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Delivering effective cognitive behavioural group treatment for women in secure psychiatric settings
- Author:
- LONG Clive G.
- Journal article citation:
- Journal of Forensic Practice, 15(1), 2013, pp.55-67.
- Publisher:
- Emerald
This paper reviews issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings. The literature on CBT as applied to women in secure settings is reviewed and aspects of best practice are illustrated with examples from a women's medium secure service. Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment. (Edited publisher abstract)
What is effective in promoting a healthy lifestyle in secure psychiatric settings? a review of the evidence for an integrated programme that targets modifiable health risk behaviours
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Journal of Forensic Practice, 18(3), 2016, pp.204-215.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions. Design/methodology/approach: Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas. Findings: Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space. Practical implications: Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes. Originality/value: This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services. (Publisher abstract)
Increasing physical activity in a secure psychiatric service for women
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Mental Health Review Journal, 20(3), 2015, pp.144-155.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care. Design/methodology/approach: A range of interventions (environmental and motivational) designed to increase participation in physical activities were introduced on two secure wards for women. A pre-post design assessed frequency, duration and intensity of physical activity, attendance at physical activity sessions, exercise motivation, exercise-related mood, attitudes to exercise and health and biological indices. Measures collected over a three-month baseline period were repeated six months post-intervention. Findings: Significant changes occurred in both attitudes to exercise and health, exercise motivation and exercise behaviour following change initiatives. With the exception of resting pulse rate and perceived exertion, the increased level of activity was not reflected in changes in body mass index, body fat or body muscle. Practical implications: Management led, multi-disciplinary interventions to increase physical activity can have a positive impact on both lifestyle behaviours and physical health. Originality/value: This study adds to a small literature on increasing physical activity in women in secure psychiatric settings where obstacles to change are formidable. (Publisher abstract)
The benefits of environmental change in a secure service for people with intellectual disabilities
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(5), 2014, pp.309-320.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards. Design/methodology/approach: Ten patients/service users and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards. All participating service users were detained under the Mental Health Act 1983. Not all had committed offences. Findings: The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment. Originality/value: Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care. (Edited publisher abstract)
Tackling obesity and its complications in secure settings
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Mental Health Review Journal, 19(1), 2014, pp.37-46.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI). Design/methodology/approach: Electronic patient records were used to determine levels of obesity and weight change over a three-year period. BMI levels were related to status, medication and patient characteristics. Findings: The incidence of obesity (34 per cent) in the sample (n=351) was higher than in the general population. One-third of patients were on medication for hyperlipidaemia and 10 per cent were diagnosed with type II diabetes. Patients on regular antipsychotic drugs and sodium valproate and who were less active had higher BMIs. Gender differences over a three-year period showed a tendency for women's weight to continue to increase which may be linked to lower levels of engagement in activities of moderate or vigorous intensity. Originality/value: Previous surveys using secure psychiatric populations have been point in time reviews. The current study tracks changes over a three-year time period and related this to a range of interventions. (Publisher abstract)
Women transferred from prison to medium-secure psychiatric care: the therapeutic challenge
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 23(2), April 2012, pp.261-273.
- Publisher:
- Taylor and Francis
Medium-secure prisons have a high proportion of patients who have been transferred from prison for either treatment or assessment. This study used a matched pair design to compare 17 women admitted to a medium-secure psychiatric facility from prison and from the mental health service. Results indicated a number of hypothesised differences between the two groups: prison admissions took longer to engage in treatment; had more unmet needs and continued to pose a greater risk of self-injury. The majority of both groups have significant substance misuse problems that require psychotherapeutic treatment. The authors concluded that the findings supported previous work indicating significant levels of unmet need among prisoners and the urgent need for therapeutic input to address the deficiencies of current rehabilitation programmes.
Architectural change and the effects on the perceptions of the ward environment in a medium secure unit for women
- Authors:
- LONG Clive G., et al
- Journal article citation:
- British Journal of Forensic Practice, 13(3), August 2011, pp.205-212.
- Publisher:
- Emerald
It is recognised that architectural design may have strong effects on mood, health and wellbeing. This paper explores the architectural design considerations and effects of moving a group of English patients from an adapted Victorian medium secure unit to a purpose built facility. Patients (n=9) and staff (n=16) views of the old and new unit environments were compared in terms of homeliness, architectural features, ward atmosphere (WAS) and patient satisfaction. The new unit was rated as more homely. The change of environment did not increase risk behaviours and was associated with a reduction in symptomatology. The small study size limits the findings but the authors suggest that it points to the need for more research into the constituents of “planned” environments where the physical environment is the primary intervention.
The nutrition and eating habits of women in secure psychiatric conditions: a survey with implications for practice and action
- Authors:
- LONG Clive G., et al
- Journal article citation:
- British Journal of Forensic Practice, 11(3), September 2009, pp.28-34.
- Publisher:
- Emerald
The nutrition and eating habits of women in a secure psychiatric service were surveyed. Forty-one women in three secure units in Northampton agreed to participate. Sixty per cent of these patients had a BMI over 30 and the remaining 40% had an average BMI of 27.2. In vivo observations of the nutrition and eating practices of the participants at mealtimes were made by an observer, and an assessment was also made of food and drink provided on wards outside mealtimes. In addition, the participants completed a Lifestyle Questionnaire on areas relating to healthy eating and weight management. The results indicated an obesogenic environment which inadvertently promoted over-eating and under-exercising and in which patients made unhealthy food choices. The results have provided the basis for various initiatives to improve the overall health care of the patients, including menu variation and provision of healthy menu dishes.
Back to basics: progressive muscle relaxation (PMR) training for women detained in conditions of medium security
- Authors:
- HALL Louise, LONG Clive G.
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 20(3), June 2009, pp.481-492.
- Publisher:
- Taylor and Francis
There is a large evidence base that demonstrates the efficacy of abbreviated progressive muscle relaxation (PMR) in the treatment of a wide variety of psychiatric and somatoform or psychosomatic disorders. A review of literature published in the last decade suggests that, in recent years, abbreviated PMR has been used primarily as an adjunctive therapy for people with a range of physical health problems. Doubts remain about its applicability to schizophrenic and severely emotionally and behaviourally disturbed populations within secure mental health settings. This article describes the development and evaluation of a relaxation training programme using abbreviated PMR techniques for female service users detained in conditions of medium security. More rigorous experimental evaluation is necessary to draw firm conclusions but preliminary results are positive and suggest that a group relaxation training programme that teaches abbreviated PMR techniques could be a useful intervention for this client group.
Factors associated with quality of life in a cohort of forensic psychiatric in-patients
- Authors:
- LONG Clive G., et al
- Journal article citation:
- British Journal of Forensic Practice, 10(1), March 2008, pp.4-11.
- Publisher:
- Emerald
Self-reported quality of life 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.