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Post-traumatic stress disorder caused in mentally disordered offenders by the committing of a serious violent or sexual offence
- Authors:
- GRAY Nicola S., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 14(1), April 2003, pp.27-43.
- Publisher:
- Taylor and Francis
The aim of the study was to measure in a sample of mentally disordered offenders the frequency of post-traumatic stress disorder (PTSD) symptoms related to the committing of an offence and to consider what factors might be contributory to the onset and maintenance of these symptoms. The study was the rst to investigate the incidence of PTSD in a primarily mentally ill population. A sample of 37 mentally disordered offenders was assessed for PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R) and the Impact of Events Scale (IES). Of this sample, 33% met diagnostic criteria for PTSD and 54% had signi cant PTSD symptomatology as indexed by the IES. The IES scores were greater in those who had committed violent offences than in those who had committed sexual offences, and in those who had an affective diagnosis. Frequency of PTSD symptoms was greater in those offenders who now felt regret for their actions. The high frequency of PTSD symptoms in this population may serve as a signi cant stressor and may exacerbate co-morbid psychiatric illness and contribute to poor treatment response and relapse. Many mental illnesses are exacerbated by stress and the presence of untreated PTSD symptoms may serve to prevent treatment gains for the primary mental disorder. If risk of future dangerousness is associated with unstable mental state, as is often the case in a mentally disordered population, then the development of PTSD post-offence may serve to prolong or increase risk of harm to both self and others.
WARRN – a formulation-based risk assessment procedure for Child and Adolescent Mental Health Services (CAMHS): the view of clinicians
- Authors:
- GRAY Nicola S., TILLER Jacqui, SNOWDEN Robert J.
- Journal article citation:
- Journal of Forensic Practice, 21(4), 2019, pp.228-239.
- Publisher:
- Emerald
Purpose: Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services which has been adopted across most Child and Adolescent Mental Health Services (CAMHS) across Wales. The paper aims to discuss this issue. Design/methodology/approach: An online survey was disseminated to National Health Service clinicians in CAMHS to evaluate their perceptions of the use and effectiveness of WARRN. Data from 88 clinicians were analysed with both quantitative and qualitative methods. Findings: Clinicians reported increased clinical skills, increased confidence in their assessment and management of risk and in safety planning, the increased safety of service users and the general public, and a belief that WARRN had saved lives. The qualitative data showed that clinicians thought a common risk evaluation instrument across Wales and different agencies had created a common language and understanding that improved communication. Practical implications: WARRN appears well accepted in CAMHS services with the view that it is having a very positive effect on service user well-being and safety and could be implemented in other services. Originality/value: This is the first report of a formulation-based approach to the management of serious problem behaviours in CAMHS services. (Publisher abstract)
Predicting violent reconvictions using the HCR–20
- Authors:
- GRAY Nicola, TAYLOR John, SNOWDEN Robert J.
- Journal article citation:
- British Journal of Psychiatry, 192(5), May 2008, pp.384-387.
- Publisher:
- Cambridge University Press
Risk assessment of future violent acts is of great importance for both public protection and care planning. Structured clinical assessments offer a method by which accurate assessments could be achieved. The aim was to test the efficacy of the Historical, Clinical and Risk Management Scales (HCR–20) structured risk assessment scheme on a large sample of male forensic psychiatric patients discharged from medium secure units in the UK. In a pseudo-prospective study, 887 male patients were followed for at least 2 years. The HCR–20 was completed using only pre-discharge information, and violent and other offending behaviour post-discharge was obtained from official records. The HCR–20 total score was a good predictor of both violent and other offences following discharge. The historical and risk sub-scales were both able to predict offences, but the clinical sub-scale did not produce significant predictions. The predictive efficacy was highest for short periods (under 1 year) and showed a modest fall in efficacy over longer periods (5 years). The results provide a strong evidence base that the HCR–20 is a good predictor of both violent and non-violent offending following release from medium secure units for male forensic psychiatric patients in the UK.
A comparison of WAIS-R and WAIS-III in the lower IQ range: implications for learning disability diagnosis
- Authors:
- FITZGERALD Suzanne, GRAY Nicola S., SNOWDEN Robert J.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(4), July 2007, pp.323-330.
- Publisher:
- Wiley
Whether the Flynn effect (the increase in the populations’ IQ over time) affects the IQ scores of people with learning disability or borderline learning disability remains unclear. The issue is important as the Flynn effect should alter the number of people eligible for health service resources. A comparison of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) with the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) in individuals with learning disability or borderline learning disability was conducted. All participants completed the WAIS-R and the WAIS-III. Discrepancy scores were calculated for the Full Scale IQ score and the Verbal and Performance subscale scores. WAIS-III Full Scale scores were significantly lower by over 4 IQ points. Verbal and Performance Scale IQ scores were also significantly lower than the corresponding WAIS-R scores. The shift from WAIS-R to WAIS-III means that 66% more people meet criterion A for the diagnosis of learning disability and hence this has major resource implications for health service providers.
Management of sexually inappropriate behaviours in men with learning disabilities
- Authors:
- GREEN Gill, GRAY Nicola S., WILLNER Paul
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 14(1), April 2003, pp.85-110.
- Publisher:
- Taylor and Francis
Care professionals were interviewed regarding the extent, nature and victims of inappropriate sexual behaviour of 46 men with learning disabilities, and an adapted form of a version of the Structured Anchored Clinical Judgement risk assessment protocol (SACJ-Min) was completed for each. Risk judgements were unrelated to objective risk, as assessed by the SACJ-Min, to seriousness or frequency of sexual offending, to treatment outcome, or to a wide variety of other factors examined. The variables most strongly associated with risk judgements were the presence of a child victim and criminal convictions for inappropriate sexual behaviour, both of which, paradoxically, were perceived to decrease the risk of reoffending. Respondents were con dent that existing management arrangements were effective in decreasing the risk of reoffending, and that the more intensely clients were supervised, the greater was the decrease in risk. However, level of supervision was unrelated to objective risk, as assessed by the SACJ-Min, to seriousness or frequency of sexual offending, to identity of the victims targeted, or to a wide variety of other factors examined. A few variables were found to be associated with supervision level, but in every case these differences are most plausibly understood as consequences of supervision, rather than causes. The results suggest that the management of sexually inappropriate behaviour in men with learning disabilities has little if any rational basis.
Factors associated with criminal convictions for sexually inappropriate behaviour in men with learning disabilities
- Authors:
- GREEN Gill, GRAY Nicola S., WILLNER Paul
- Journal article citation:
- Journal of Forensic Psychiatry, 13(3), December 2002, pp.578-607.
- Publisher:
- Routledge
Care professionals were interviewed regarding the extent, nature and victims of inappropriate sexual behaviour of 46 males with learning disabilities, and an adapted and expanded form of a version of the Structured Anchored Clinical Judgement risk assessment protocol (SACJ-Min) was completed for each client. Comparisons of the 16 criminally convicted and 30 non-convicted men revealed few differences on factors associated with sexual recidivism. However, convicted men were more likely to have targeted children and males as victims and had perpetrated more serious sexual offences. The only significant predictors of convicted status to emerge from this analysis were child victim and, less reliably, emotional loneliness. The results suggest that the decision to prosecute a man with learning disabilities who displays sexually inappropriate behaviour is based more on the identity of the victim than on the nature of the offence.
Independence of 'reaction to hypothetical contradiction' from other measures of delusional ideation
- Authors:
- HURN Catherine, GRAY Nicola S., HUGES Ian
- Journal article citation:
- British Journal of Clinical Psychology, 41(4), November 2002, pp.349-360.
- Publisher:
- Wiley
Given the increasing pressure on Community Mental Health Teams to provide effective services for people with serious mental health problems and the relative scarcity of clinicians working therapeutically with this group, the ongoing search for reliable prognostic factors has both economic and clinical implications. Although previously somewhat overlooked, 'reaction to hypothetical contradiction' (RTHC) has been described as a potential predictor of amenability to psychological treatment for people holding delusional beliefs. Associations were found between RTHC and a range of other clinical variables, including the existence of perceptual experiences and the impact and extent of delusional beliefs. These factors can be difficult to measure, and it is argued that RTHC may be easier to assess than these other variables. RTHC was found to be independent from other variables such as insight, degree of conviction, degree of preoccupation, anxiety and depression. The current research found that RTHC was associated with the extent to which delusional beliefs influence thoughts, behaviour and distress levels.
Returning to school: children and young people living with chronic illness
- Authors:
- GRAY Nicola J., JOURDAN Didier, MCDONAGH Janet E.
- Journal article citation:
- Journal of Children's Services, 15(4), 2020, pp.235-241.
- Publisher:
- Emerald
Purpose: The reopening of schools during the SARS-CoV-2 pandemic is full of challenges for families, which are heightened for children and young people (CYP) who live with chronic illnesses. This paper aims to offer a framework to support the successful return of CYP with chronic illnesses to school using appropriate intersectoral strategies. Design/methodology/approach: This paper draws on research data on the impact of school closure on CYP with chronic illness and emerging findings of global research about their lives during the pandemic. It is also informed by the perspectives of practitioners in the field, who are working with these CYP and their families. Findings: A framework based on three different strategies for a successful return is established. A small but significant group of CYP living with conditions such as cancer will not yet return and will need ongoing home education provision. CYP with well-controlled symptoms of chronic illness will benefit from school routines and socialization with peers. CYP with poorly controlled illness will need close supervision and individual plans. All groups will benefit from better intersectoral working across education and health and from recent rapid developments in hybrid learning models and telemedicine. Originality/value: This viewpoint highlights the need for a strategic approach to the return to school of CYP with chronic illness that goes well beyond classifying them as vulnerable students. This group of CYP is already at risk of lower educational attainment, so widening inequalities must be halted. This paper provides a framework for anchoring local intersectoral approaches adapted to the different situations of CYP. (Edited publisher abstract)