bluuebunny/crossref_metadata_2025 huggingface dataset:
Deaths in police custody: a question of health or discipline?
Authors: Howe Leonie
Published: August 2011

This paper addresses the issue of deaths in police custody. The role and effects of ‘proactive’ and ‘reactive’ policing in addressing suicidal and non‐suicidal deaths is considered. Failings in the training and public accountability of police services and forensic medical examiners are discussed. Some of the past failings, it is argued, seem set to continue in the face of the Secrecy Bill (1999).
Forensic Psychiatric Nursing In Close Supervision Centres
Authors: White Tracy
Published: August 2011

This article outlines the work of close supervision centres within the prison services. The work outlines the development of such centres and how they currently manage those prisoners considered to be highly dangerous. The author illustrates how the role of the forensic psychiatric nurse in such a setting contributes to the assessment and management of severe personality disorder among such prisoners, and how the use of evidence based practice can enhance care of this client group.
A Proposed Socio‐legal Classification of Unlawful Killing ‐ with Special Reference to ‘Serial Killing’
Authors: Prins Herschel
Published: August 2011

So‐called ‘serial killing’ is frequently a topic of both professional and media concern and comment. As such, the term can be misused and may serve to obfuscate rather than illuminate.This short contribution proposes a socio‐legal classification of all forms of unlawful killing into which serial killing might best be fitted.
Developing Service Specifications for Secure Provision
Authors: Vaughan Phillip
Published: August 2011

There is not only an absence of guidelines for the development of medium and low secure units but also confusion over the definitions of these types of provision.
Cognitive Therapy: A Complementary Strategy for Expressed Anger During the Restraint of an Aggressive Individual
Authors: Hibbs Andrew
Published: August 2011

This paper proposes a complementary strategy that works in conjunction with physical restraint and which seeks to address dysfunctional thinking patterns thought to be contributory to the maintenance of the emotion of anger during an incident of aggression. The paper also includes a clinical case example to illustrate a variety of techniques that are designed to engage, challenge and dispute negative automatic thoughts and expressed verbal dialogue in an individual who requires restraint due to his aggressive and potentially harmful behaviour, which is driven by anger.
Cultural Awareness within Forensic Psychiatry: a Literature Review
Authors: Parkes J.
Published: August 2011

A review of literature concerning the over‐representation of young, African‐Caribbean males within secure psychiatric services.
Understanding the Therapeutic Relationship ‐ Women Diagnosed as Borderline Personality Disordered
Authors: Wilkins Tracy , Warner Samantha
Published: August 2011

It has been suggested that children's repeated traumatisation, such as repeated exposure to physical or sexual abuse, evokes defensive operations and experiential distortions that lead to personality disorder. This understanding has major implications with regard to how staff understand their patients, their role within the relationship and the therapy approach they take. Analysis of staff's understandings regarding influences upon the therapeutic relationship with women diagnosed as borderline personality disorder, acknowledges the centrality of trauma/attachment difficulties; however, this continues to perceive relationships as internalised difficulties within the women. This research explores the negative compounding factors that result in re‐enactments of early attachments and the need for shared responsibility for producing such relationships, in order to develop a more therapeutic, supporting and validating experience for both patients and staff.
Forensic Nursing in the Prairies of Western Canada
Authors: Kettles Alyson , Adams Lesley
Published: August 2011

Travel bursaries enable staff to visit centres of excellence in order to study practice that is different or innovative. This study tour enabled visitors to study the practice in Provincial Forensic Assessment Units, Remand Centres and Prisons, in Alberta and Saskatchewan, Canada.
Forensic Nursing: International Origins and Directions
Authors: Mason Tom
Published: August 2011

Forensic nursing is a fast‐developing branch of psychiatric nursing and now at an international level covers many aspects of practice. As its field of study develops to incorporate working with vicyims, survivors and offenders, it becomes increasingly important to establish the evidence base for the practice areas. This paper outlines these developing areas and highlights the expansive nature when see from an international perspective.
Staff Attitudes to Self‐harm and its Management in a Forensic Psychiatric Service
Authors: Gough Karen , Hawkins Andrew
Published: August 2011

Identified risk factors and clinical experience suggest that self‐harm is a common and very significant problem in forensic psychiatric settings. Sparse training on self‐harm given to staff throughout professional development is a concern for staff who can be left feeling dissatisfied and powerless as how to manage the patient who self‐harms. Consequently, staff often have to rely on idiosyncratic beliefs about self‐harm and its management to guide their practice. This survey investigated staff attitudes towards self‐harm in a forensic psychiatric service. The results highlight much variation in attitudes and a sub‐population of staff holding relatively more punitive/negative beliefs. In addition, the survey drew attention to the difficulty of managing self‐harm in forensic settings‐especially in relation to issues around facilitating safe self‐harm.
The Relationship Between Nurse Counselling and Formal Psychotherapy on a Severe Personality Disorder Unit
Authors: Westwood S. , Batey A.
Published: August 2011

This review examines the complementary roles of nurse counselling and psychotherapy. Nurse counselling is essential to ‘hold’ severe personality disordered patients between psychotherapy sessions. The psychotherapist assists nurses in making sense of the impact of psycho‐pathology on nurse‐patient relationships. Good communication is important for effective team‐working. Successful working results from nurses and psychotherapists valuing their respective roles.
Discharges from a Learning‐disability Medium Secure Unit: What Happens to Them?
Authors: Halstead Simon , Cahill Alyson , Fernando Lalini , Isweran Mike
Published: August 2011

Thirty‐five patients who had received at least one year's treatment in a learning‐disability medium secure unit were followed up for a maximum of five years. A good treatment outcome was more common in those with significant learning disability. At the end of follow‐up, 21 subjects (60%) were living in the community with support. The early months after discharge were a peak period for relapse. A very low level of reconviction was found, affecting only one subject. Patients who were older on discharge were less likely to re‐offend. The two deaths that occurred during follow‐up, and the three patients who required special (high security) hospital referral, are reported in detail. The findings are contrasted with the only comparable study (Day, 1988).
‘And now for something completely different!’ (Monty Python) Forensic psychiatric practice ‐ a complementary view
Authors: Prins Herschel
Published: August 2011

Although there is an abundance of literature dealing with the techniques of work with offenders and offender‐patients, less attention has been paid to alternative and additional means of invoking empathy and insight into behaviours that often produce anxiety, confusion and, on occasion, abhorrence. This article attempts to redress the balance.
Evaluation of the CORE outcome measure in a therapeutic forensic setting
Authors: McCloskey Helena
Published: August 2011

This study seeks to establish whether the published test characteristics of the CORE (Clinical Outcomes in Routine Evaluation Measure) outcome measure can be reproduced in a therapeutic forensic setting. The measure has been designed to address the needs of psychological therapy services for clinical, audit and management feedback regardless of the clinical setting, mode of therapy, or specific problems (clinical population) of the patients (CORE System Group, 1998). Data was collected on 53 men and compared with the normative data for clinical and non‐clinical samples published in the CORE manual.The findings show that:• the inmate sample means fall between those of the clinical and non‐clinical samples• the internal consistency of the measure was found to be generally as good as that claimed by the authors of the test• the test/retest stability figures were lower in the inmate sample• age effects were generally the same as those quoted in the manual• the refusal rate and incidence of missing items indicate that the test had good acceptability by the forensic group.It is concluded that CORE is a useful tool in a therapeutic forensic setting.
A Further 12‐Month Study of Violent Incidents Within a Medium Secure Psychiatric Unit (and a Comparison with the Previous 12 Months)
Authors: Green Barrie , Robinson Lynne
Published: August 2011

Records of violent incidents were retrospectively analysed to identify trends associated with violent incidents within an NHS medium secure psychiatric unit. Over a 12‐month period, 116 incident forms related to 112 incidents. These incidents were compared with a study from the previous 12 months within the same unit. Both studies were based upon work from within a high‐security setting (Caldwell and Naismith, 1989). There was a significant reduction in the overall number of violent incidents.The majority of incidents continued to occur within the intensive care admission unit. There continued to be a higher incidence of assaultive behaviour throughout the afternoon and evening. Seasonal variations demonstrates a reduction of incidents throughout the autumn and winter months compared with the previous year, and a significant change in the number of incidents that occurred during the summer.There remain opportunities for comparison with other secure units and further refinement of the methodology.
Current Approaches to Sex‐offender Risk Assessment: a Critical Review
Authors: West Adrian
Published: August 2011

This critical review considers the limitations and advantages of the clinical, actuarial and structured clinical judgement approaches as they are applied to the assessment of risk in general and sex‐offenders in particular. It concludes by endorsing an inclusive approach, acknowledging that a central ethic of clinical practice is that it should be based on a current knowledge of the research literature (Singer, cited in Douglas et al. 1999).
Education in secure psychiatric units
Authors: Taylor John , Healy Patricia
Published: August 2011

This paper highlights the levels of poor basic education in the general population and the additional difficulties faced by patients with severe and enduring mental illness.For some years concern has been expressed regarding lack of provision of education in the mental health sector and, despite successive governments' acceptance of the Reed Committee's (Reed, 1991) recommendations, little provision has materialised.The paper points out the opportunity for education in medium secure units and describes the work of the education department in an independent medium secure psychiatric hospital.Further research is needed to evaluate the contribution of education departments in the rehabilitation of people with chronic mental illness.
Mentally disordered offenders: everyone's responsibility
Authors: Vaughan Phillip
Published: August 2011

Mentally disordered offenders (MDO), contary to general belief, are not the sole concern of specialist and secure services. Their numbers are far greater in the community. Instead of denying involvement with and responsibility for this group, mainstream mental health services need to recognise the reality of their presence on their caseloads and take steps to provide services to them. However this client group often has complex needs that may transcend the capacity of individual key workers or single agencies to meet. This has important implications for the training, supervision and support of individual staff, and for improved liaison and inter‐agency working, particularly with forensic practitioners in prisons and secure mental health services.
Risk assessment: still a risky business
Authors: Prins Herschel
Published: August 2011

There are three themes in this short paper. First, a brief historical context; second, the semantics of ‘dangerousness’ and ‘risk’; third, some issues that emerge from recent inquiries into homicides committed by persons known to the psychiatric service.
A review of the literature on positional asphyxia as a possible cause of sudden death during restraint
Authors: Parkes John
Published: August 2011

A small but significant number of people die during restraint by hospital staff, police or prison officers. One possible mechanism for this has been termed ‘positional asphyxia’. There is literature to suggest that deaths that occur in circumstances involving restraint may be related to certain positions, but early research has been contested. This article presents a balanced review of the literature and findings and concludes that the evidence remains unclear. However the literature does point to practical measures that should be adopted by those whose work is likely to require restraint of extreme violence, to avoid risk of death. These are summarised.
Supervision as an intervention with mentally disordered offenders: some observations
Authors: Ousley Leah , Robinson David
Published: August 2011

The supervision of mentally disordered offenders at risk of harm to themselves or others is universally practised, but there is little research evidence in the literature as to how, in what circumstances, with which patients, to what end and with what results for the patient and/or staff. This article reviews the available evidence on the practice and calls for evidence based guidelines for the role inherited by nurses to inform effective practice. It concludes:• empirical evidence is lacking on the supervision of mentally disordered offenders as an effective nursing intervention• there is evidence of ambiguity as regards psychiatric nursing interventions• supervision of mentally disordered offenders is subject to covert and inconsistent practice• there is a need for research on which to base training, skill mix decisions and the general management of supervision.
The effect of a psycho‐educational programme on knowledge of illness, insight and attitudes towards medication
Authors: Jennings Les , Harris Brian , Gregoire Jan , Merrin Jane , Peyton Jackie , Bray Liz
Published: August 2011

This paper looks at the outcomes of a mental health education group for patients in a high secure setting. The effects measured included assessments of knowledge about schizophrenia and its treatments, insight into the illness, drug compliance and attitude, and self esteem. The results from the measures were broadly consistent with findings from previous studies in non‐forensic settings: notably, that patients were able to acquire knowledge about their illness and its treatment and also that psycho‐education could have a positive impact on their attitudes towards taking medication and their levels of insight.The study outlines the structure and content of the group sessions and the teaching methods used. It offers discussion on the findings and concludes with recommendations about high secure service issues that may have relevance for wider service settings.
Risk assessment and the Care Programme Approach: an independent sector initiative
Authors: Vick Nicola , Birke Simon , McKenzie Richard
Published: August 2011

In the context of public concern about homicides committed by mentally ill people, the assessment and management of risk has become a central feature of national mental health policy and practice. This article reports the increasing profile given to the assessment and management of risk in national guidance on the Care Programme Approach (CPA). It goes on to describe findings from a two‐phase qualitative study to evaluate the integration of risk assessment procedures within the framework of the CPA process and the development of a risk assessment strategy by staff at Redford Lodge Hospital, an independent sector provider of medium secure and forensic rehabilitation psychiatric services.The evaluation demonstrated that Redford Lodge has successfully integrated risk assessment within the CPA process and has developed tools that offer a basis for guiding interventions while the service user is detained in hospital and to inform future strategies for supporting them in the community.
Tribunals, lawyers and withdrawals
Authors: Kaiser Fawad
Published: August 2011

There has been a substantial increase in the number of applications for Mental Health Review Tribunal (MHRT) hearings since they were introduced under the Mental Health Act 1983. This article discusses the implications of an apparent high level of last‐minute cancellations of scheduled hearings, often linked to the absence of independent psychiatric reports (IPRs). The author suggests a streamlined ‘one medical member review’ system would reduce the likelihood of such costly cancellations.
Referrals to a forensic service in the psychiatry of learning disability
Authors: Alexander Regi , Piachaud Jack , Odebiyi Lola , Gangadharan Satheesh
Published: August 2011

This survey describes the socio‐demographic, clinical and forensic variables of all patients referred to a medium secure unit in the psychiatry of learning disability. Of the sample, 67.5% were referred following an index offence and 76.6% had at least one previous conviction. Just over half (50.6%) came from either prisons, special hospitals or medium secure units and the remainder from mental health/learning disability hospitals or community resources. The majority (91.7%) had prior contact with a mental health or learning disability team. Most (81.5%) had a mild or ‘borderline’ learning disability, 46.8% had either a psychosis or major mood disorder, 58.4% had personality disorders and 56.6% had a history of illicit substance abuse. Of the 79 referrals 29.1% were accepted for admission. Arson as an index offence and a previous conviction for arson were significantly associated with being accepted for admission.
Self‐inflicted deaths during 2001: an analysis of trends
Authors: Snow Louisa , Paton Jo , Oram Chris , Teers Rebecca
Published: August 2011

This paper summarises the findings of an unpublished Prison Service report into self‐inflicted deaths in prisons in England and Wales over the period 1990‐2001. The key findings are that the number and rate of deaths in prisons has increased during the period examined. The majority of deaths are among men, although there has been a recent increase in the number of women who have died over and above any increase in their proportion in the prison population. Women are likely to be younger than men when they die. There is a statistically significant association between increased rates of throughput in local prisons and an increase in the rate of self‐inflicted deaths. Deaths are most likely to occur soon after prisoners have been received into custody. Few prisoners who die have been identified as at increased risk of suicide. There is some evidence that the period immediately following closure of an F2052SH is a high‐risk period. Most prisoners who die are in single cells. Those who die in shared cells are usually alone at the time of death. The findings support the direction of the current Safer Custody strategy: in particular the focus on local prisons, on improved vigilance and care in the early days of custody and on providing improved facilities and care in health care centres and segregation units.
Prisoners' motives for self‐injury and attempted suicide
Authors: Snow Louisa
Published: August 2011

This paper reports findings from a study of the social, situational and environmental factors that contribute to suicide and self‐injury in prison, focusing here on prisoners' motivations for their actions. In‐depth interviews were conducted with 143 prisoners in ten prisons in England and Wales who had engaged in an act of self‐injury or an attempt at suicide. The majority of participants described a number of precipitating or motivational factors related to concrete events, feelings/emotions (or both), operating within five different dimensions: offence‐related, interpersonal, symptom relief, instrumental and situational. In very few cases were there single reported causes. Motivational factors more prevalent among participants who attempted suicide included relationship problems, concerns about forthcoming court appearances and factors relating to drug withdrawal. Those who attempted suicide were more likely to describe concrete events or experiences as motivational factors. Those who injured themselves without suicidal intent were much more likely to describe negative feelings or emotions as precipitating factors. The results highlight the complex and multifactoral nature of suicidal and self‐injurious behaviours. At the very least they lend support to the suggestion that different strategies should be developed for those who attempt suicide and those who injure themselves for other reasons.
Self‐inflicted deaths of women in custody
Authors: Mackenzie Nicola , Oram Chris , Borrill Jo
Published: August 2011

Studies of prison suicides have consistently reported higher numbers of deaths for men than women. However it is not clear whether male or female prisoners have higher rates of self‐inflicted deaths proportionate to their population. This paper explores the number, rate and patterns of self‐inflicted deaths of women in prison over the last ten years (1992‐2001) compared with death rates for male prisoners and identifies from 13 case studies possible precipitating factors and implications for prevention.The female prison population increased by 237% over the period 1992 to 2001, from an average annual figure of 1,577 to 3,739. During the same period there were 33 self‐inflicted deaths: an increase from one death in 1993/94 to a peak of eight in 2000. Just over half (51%) of the women were unsentenced/on remand; 14 (43%) had an open F2052SH at the time of death, compared with 28% of all self‐inflicted deaths in the general prison population between 1997‐2001, and nine were known to have self‐ harmed previously (27%).Of the 13 case studies, all but one had recently used illicit drugs. Many had shown disturbed and difficult behaviour throughout their short time in custody, including non‐compliance with medication for mental health problems and behaviour resulting in adjudications. The women all had multiple problems in the days and weeks prior to their deaths, including withdrawal from drugs, lack of contact with families, bereavement and relationship problems within the prison. However more than two thirds had recently been relocated, often against their wishes or to accommodation they found less acceptable.
Dialectical behaviour therapy observed
Authors: Wix Stuart
Published: August 2011

A forensic service in Pueblo, Colorado, USA has successfully introduced a dialectical behaviour therapy (DBT) model of cognitive behavioural therapy which has been an integral part of the therapeutic programme since the mid‐1990s. The introduction of DBT to a forensic patient population has resulted in improvement of service user involvement with therapy, a possible solution to addressing staff burn‐out and a potential mode of treatment to encompass a range of diagnostic categories.DBT is a psychological intervention to help change an individual's distorted cognitions and assist the development of coping strategies. The emphasis of DBT in this instance is upon treating life‐threatening behaviour exhibited by patients in a forensic setting. A quasi‐experimental study comparing DBT with treatment as usual, conducted over a 20‐month period, helped this service to validate the therapy as an appropriate form of treatment for this patient population.
Therapeutic value of anger management programmes in a forensic setting
Authors: Hilton Nicola , Frankel Andrew
Published: August 2011

Kemple View is a secure psychiatric service for 64 male and female patients with enduring mental health problems. This paper describes how the need for an appropriate, therapeutic anger‐management package was identified and how the programme was developed and implemented. The pilot run of the programme was fully evaluated and case studies are presented to demonstrate both the process of evaluation and the outcome. While the evaluation did not produce conclusively positive results, the process highlighted a range of practical and theoretical issues that have been used to adapt the existing material. The development of a more robust and relevant package for use in a forensic psychiatric setting is discussed. The paper aims to address some of the practical challenges involved in setting up the anger management programme at Kemple View and the implications for good practice.
Contributors to stress among Prison Service staff
Authors: Holmes Susan , Maclnnes Douglas
Published: August 2011

It is often assumed that prison staff are particularly stressed due to their frequent exposure to traumatic events, which may damage not only individuals but also prisons and prisoners. While the impact of such stress may be recognised, the factors contributing to its development are unclear.The work reported here is part of a larger investigation of health care provision in a Greater London prison. Qualitative approaches were used to access the understandings of staff and key informants of the difficulties associated with their working environment. This enabled us to accommodate different working contexts, ensuring that the findings were grounded in the reality of the work undertaken by the participants.The data revealed that lack of training contributed significantly to the development of stress, reducing confidence in dealing with the many traumatic situations encountered. However, interpersonal relationships provided mutual support during crises. General working conditions, including workload and staff redeployment, were also important contributors to high levels of sickness‐absence which, in turn, exacerbated stress. Poor management practices, combined with a perceived lack of support, further aggravated stress.While it may be tempting to blame individuals for their inability to cope, all organisations have a duty of care to their employees and must take steps, at both the individual and organisational level, to prevent and manage work‐related stress.
Clozapine in forensic settings: persuading patients
Authors: Swinton Mark , McNamee Hugh
Published: August 2011

This article describes the practical steps needed to establish and maintain patients on clozapine within secure psychiatric services, particularly where patients have a history of non‐adherence to treatment. The role of psychiatric nurses in creating a climate of therapeutic optimism is stressed. A number of techniques which optimise adherence are described.
Nursing personality‐disordered in‐patients: a schema‐focused approach
Authors: Murphy Naomi , McVey Denis
Published: August 2011

Psychiatric nurses were given training in schema‐focused therapeutic approaches. They were then applied in a forensic setting with a focus on the needs of those patients diagnosed with a ‘personality disorder’. The paper discusses and reflects on the results of the approach and its relevance to the training of psychiatric nurses.
Suicide in prisons
Authors: Towl Graham
Published: August 2011

Suicide in prisons has been the subject of much research effort (Topp, 1979; Dooley, 1990; Liebling, 1991; Bogue & Power, 1995; Towl & Crighton, 1998; Snow, 2002). For a pithy critique of UK research and practice see Crighton (2000) and Crighton (2003) respectively. Some of the research has clearly had a direct influence upon policy and practice in suicide prevention. However, despite this, the overall trend of rates of suicide in prisons is upwards.The comparatively high rate of suicide among prisoners and indeed offenders more generally may call into question the very humanity of our criminal justice structures and processes. The nature of imprisonment involves state containment; this carries with it a heavy weight of responsibility and accountability for the well‐being of the prisoner, a responsibility that may be amplified in the case of specific groups of prisoners, such as juveniles or young offenders.This paper reflects on research and practice in what is known about suicide in prisons. The language of suicide is also touched on, because of its relevance in working with the suicidal. Following on from this, the potential role of applied psychologists in preventing suicide will be outlined.
Is readmission a failure?
Authors: Brewster Stephen
Published: August 2011

How should we judge a readmission to high secure psychiatric services? A case‐by‐case view is insufficient to make sense of potential service deficiencies. People in high secure psychiatric settings more often than not test our services and cause considerable alarm. The local clinical response is to seek to improve the condition, and they enter the high secure service. The political, legal and clinical imperatives ensure that patients return just as soon as they are ‘fit’. This paper details the career paths of 11 ‘readmissions’ to Ashworth Hospital, now part of Mersey Care NHS Trust, and suggests that it is more a question of tackling gaps in our combined services than of ascribing individual failings.
Substance misuse among young people referred to a UK psychiatric servicemxSubstance misuse among young people referred to a UK psychiatric service.
Authors: Mutale Theodore
Published: August 2011

Although substance misuse by adolescents is widespread, few previous studies have investigated illicit drug use in adolescent psychiatric populations. The literature on adolescent substance misuse has focused on risk factors, and protective factors have received little or no attention. The study examined substance misuse and its correlates among young people referred to a regional adolescent psychiatric service. Co‐morbidity of substance misuse and psychiatric disorder was discussed, and the possible role of substance misuse as a gateway to adolescent offending examined. Recommendations for the development of adolescent substance misuse services are made.
The effects of relocation and staff changes on individuals with a personality disorder
Authors: Coughlin Louise
Published: August 2011

The purpose of this research was two‐fold: first, to compare staff and patient perceptions of two new wards in a medium‐secure unit with perceptions obtained previously for a unit that has since closed, and second, to compare staff and patient perceptions of the new ward with their ideal ward environment. The results obtained from patients indicated that there were differences between perceptions of the new treatment unit and the former treatment unit. The results obtained from patients also indicated that there was a difference between perceptions of the new treatment unit and the ideal ward environment. Results obtained from staff could not be analysed because of a low response rate.
Aggression in an Australian forensic psychiatric hospital
Authors: Daffern Michael , Ogloff James , Howells Kevin
Published: August 2011

There is a considerable body of research on the assessment and prediction of aggression in psychiatric hospitals. A range of clinical and demographic characteristics associated with aggressive inpatients, such as young age and active symptoms of psychosis, have repeatedly been shown to contribute to aggression. Environmental factors have also been shown to be important. The study examined aggressive behaviours in an Australian forensic psychiatric hospital, using aggression‐specific recording instrumentation developed for the study. The purpose of the study was to compare results using aggression specific‐recording instrumentation with a previous study using retrospective methods relying on standard hospital incident forms, and to examine the relationship between type, direction and severity of aggression with the use of seclusion.In contrast with the results obtained in a previous study, staff rather than patients were more often the victims of both verbal and physical aggression, although patients were more frequently the victims of more severe forms of aggression. Patients were verbally and physically aggressive towards other patients at similar rates, although they were more frequently verbally, rather than physically, aggressive to staff. Acute wards recorded more aggression than rehabilitation wards. Males and females were aggressive at similar rates. A reduction in reported incidents of verbal and physical aggression, particularly against staff, occurred over the course of the study. Patients were secluded and incident forms were completed following approximately 30% of aggressive behaviours. Whether or not a patient was secluded and whether or not an incident form was completed depended on a range of factors, including the nature of the victim and the type and severity of the aggression.
Intentional deception and lies
Authors: Wilson Dave
Published: August 2011

This paper looks at professional and philosophical concerns about intentional deception and lies by professionals to clients. The implications for forensic practice are discussed.
The psychological effects on nursing staff of administering physical restraint in a secure psychiatric hospital: ‘When I go home, it's then that I think about it’
Authors: Sequeira Heather , Halstead Simon
Published: August 2011

The study examines the experiences of physical restraint procedures reported by nursing staff in a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Nursing staff reported a range of emotional responses to the use of restraint procedures. They included anxiety, anger, boredom, distress and crying. In some cases these responses were confirmed by descriptions from patients.Staff coped with the emotional responses to restraint in a variety of ways. Some staff discussed the ‘stigma’ attached to showing feelings to other staff. They described how laughter was used to reduce stress following an incident and how distressing emotions had to be taken home. Some staff described how they had become ‘hardened’ to the experience of restraint. A substantial proportion of staff suggested that they had ‘no’ emotional reactions and many reported ‘automatic’ responding during a restraint event in which they did not feel any emotion.Possible implications of these responses and clinical practice are discussed.
Life in a prison‐based therapeutic community: one man's experience
Authors: Greenall Paul
Published: August 2011

Research suggests that prison‐based therapeutic communities (TCs) have a positive impact on inmates and recidivism. This study sought to establish the benefits of being in a prison‐based TC rather than a normal wing. A semi‐structured interview was conducted with an inmate on the TC at HMP Wymott in Lancashire and then analysed using thematic analysis.Eight themes emerged, suggesting that TCs are a better environment with better interpersonal relationships, have more help available, are safer, are more structured and hierarchical, have groups and group work, are more challenging, provide confrontational assistance and have various incentive schemes. Such factors brought real benefits to the research participant.Research on the efficacy of TCs is considered, as are the implications of this study's findings for the future of prison‐based TCs. Despite the positive findings, they should nonetheless be cautiously applied.
Searching for ‘What Works’: HM Prison Service accredited cognitive skills programmes
Authors: Falshaw Louise , Friendship Caroline , Travers Rosie , Nugent Francis
Published: August 2011

This study evaluated the effectiveness of prison‐based cognitive skills programmes in England and Wales in reducing reconviction. Two‐year reconviction rates were compared for adult male offenders who had participated in a cognitive skills programme between 1996 and 1998 (N = 649) and matched adult male offenders who had not participated (N = 1,947). There were no significant differences in the rates of reconviction between the treatment and matched comparisons. This contrasts with a previous study of prison‐based cognitive skills programmes. Possible explanations for the current finding are discussed. For example, these results may merely reflect expected variation; international experience mirrors the variable reductions in reconviction rates found so far in the evaluation of prison‐based programmes. This evaluation relates to a period when programmes were expanded rapidly, and this may have affected the quality of programme delivery.
Secure care and treatment needs of mentally disordered adolescents
Authors: Vaughan Phillip
Published: August 2011

A survey was undertaken to determine the number of young people needing secure psychiatric inpatient care as at 1st January 2001. Twenty‐three individuals were identified who were placed in a variety of settings. However, few of the placements could be considered ideal. There was a wide range of diagnoses, and most young people had additional problems of social and education deficits and offending behaviour.Specialist resources need to be made available to local secure and residential facilities to reduce the need for secure placements. However, there may be a case for developing a regional secure service although, given the wide range of needs presented, it is unlikely that a single secure resource could meet them all.
The extent and impact of sexual harassment by patients upon staff working at a medium secure facility
Authors: Hebb Jo , Hughes Gareth , Nyamande Eugene , Blackwell Cheryl , Gunn‐Westland Amber
Published: August 2011

This article provides a report on the extent and nature of sexual harassment by patients towards staff. The analysis is based on a large medium secure psychiatric unit in the UK.
Violence risk assessment training for local mental health services
Authors: Garrett Tanya , Rowe Renarta
Published: August 2011

This article describes an initiative undertaken by a clinical team in a medium secure unit to manage their workload by offering training in structured violence risk assessment to local mental health professionals. The HCR‐20 violence risk assessment tool was used in this context. A number of half‐day training sessions were offered to a multidisciplinary audience in three local areas in the West Midlands covered by the team. This initiative was evaluated by feedback from participants, which suggested that the training was well‐received and considered broadly useful.
Leadership and management in the criminal justice system: an exploration of the management of change in a ‘failing prison’
Authors: Podmore John
Published: August 2011

Brixton Prison has had a long and chequered history, and became famous for all the wrong reasons: branded as a racist institution, criticised for its appalling record on health care and eschewed by the private sector. This article sets out how the author, as newly appointed Governor, turned theories of leadership and management in the criminal justice system into practice. Three key components of the institution ‐ prisoners, staff and ‘business’ ‐ are described, and the problems in maintaining an effective balance discussed.
The impact of borderline personality traits on challenging behaviour: implications for learning disabilities services
Authors: Dunn Barnaby , Bolton Winifred
Published: August 2011

This case study describes how threats to stab people, in a client with learning disabilities, may have been inadvertently reinforced during detention in a medium secure unit by over‐looking borderline personality traits. Formulating the case from the biopsychosocial model of borderline personality disorder (Linehan, 1993), the article illustrates how an invalidating environment provided by learning disability services may have interacted with underlying difficulties in emotion regulation to reinforce challenging behaviour. Explaining threats to stab purely in terms of learning disability accidentally invalidated the client's emotional distress, so the only way he could convey how he was feeling was by escalating challenging behaviour. Risk management procedures also strengthened the client's belief that he was a dangerous person, and reinforced the challenging behaviour by gaining interpersonal attention. The need for learning disability services to be aware of how personality features contribute to learning disability presentations and to formulate from an interactive perspective is highlighted.
Hair‐testing for illicit drugs
Authors: Parkes John
Published: August 2011

Human hair may contain deposits of illicit drugs. Testing of hair will provide an indicator of drug use at the time the hair was grown. Hair samples have several advantages over urine samples, particularly length of surveillance period (months rather than days) and resistance to tampering. Any form of drug‐testing must be seen as a component of a clinical plan for the management of the patient's drug misuse, mental disorder and offending.
Care programme approach in a forensic learning disability service
Authors: Selby G , Alexander R
Published: August 2011

De‐institutionalisation and the closure of long‐stay hospitals brought about an increased focus on the development of alternative systems for the safe and effective treatment of people with mental health problems. One result of this focus was the introduction of the care programme approach or CPA (DoH, 1989; 1990a; 1990b). The main elements of the CPA are systematic arrangements for assessing the health and social needs of people accepted into mental health services, formulation of a care plan which identifies all health and social care needs, and appointment of a care co‐ordinator to keep in close touch with the patient and to monitor care, regular review, and, if necessary, agreed changes to the care plan.Though the CPA was originally seen as a mechanism to ensure proper aftercare for those discharged from hospitals, the Government later made it clear that it should be seen as a framework for the delivery of mental health care (DoH, 1998). All health authorities are now required to implement it for people with mental health needs referred to specialist psychiatric services.
Management of bullying on an NHS open forensic unit for people with borderline/mild learning disabilities
Authors: Sasse James , Gough Karen
Published: August 2011

The purpose of the study discussed here was to review the experience and management of bullying on an open forensic borderline learning disability unit. Semi‐structured interviews were used to gather the perceptions, experiences and recommendations of service users about current and future management of bullying. Staff completed a questionnaire seeking information on the incidence and characteristics of bullying, management techniques and training requirements. Service users' results highlighted the importance of the level and predictability of staff presence on the ward, difficulties in reporting episodes for fear of retribution, and improving availability of information about bullying. Staff results highlighted a consistent response to bullying but reluctance to rate highly the strategies used or their confidence in assessing bullying, and a desire for bullying‐specific training. Both groups were interested in unitwide interventions to promote greater openness and wider involvement in dealing with bullying and to reduce the impact of negative factors such as fear and secrecy.
Client progress in a community team for mentally disordered offenders
Authors: Dalton Rita
Published: August 2011

A community team for mentally disordered offenders in a London borough was reviewed three years after its inception. As this term covers a broad spectrum of people, a profile of the team's clients was compiled and there is some discussion of what might constitute suitable measures of progress for the client group. In view of this, details are provided of reconviction and re‐arrest, hospital re‐admission, Health of the Nation Outcome (HONOS) scales and the views of clients themselves. Low rates of reconviction and re‐arrest were found, and improvements were evident on all other measures.
Reactive stalking: a new perspective on victimisation
Authors: Bocij Paul
Published: August 2011

Although much has been learnt about the psychological and physical harm caused to victims of stalking and cyberstalking, relatively little is known about the impact of stalking on social behaviour and relationships. This paper argues that victims of stalking sometimes go on to employ stalking behaviours against others. Although often arising from an instinctive need for self‐protection, such reactive stalking can be defensive or offensive in nature. Those who engage in such behaviour may do so from a need to assert control over their lives, or from fear of further victimisation. In pursuing this argument, a case study is used to illustrate the behaviours described. The case study focuses on the experiences of three stalking victims and describes attempts to victimise the author during his research. The article also discusses some of the implications of reactive stalking for the criminal justice system and the way in which victims receive support.
Guidelines for managing self‐harm in a forensic setting
Authors: Gough Karen
Published: August 2011

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a forensic psychiatric setting. In the preparation of these guidelines, a literature search was conducted to examine the evidence on clinical effectiveness for managing self‐harm. Overall, the evidence for defining a definitive treatment approach to self‐harm is extremely limited. However, a number of studies/reviews have identified aspects of treatment and care that are considered to be effective. Guidelines have been produced that capitalise on this information and provide front‐line staff (such as nurses) with advice that can be used on a daily basis when working with a service user who self‐harms.
Issues in running smoking cessation groups with forensic psychiatric inpatients: results of a pilot study and lessons learnt
Authors: Long Clive , Jones Kelly
Published: August 2011

Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric) militate against effective treatment. Despite this, few studies have reported on the use of population‐appropriate treatment approaches. This pilot study reports the results of group and individual treatments involving combination nicotine replacement therapy (NRT), motivational enhancement therapy (MET) and cognitive behavioural treatment. The importance of selecting patients with some skills in emotional regulation is highlighted, along with ways of reducing institutional obstacles to change and maximising environmental support for quit attempts.
Psychological services in prisons
Authors: Towl Graham
Published: August 2011

Psychological services in prisons in England and Wales have a relatively lengthy history going back over 50 years. Over the past ten years there have been significant changes in psychological practice, in terms of both increases in numbers of staff and in the types of professional activity undertaken. Changes to the organisational structure of services are outlined, reflecting the concept of ‘offender management’, in prisons and probation in particular, but also in the wider context of ‘joined up government’. The need to look at the configuration of psychological services afresh is discussed.