improving health and health services for offenders in the community.The projects are described and the challenge noted of bringing together more effectively and efficiently these two large systems.
Perspectives of Enhanced Thinking Skills in prisons in the United Kingdom: a qualitative case study
Authors: Clark Jill
Published: August 2011

This article discusses findings from one phase of a research study funded by the Learning and Skills Development Agency which aims to improve the thinking and communication skills of prisoners in England and Wales. Perceptions and discussions of a qualitative case study of an offending behaviour intervention ‐ Enhanced Thinking Skills (ETS) ‐ are presented, including perceptions of the ETS experience. Discussion includes factors which affect the delivery of the programme, such as group climate and dynamics, personality differences, responses of inmates and accounts of motivation. These are set in the context of current criminal justice policy in England and Wales.
A solution‐focused model and inpatient secure settings
Authors: Gralton Ernest , Udu Victor , Ranasinghe Shan
Published: August 2011

There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these services. There is longstanding tension between security and treatment that can be difficult to resolve. Solution‐focused ideas may provide a bridge between these two issues, by improving multi‐disciplinary working and providing an appropriate relationship style that optimises the delivery of care to forensic patients.
Social circumstances reports presented to mental health review tribunals
Authors: Lewis Keith
Published: August 2011

This paper describes the social circumstances report, written for the MHRT in an historical setting, and incorporates a small‐scale audit to determine the effect of implementing national guidelines in July 2002. Sixty reports were audited ‐ thirty in the period immediately before the introduction of national guidelines, and thirty immediately following the introduction of national guidelines. These reports concerned only patients subject to a hospital order with restriction under Section 37/41 of the Mental Health Act 1983. National guidelines comprised 102 individual sub‐headings within 17 main headings. Each report was scored using these guidelines as a checklist. Results show that compliance as measured by the national guidelines significantly improved following their circulation.Very little previous research has been undertaken in this area and only by researchers from the legal profession. Further research may need to be undertaken by social work professionals themselves, and by local authorities, which may encourage others in the profession to build on this knowledge. At present the process appears to be exclusively a legal interest rather than a joint interest with social care.
Attitudes towards sex offenders and the influence of offence type: a comparison of staff working in a forensic setting and students
Authors: Ferguson Kerry , Ireland Carol
Published: August 2011

The objective of this study was to investigate attitudes towards individuals who commit different types of sex offence, with subsidiary aims of exploring the influence of respondent sex and the influence of personal experience of sexual abuse. The sample comprised 139 participants (49 students and 90 forensic staff). All were provided with a vignette depicting a specific type of sex offence, and asked to complete a scale assessing attitudes towards sex offenders (Hogue, 1993). Forensic staff were more likely than students to view sex offenders in positive terms, viewing them as individuals who could be rehabilitated. Participants who reported being victims of sexual abuse, or that someone close to them had been abused, viewed sex offenders less negatively than non‐victims. Men demonstrated less positive attitudes towards child incest and child indecent assault offenders than to stranger rapists. Women held more positive views towards sex offenders than men, and this was consistent across offence type.
Inducing traumatic attachment in adults with a history of child abuse: forensic applications
Authors: de Zulueta Felicity
Published: August 2011

Childhood trauma is very likely to produce ill‐health and psychiatric disorder in adulthood. The paper discusses attachment theory and various forms of insecure attachment to the parent/caregiver, particularly disorganised attachment behaviour and the traumatic attachment response. Eliciting the (usually hidden) traumatic attachment in adults can give access to the patient's representational models of their parents, allowing a basis for treatment of disorders. The paper describes and illustrates the use of the TAIT technique for eliciting such models.
Motivating convicted sex offenders into treatment: a pilot study
Authors: Theodosi Eleni , McMurran Mary
Published: August 2011

Sex offenders who refuse a place on a sex offender treatment programme are estimated to make up about half the prison sex offender population in England and Wales. It is important to motivate refusers to participate in treatment to reduce the likelihood of their re‐offending. In this pilot study we used the Personal Concerns Inventory‐Offender Adaptation (PCI‐OA), a semi‐structured motivational assessment, further adapting it for treatment refusers. We examined the effectiveness of the PCI‐OA (TR) with nine prisoners who had refused sex offender treatment (the treatment group) compared with nine refusers who received no intervention (the control group). The treatment group were at least 0.6 times as likely to show a positive motivational shift towards sex offender treatment as the untreated group. The practice implications of these results are discussed, and further evaluation of the PCI‐OA (TR) is recommended.
A cognitive behavioural groupbased educational programme for psychotic symptoms in a low secure setting: a pilot evaluation
Authors: Mclnnis Erica , Sellwood William , Jones Clair
Published: August 2011

This study reports a recovery‐themed cognitive behavioural educational group for clients suffering from chronic positive and negative symptoms of schizophrenia, on a low secure inpatient unit. Nine participants completed baseline and post‐intervention measures of insight, self‐esteem and knowledge about schizophrenia. Additional post‐intervention measures included compliance with medication, feelings about schizophrenia, qualitative views and access to the community. Overall, the results were positive within the limits of this small‐scale study. Following the intervention, most participants reported that they were less frightened about psychosis, and felt more in control of their illness and more optimistic about their future. This study suggests that there may be clinical benefits of having CBT‐orientated educational groups in low secure settings with clients with longstanding co‐existing positive and negative symptoms of schizophrenia. Recovery style should be evaluated systematically in future studies.
High‐risk inferences in assessing high risk: outstanding concerns in the clinical use of the PCL‐R
Authors: Thomas‐Peter Brian , Jones Jason
Published: August 2011

The PCL‐R has been heralded as the ‘unparalleled’ (Salekin et al, 1996) risk assessment tool for assessing risk of violent and non‐violent recidivism. In the UK, the PCL‐R looks likely to become an industry standard assessment in psychological evaluation of individuals thought to have a dangerous and severe personality disorder. However, current knowledge about the PCL‐R is unsatisfactory, and a number of issues need to be addressed before clinicians can be confident in the use of this measure. This paper highlights these issues from the perspective of the practising clinician. Questions are raised about the theoretical, methodological and treatment implications of the use of the PCL‐R. Future research needs are established in this context of caution over the use of the measure in routine clinical and academic assessment.
Forensic personality disorder in an MSU: lessons learnt after two years
Authors: Clarke Amory , Ndegwa David
Published: August 2011

For the last two years, the Forensic Mental Health Service at South London & Maudsley NHS has been one of the pilot sites funded by the DSPD programme. In this paper we are reporting on one segment of the Personality Disorder Service. As of December 2006, the service will have been operating for two years. This is one of several Home Office‐funded forensic personality disorder treatment sites in the UK. It consists of a 15‐bed medium secure inpatient service, a community team and two hostels.We begin by describing briefly our treatment model and the theoretical underpinnings of our service. However, the bulk of this paper will report on the lessons we have learned.
Working with mentally disordered offenders: government policy, NOMS and inaction
Authors: Fitzgibbon Diana , Cameron Angus
Published: August 2011

This article seeks to explore the historical context of government policy in relation to mentally disordered offenders. The article will relate this context to the work of the Probation Service, in particular the development of the Offender Management System (OASys), risk assessment and the implications and challenges that face the National Offender Management Service (NOMS). The key question to be assessed is whether NOMS and OASys can lead to a better service for those with mental disorder, and therefore reduce their risk.
Running a sexual health group in a women's medium secure unit
Authors: Hebb Jo , Donnelly Tracey
Published: August 2011

This paper explores sexual health, the problems faced by women with severe and persistent mental illness (SPMI) in attaining sexual health, and concerns about sexual vulnerability. It goes on to look at the difficulties faced by women detained in a medium secure unit. It describes the development, running and evaluation of a pilot sexual health group aimed at meeting some of the needs highlighted in the literature.
The Life Skills group ‐ an introductory multi‐modular group programme in forensic learning disability
Authors: Hearne S , Garner K , O'Mahony B , Thomas C , Alexander R
Published: August 2011

This paper describes an innovative, multi‐modular group therapy programme based on cognitive‐behavioural principles and psycho‐education. It introduces participants to strategies and skills to assist with deficits such as poor social skills, low self‐esteem, poor emotional regulation and problematic inter‐personal relationships. The manual‐based format of this programme enables members to be introduced to working in a group, and enables facilitators to obtain qualitative information about group members to promote existing skills in future treatment programmes. The core deficit areas targeted by the programme are not by any means exclusive to individuals in in‐patient forensic learning disability settings, so the programme can be useful for clients with learning disability and offending behaviours who are resident in the community.
Assessing burn‐out and occupational stressors in a medium secure service
Authors: Oddie Sharon , Ousley Leah
Published: August 2011

The study aimed to identify occupational stressors and measure experiences of clinical burn‐out among a group of mental health nurses and occupational therapists in a medium secure service. All the nursing staff (n=115) and occupational therapists (n=9) on three wards in a medium secure hospital were asked to partake in the study, and to complete a modified version of the Psychiatric Nurse Occupational Stress Scale (PNOSS), the Maslach Burnout Inventory (MBI) and a demographic questionnaire designed for the study.Results from the PNOSS revealed that organisational issues elicited the greatest stress and were most strongly related to high burn‐out scores, identified by the MBI. Limited resource and staff conflict were also associated with stress and burn‐out. Patient care had a relatively small impact. MBI findings were that a substantial proportion (54%) were experiencing high burn‐out in relation to emotional exhaustion.
Can goals limit interpersonal growth? Tackling mood difficulties using the goal discrepant model of affect: a case study
Authors: Coote David , Kevis Clare
Published: August 2011

There is a growing trend in psychiatry that claims that all goal‐orientated therapy is predictive of healthy outcomes. However, there is evidence that an excessive focus on materialistic goals may be related to problems with ‘mood’. The exact way in which goals are internalised and affect our unconscious motivations is here explored in a clinical context.
The concept of unfitness to plead
Authors: De Souza Dominic
Published: August 2011

The concept of unfitness to plead is central to conduct of a fair trial for someone accused of a crime. The historical origins go back several centuries, developing through a number of legislative changes. The modern concept of unfitness to plead arose from a number of legal cases in the 19th century. The Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 followed a number of concerns over existing legislation. More recently, there have been a number of amendments made through the Domestic Violence, Crime and Victims Act 2004. This paper reviews the history and changes in legislation to the present day, and provides an example of the practical application of fitness to plead in practice. It also reviews relevant research and attempts to consider the future of this important medico‐legal term.
An audit of admission physical examinations in the settings of medium security
Authors: Galappathie Nuwan , Jethwa Krishma
Published: August 2011

The paper presents an audit of admission physical examinations performed in the settings of medium security. Documentation regarding 16 key items of the admission physical examination was assessed. During the first audit, 51 admission physical examinations were assessed, and 50 were assessed on repeat audit. The standard of documentation of the physical examination was poor, and remained poor on re‐audit. Significant improvement was noted only in the recording of temperature, which had improved from 4 out of 51 (8%) to 13 out of 50 (26%) in audit 2 (Yates‐corrected ‐2 =4.72, d.f.=1, p<0.05). Of particular concern are ongoing omissions in the neurological examination and poor recording of marks, bruises and injuries.
The role of the mental health professional in cases of online sexual activity
Authors: Hynes Fiona , Taylor Nicholas , Lenihan Fionnbar
Published: August 2011

This article seeks to explore the role of the mental health professional when involved with assessment and management of individuals with a history of online sexual activity. This is a relatively new area for many professionals, who are often unaware of the novel and expanding theoretical base for work in this area. A review is provided of the aetiological theories relating to online sexual activity.
Secure settings and the scope for recovery: service users' perspectives on a new tier of care
Authors: Barsky Jamie , West Adrian
Published: August 2011

This research attempts to explore in‐patient perspectives on the long‐stay, medium‐secure hospital wards in which they are based. Semi‐structured interviews focused on the care provided by the hospital in comparison with the high‐secure hospitals from which the participants had been transferred. Questions focused on the participants' perceptions of recovery and the scope for it at both sites.The data suggests that participants identify increased scope for recovery at the long‐stay, medium‐secure facility, and that this is promoted by increased flexibility due to less emphasis on security. Important factors discussed by participants were increased access to a range of activities, graded access into the community, the different atmosphere in the hospital sites and the differences in potential for developing trusting relationships with staff and fellow in‐patients.
The impact of mental capacity legislation on the assessment of people with learning disabilities: a practice note
Authors: Craig Leam , Nagi Claire , Hutchinson Roger
Published: August 2011

Assessment of mental capacity in people with learning disabilities involved in criminal proceedings has been debated, and the introduction of mental capacity legislation in the United Kingdom makes provisions for people who lack the capacity to make decisions about their welfare. However, while the new legislation is designed to protect people who lack the mental capacity to make decisions, it is not clear how this legislation applies in criminal cases where the capacity to consent to sexual relations has been questioned. Until recently there was no clear definition of capacity to consent to sexual relations, and the aim of this paper is to consider the key aspects of this legislation and apply it to a case example. The definitions and assessment procedures involved in assessing ‘mental capacity’ are considered, and practice guidance for mental health professionals working in this field is offered.
Using the internet to conduct research relevant to forensic practice
Authors: Davies Jason , Oddie Sharon , Powls Jonathan
Published: August 2011

Internet‐mediated research is becoming an increasingly viable option for forensic researchers, allowing some of the limitations of traditional approaches to be overcome. Many advantages are evident in this approach, such as the ability to access large, diverse samples and specialist groups. However, there are limitations and ethical issues that researchers need to be aware of. This paper provides an overview of internet‐mediated research for forensic researchers and practitioners, and highlights some of the ways in which this approach can be used to undertake research relevant to forensic practice. Some examples of research undertaken using this approach are provided.
Arson: characteristics and predisposing factors in offenders with intellectual disabilities
Authors: Devapriam John , Raju Lammata , Singh Niraj , Collacott Richard , Bhaumik Sabyasachi
Published: August 2011

The prevalence rate of arson in offenders with intellectual disabilities (ID) has been reported to be higher than that in the general population. This retrospective study focuses on examining the characteristics of offenders with ID and the range of identified reasons for the index offence. The findings indicate a higher prevalence of arson in this population, along with the fact that the majority of people with ID who have committed arson tend to bypass the Criminal Justice System. A significant number are likely to repeat the behaviour and will also commit other offences. The most common reason for arson appears to be revenge, closely followed by suggestibility. The majority had an associated diagnosis of personality disorders along with an Axis 1 psychiatric diagnosis. Other factors include large family size, history of childhood psychiatric disorders, abuse, homelessness, unemployment and relationship difficulties.
Factors associated with quality of life in a cohort of forensic psychiatric in‐patients
Authors: Long Clive , McLean Andrew , Boothby Anita , Hollin Clive
Published: August 2011

Self‐reported quality of life (QOL) was examined in a cohort of detained psychiatric in‐patients. Two patient groups, categorised as high and low on the Lehman Quality of Life Interview (QOLI) in terms of their ‘satisfaction with life in general’, were compared. A model of satisfaction with life derived from a logistic regression analysis contained three measures: (high) QOLI satisfaction rating for living situation, (low) suicidality and (high) motivation and energy. The practical implications of these findings are discussed in terms of assessment, symptom relief and environmental change.
Offence characteristics, trauma histories and post‐traumatic stress disorder symptoms in life sentenced prisoners
Authors: Payne Elizabeth , Watt Andrew , Rogers Paul , McMurran Mary
Published: August 2011

Life‐long trauma histories and PTSD symptoms in 26 life sentence prisoners detained in a British Category B prison were examined. Prisoners were categorised on the basis of whether index offence violence resulted in human fatality, and whether reactive or instrumental violence was used in the index offence. Symptom measures included the Impact of Events Scale ‐ Revised and the Posttraumatic Stress Diagnostic Scale. Eight prisoners (31%) met all DSM‐IV criteria for current PTSD diagnosis. Partial PTSD was common in the remaining prisoners. Number of PTSD symptoms was unrelated to both the act of killing and the nature of violence. The rate of trauma prior to index offences was positively related to intrusive, avoidant and hyperarousal symptoms attributed by the prisoners to their index offence. The results suggest that prior trauma sensitised prisoners' traumatic reactions to their offences.
A survivor‐orientated approach to the rehabilitation of a personality‐disordered institutionalised medium secure service user: case study
Authors: Hossack Alex , McCarthy Jennie , McClean Elaine , Serette Leslie
Published: August 2011

This case study illustrates the rehabilitation of a woman who suffered chronic sexual, physical and emotional abuse throughout childhood that resulted in 20 years of secure psychiatric care and a ‘psychopathic personality’ diagnosis. Rehabilitation used a survivor‐orientated approach to resolve symptoms of posttraumatic stress disorder, institutionalisation and a dysfunctional narrative.
The first three years of a community forensic service for people with a learning disability
Authors: Benton Carl , Roy Ashok
Published: August 2011

This paper reports on the first three years of a community forensic team in Birmingham working with individuals with learning disabilities who have offended or are at risk of doing so. Using an interprofessional model, the team provided assessment, intervention and management, enabling individuals to live in the least restrictive environment. There were 113 referrals, the majority (94%) of whom were males. Only 26 had been convicted. The problems this raised for the team are discussed, along with the cost‐effectiveness, impact on admission rates and benefits of providing such a service. Two case scenarios are presented to highlight some of the issues encountered by the team. The paper supports the development of such services.
Getting out and staying out: does substance use treatment have an effect on outcome of mentally disordered offenders after discharge from medium secure service?
Authors: Derry Andrew , Batson Amy
Published: August 2011

Although a majority of mentally disordered offenders have substance use problems (Wright et al, 2002), as yet there have been few attempts to understand the human and financial cost of this problem in forensic mental health services. The current study examined the effect of a drugs and alcohol programme (Derry, 2005) on re‐admission rates. As would be expected, patients with a history of substance misuse were found to be more likely to use drugs and alcohol on discharge. This group of patients were found to be at increased risk of re‐admission to forensic mental health services. Patients who participated in a 24‐session cognitive behavioural substance use programme were found to spend significantly more time in the community (89%) than those who did not (77%). These initial findings suggest that treatment for drug and alcohol problems can be effective in reducing re‐admission rates, and warrants further investigation.
Cognitive impairment and sex offending: management during therapy and factors in offending
Authors: Ireland Carol
Published: August 2011

This paper will discuss the potential impact of a range of cognitive impairments when working with sex offenders who present with them. It will begin by outlining the nature of cognitive impairment and the research examining the extent of such difficulties in sex offenders. It will then explore the impact of such impairments when engaging a sex offender in treatment, including the role that cognitive impairment might play in the function of their offence. Finally, some methods by which to manage and compensate for cognitive impairments will be presented. While the focus of this paper is on sex offenders, the issues presented in this paper are not exclusive to this group and may be applied to offenders in general.
Staff stress and challenging behaviour on a medium secure development disabilities ward for women: the outcomes of organisational change, and clinical interventions
Authors: Long C , Collins L , MacDonald C , Johnston D , Hardy S
Published: August 2011

The effects of organisational change on a medium secure ward for women with developmental disabilities are examined. Intervention followed the BAITS model (Milne et al, 2003) in focusing on behavioural analysis, intervention, training and support as a way of amalgamating psychological perspectives to address problems and promote positive attitude change. The positive benefits of this programme are described in terms of pre‐ and post‐changes in the perceived work environment, job satisfaction and burn‐out, and levels of disturbed behaviour. The implications of these findings are discussed in terms of promoting positive evidence‐based practices in secure developmental disability services.
The clinical response to substance use problems in forensic mental health services
Authors: Derry Andrew
Published: August 2011

In recent years, a number of studies have linked mental health problems, substance use and offending. These findings have been reflected in government directives aimed at targeting substance use problems within mental health services. The current study surveyed the proportion of patients with substance use problems in 87 forensic patients, and the service response by Lambeth Forensic Services as measured by care planning and substance use interventions. While 76% of patients had historical substance use problems and 35% of patients were currently using drugs or alcohol, only in patients whose substance use problems had been documented in their care plan approach (CPA) or addressed therapeutically was the percentage significantly lower.
Cognitive analytic therapy (CAT): a therapy in a medium secure hospital for a mentally disordered offender with a personality disorder
Authors: Withers Jacqueline
Published: August 2011

Cognitive analytic therapy (CAT) has a developing evidence base for working with complex cases including personality disorder. This article describes the use of CAT with a single 25‐year‐old male patient with severe personality difficulties who was residing in a medium secure hospital. It is suggested that, in treatment of severe personality difficulties, rather than aiming at ‘cure’, therapy may have a more modest goal such as movement from personality‐disordered functioning to adequate or optimal personality functioning.
Treatment outcome following intervention in a prison‐based therapeutic community: a study of the relationship between reduction in criminogenic risk and improved psychological well‐being
Authors: Shuker Richard , Newton Margaret
Published: August 2011

172 adult male prisoners were assessed before and after intervention in a UK prison‐based therapeutic community using psychometric measures of psychological well‐being and offence‐related risk. All mean scores changed significantly in the expected direction. For men tested after 12 months or more, concurrent changes occurred in both domains. Significant relationships were also found between parole board assessments of risk reduction and psychometric changes. The study suggests that interventions with offenders can target offence‐related risk and mental health as clinically compatible treatment targets. Interventions with offenders may need to focus on improvements in mental health to enhance participants' readiness to address risk.
Advanced videogame consoles ‐ a new and unrecognised threat to secure service provision?
Authors: Reed James , Taylor Nicholas , Mackay John
Published: August 2011

Games consoles are ubiquitous in the community, and increasingly in demand in secure forensic psychiatric settings. They contain a range of sophisticated technologies, which may pose a significant security risk, including provision for secure wireless communication, Internet access, playing and duplication of video and audio discs, and storage of large amounts of potentially worrying video and audio content. Staff awareness of this risk is limited by ignorance and the perception that games consoles are ‘toys’ for the use of children and adolescents. This paper highlights the risks related to specific machines and provides guidance on effective management of these risks.
The psychological aspects of coping with being accused of sexual offences
Authors: Aslan Deniz
Published: August 2011

The effects of stigmatisation regarding sex abuse and rape crimes have rarely been studied. This present study explores the effects of social stigma by examining coping style, thought suppression, depression and anxiety in those falsely accused of sex crimes compared with those convicted of sex crimes. A total of 60 males volunteered to complete a questionnaire. The questionnaires were given to participants from organisations that support people falsely accused and people who have been found guilty of sexual offending. The findings indicate that falsely accused individuals employ an emotion‐focused coping strategy significantly more than convicted sex offenders.
The alcohol treatment needs of violent and non‐violent prisoners
Authors: Bowes Nicola , Sutton Adele , Jenkins Serena , McMurran Mary
Published: August 2011

In 2004, HM Prison Service launched an alcohol strategy that promotes treatment of alcohol‐related problems in imprisoned offenders. In commissioning services for prisoners, the needs of any prison population must first be established. The purpose of this study was to establish the need for an alcohol intervention in a local prison and to explore whether there might be a need to address alcohol‐related violence, rather than simply looking at alcohol misuse. The research identified the extent of the need for alcohol interventions in a UK prison for men, concluding that in this sample those who had also committed violent index offences might require interventions that specifically target alcohol‐related violence.
Attitudes towards male and female sex offenders: a comparison of forensic staff, prison officers and the general public in Northern Ireland
Authors: Higgins Caitriona , Ireland Carol
Published: August 2011

This study explored the attitudes of prison officers, forensic staff and members of the public towards and male and female sex offenders. Participants were provided with a vignette depicting a specific sexual offence committed against either an adult or a child, by either a male or a female perpetrator, and were then asked to complete a scale assessing attitudes to sex offenders based on the offender depicted in the vignette. Forensic staff emerged as having the most positive attitudes to sex offenders, viewing them as individuals who could be rehabilitated. Prison officers emerged as having the most negative attitudes, in that they were supportive of harsh and untrusting attitudes. Overall, females emerged as viewing sex offenders in more positive terms, whereas males were more supportive of harsh attitudes to sex offenders. Respondents did not have a more negative attitude to female sex offenders than to male sex offenders.
Detecting memory malingering: a case study
Authors: Galappathie Nuwan , Vakili Kian
Published: August 2011

This case report highlights initial difficulties in identifying poor effort and malingering in relation to memory, cognitive deficits and mental disorder. We provide information on the outcome for a man charged with murder who was found to be unable to stand trial as a result of poor memory. After being sentenced by way of a hospital and restriction order, he was found upon inpatient assessment to be malingering and was remitted back to prison in order to continue his murder trial. We comment on the psychological tests, physical investigations and inpatient assessment required to confirm the presence of memory malingering.
Evaluating strategies for detecting test faking
Authors: Davies Jason , Hepworth Claire
Published: August 2011

Ensuring the validity of individual responses to psychometric tests is important in a wide range of psychology practice and research. This study compares a number of methods for detecting test faking on a measure not designed with explicit validity checks. A total of 270 students took part in two related studies, one using a standard ‘pencil and paper’ test presentation and the other a computer‐based presentation. Techniques such as responses to specific test items and speed of responding may be useful for assessing the validity of responses. The implications are that such procedures may offer methods for identifying faked responding in a range of psychometric instruments where previously this has not been possible.
Ecological validity and risk assessment: the importance of assessing context for intellectually disabled sexual offenders
Authors: Boer Douglas
Published: August 2011

In psychological testing, the term ‘ecological validity’ (EV) refers to the degree to which a test assesses (or estimates) via a proxy task a person's ability to do a ‘real‐life’ task. While EV has been a critical evaluative component of some areas of psychological testing, it has not featured to date as important in the area of risk assessment. If the goal of risk assessment is to enhance risk management, then this is a critical oversight. It would appear that all forms of risk assessment measures are lacking EV. EV is important because risk management occurs in the community. The ARMIDILO is mentioned as an instrument that has attempted to include environmental variables to enhance EV and thus facilitate the risk manageability of ID sex offenders. It is proposed that the EV of other risk measures could be enhanced by the inclusion of similar environmental variables.
Patient‐to‐patient bullying in secure psychiatric services: exploring the value of official records for documenting patient‐to‐patient bullying
Authors: Henson Joanne , Ireland Jane
Published: August 2011

The study presented here examines the reporting of patient‐to‐patient bullying in a high secure psychiatric hospital housing adult men. It examines official records of bullying recorded on Suspected Bullying Report forms (SBRs), noting motivations for bullying and exploring how information was recorded. Its subsidiary aim was to explore the value of official records, presenting comparison data from three patient bullying surveys completed at the same hospital. All suspected reports of bullying in the hospital documented for a two‐year period were collected. The patient surveys included data from three data‐sets collected at the same hospital over a five‐year period. The prediction that the patient surveys would suggest a higher level of bullying behaviours than official records was confirmed. Results for official records also demonstrated that motivation for bullying was either not recorded or was reported as a typology, bullying was not likely to be recorded as hospital incidents, and perpetrators were unlikely to be offered supportive intervention. The results are discussed with regard to the value of official records as a reporting mechanism.
Considering physical intervention as a manual handling procedure: learning lessons from our general nursing colleagues
Authors: Stubbs Brendon
Published: August 2011

Mental health staff are at risk of sustaining injury from the application of physical intervention, two recent studies reporting that the risk is almost one in every five inidents. It is important that health care organisations are proactive in attempting to reduce the injuries to staff from all sources. Current physical intervention training focuses on safeguarding staff from physical assault and little time is dedicated to ensuring that staff use ergonomically safe and efficient body postures while using physical interventions, in spite of the risk of work‐related musculoskeletal disorders. To combat this problem, those in general nursing have produced a variety of risk assessment tools and conducted research on optimal ways of conducting manual handling training so that staff receive optimal uptake and transference of information from training. This article reviews the research in general nursing and analyses it with a view to informing future physical intervention training programmes.
Using the revised Problem Identification Checklist to predict inpatient and community violence: a pilot study
Authors: Nagi Claire , Ostapiuk Eugene , Craig Leam , Hacker David , Beech Anthony
Published: August 2011

The purpose of this study was to explore the predictive validity of the revised Problem Identification Checklist (PIC‐R) in predicting inpatient and community violence using a retrospective design. The Historical Scale (H‐Scale) of the HCR‐20 was employed to control for static risk factors. The predictive accuracy between predictors and outcome measures was evaluated using Receiver Operating Characteristics (ROC) analysis. The PIC‐R significantly predicted inpatient violence (AUC range 0.77‐0.92) over a 12‐month follow‐up period but did not predict community violence. Conversely, the H‐Scale significantly predicted community violence (AUC 0.82) but did not predict inpatient violence over a 12‐month follow‐up period. The findings offer preliminary validation for the predictive accuracy of the PIC‐R for violence in a UK inpatient population. Additionally, the findings suggest that short‐term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables rather than to static ones.
The nutrition and eating habits of women in secure psychiatric conditions: a survey with implications for practice and action
Authors: Long Clive , Brillon Addic , Schell Donna , Webster Paula
Published: August 2011

The nutrition and eating habits of women in a secure psychiatric service were surveyed using in vivo participation, observation and self‐report procedures. It was predicted that high levels of obesity were partly related to unhealthy eating preferences, over‐consumption of food and environmental factors that supported an unhealthy lifestyle. The results indicated an obesogenic environment in which patients made unhealthy food choices to supplement meals. Post‐survey initiatives have led to increased satisfaction with a healthier and more palatable diet and proactive attempts to help patients engage with a therapeutic and healthier lifestyle to address obesity. The importance of environmental change, education and motivational strategies to engage patients is highlighted.
Reducing prisoner vulnerability and providing a means of empowerment: evaluating the impact of a Listener Scheme on the Listeners
Authors: Dhaliwal Rani , Harrower Julia
Published: August 2011

A 37% rise in suicides among prisoners in 2007 focused attention on the needs of vulnerable prisoners (Ministry of Justice, 2008). Suicide is a common cause of death in prisons partly because there are a large number of very vulnerable individuals in these settings, and also because of a lack of appropriate resources to support them, for example therapeutic interventions such as counselling (Appleby, 2006). A range of suicide prevention strategies has been developed in prisons, one of which is the Listener Scheme, in which volunteer prisoners are trained to provide confidential support to fellow prisoners who are distressed or vulnerable. There is, however, a significant gap in our knowledge of Listeners' own experiences and the impact on them as individuals. Interpretative phenomenological analysis is used in this study to explore the process, and the findings indicate that Listeners experience significant personal growth alongside changing attitudes to self and others.
Prosecuting inpatient violence: perceptions of staff, patients and others in a women's enhanced medium secure service
Authors: Janicki Nicholas
Published: August 2011

This paper seeks to explore the perceptions of both staff and patients to the involvement of the Criminal Justice System (CJS) as a response to physical assaults committed by patients. Even though the ‘zero tolerance’ policy advocates the prosecution of perpetrators of violence, problems can arise when attempting to take legal action against psychiatric patients as the displaying of violent behaviour can be due to their mental illness. Nevertheless, the impact of an assault on victims, including both patient and staff members, can be detrimental. To the best of the author's knowledge these issues have not been investigated in a women's enhanced medium secure service (WEMSS). The conclusions drawn from this research are that the majority of respondents perceived the involvement of the CJS as crucial to maintaining high levels of morale among patients and practitioners, as well as assisting in deterring patients from committing subsequent assaults. However, police reports illustrated reluctance on the part of the Police and the Crown Prosecution Service (CPS) to prosecute inpatients.
What can be done to make sure that counselling does not harm people?
Authors: McLeod John
Published: August 2011

This paper presents an overview of the research on abuse within counselling and psychotherapy. The concept of ‘wounded healers’ is explored alongside a range of actions that can be taken against abuse. The paper concludes with a discusssion about the integration of research into practice.