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Long-term care needs in male medium security
- Authors:
- JACQUES John, SPENCER Sarah-Jane, GILLULEY Paul
- Journal article citation:
- British Journal of Forensic Practice, 12(3), August 2010, pp.37-44.
- Publisher:
- Emerald
Medium secure units were designed to treat patients for up to three years, but some patients spend longer in acute medium secure settings. The aim of this investigation was to assess and describe the needs of these patients. The research reviewed male patients who had been admitted at least five years previously to the Three Bridges Medium Secure Unit in West London. A survey questionnaire covering demographic information, mental health diagnosis, physical health, treatment and engagement was sent to responsible clinicians. To complement the survey questionnaire, carer ratings using the Camberwell Assessment of Need: forensic version (CAN-FOR) were completed by the primary nurse for each patient. Of 122 medium secure male patients, 25 (21%) had been admitted at least five years before. The results found high levels of co-morbidity and treatment resistance. The CAN-FOR revealed two groups, one with chronic challenging behaviour, treatment-resistant mental illness and need for a high level of support, and another more able group not needing as much support but with a dependency on the hospital. The article concludes that these men have different needs from those who progress at a faster rate through medium security, and suggests that services should be tailored to meet these needs.
Personality disorders in offenders with intellectual disability: a comparison of clinical, forensic and outcome variables and implications for service provision
- Authors:
- ALEXANDER R. T., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 54(7), July 2010, pp.650-658.
- Publisher:
- Wiley
The aim of this study was to discover any differences between patients with and without a diagnosis of personality disorders, being treated in a secure inpatient service for offenders with intellectual disability (ID) in England. A total of 138 patients (109 men, approximate age on admission 30 years, 77 with a personality disorder) treated over a six year period were included. Women were more likely to be in the personality disorder group. Both groups had an equally high prevalence of abuse. Depressive disorders and substance abuse were more common in the personality disorder group, while epilepsy and autistic spectrum disorders were more common in the comparison group. The authors note that, rather than differences, what was more striking was the rate and range of the comorbidities across both groups. Although past histories of violence and institutional aggression were no different, compulsory detention under criminal sections and restriction orders were more common in the personality disorder group. There were no differences in treatment outcomes. It is concluded that although about half of patients detained in secure units for offenders with ID have a personality disorder, there were more similarities than differences between this group and the rest. Good treatment outcomes supported the case for specialised secure treatment units for people with ID, the case for more specialised ID–personality disorder units was less convincing.
Psychophysiological and behavioural characteristics of individuals comorbid for antisocial personality disorder and schizophrenia-spectrum personality disorder
- Authors:
- SCHUG Robert A., RAINE Adrian, WILCOX Rand R.
- Journal article citation:
- British Journal of Psychiatry, 191(11), November 2007, pp.408-414.
- Publisher:
- Cambridge University Press
... offending. In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group. The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced
Comorbidity of post traumatic stress disorder and paranoid schizophrenia: a comparison of offender and non-offender patients
- Author:
- SARKAR Jaydip
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), December 2005, pp.660-670.
- Publisher:
- Taylor and Francis
This study describes rates of trauma and posttraumatic stress disorder (PTSD) in forensic and non-forensic psychiatric patients, with a primary diagnosis of paranoid schizophrenia. Twenty-seven disordered offender patients (forensic) were compared with 28 non-offender (general) psychiatric inpatients. Ninety-three percent of the entire group reported previous trauma, with the forensic group reporting higher rates of physical and sexual abuse. The forensic patients had also experienced more multiple traumas then the general psychiatric patients, although the result was non-significant. There was no difference between the groups with regard to the age of the earliest trauma experienced. PTSD was common, with rates of 27% for current, and 40% lifetime diagnosis in the whole group. Forensic patients had higher rates of both current (33% v 21%) and lifetime (52% v 29%) PTSD. Very few patients had received a working diagnosis of PTSD, or were receiving trauma focussed psychological therapy. Possible reasons for high rates of trauma and PTSD, and implications for treatment are discussed.
Corrections Victoria: ensuring responsive practices for offenders with complex needs
- Author:
- FAMULARO Jo
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(3), 2011, pp.136-139.
- Publisher:
- Emerald
This paper outlines how Corrections Victoria (CV) Australia has improved best practice outcomes and solutions for offenders in the Victorian forensic system. The acquired brain injury clinic within CV is an innovative service for prisoners and offenders with an Acquired Brain Injury (ABI). Over the past three years, CV has made a commitment towards better meeting the needs of offenders with a disability, and specific research has been undertaken to identify the prevalence of acquired brain injury among Victoria's male and female population. This research has identified new challenges particularly evidence concerning the large-prisoner cohort with acquired brain injury. What has emerged in the first 18 months of the ABI programme is the presence of co-morbidities, including mental health and substance use issues in addition to offenders’ cognitive impairment. This complex profile confirms the need for a specialist response. The role of the clinician is multi-functional, including consultation, capacity building, information, education, intervention planning and staff training. The practical implications of this case study include a treatment plan. The authors conclude, however, there are issues with implementing this approach as it requires a long-term commitment from the correctional services system
Treatment of dual diagnosis in mentally disordered offenders: application of evidence from the mainstream
- Authors:
- WELDON Sarah, RITCHIE Gordon
- Journal article citation:
- Advances in Dual Diagnosis, 3(2), May 2010, pp.18-23.
- Publisher:
- Emerald
Noting that empirical evidence suggests that a complex relationship exists between substance misuse, mental illness and violence in forensic populations, this paper provides a summary of issues concerning treatment of dual diagnosis and how this may be related to mentally disordered offenders, mainly focusing on treatment and psychosocial outcomes of patients with severe and persistent mental illnesses, including schizophrenia and psychotic illness, and comorbid substance use issues. It covers treatment of substance use among people with severe mental illness, the transtheoretical model of change, psychosocial interventions, and efficacy of psychosocial treatments in forensic populations. The authors conclude that the most effective intervention currently consists of an integrated, long-term treatment approach adopting motivational interviewing principles combined with CBT, with social and coping skills training.
A demographic study of the Orchard Clinic: Scotland's first medium secure unit
- Authors:
- GOW Rona L., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(1), February 2010, pp.139-155.
- Publisher:
- Taylor and Francis
Forensic services in Scotland are evolving, based on similar developments previously in England and Wales. The Orchard Clinic in Edinburgh opened in November 2000 and was the first medium secure unit in Scotland. It was designed to serve a general population of 1.5 million, covering south-east Scotland, with 50 beds split between 2 rehabilitation wards and 1 acute ward. This paper describes all patients admitted to the unit in the first 5 years of its operation, considering antecedents to their admission, patient characteristics and progress through the system. In total 219 admissions were collected and analysed. The majority of patients were single adult males, aged 40 or under, who had a primary diagnosis of paranoid schizophrenia with a co-morbid diagnoses of personality disorder or substance misuse. The average length of admission was 285 days. In order to benchmark against established services a comparison is made with earlier studies of forensic populations in Scotland and elsewhere in the UK.
Personality disorders, psychopathy and other mental disorders: co-morbidity among patients at English and Scottish high-security hospitals
- Authors:
- BLACKBURN Ronald, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 14(1), April 2003, pp.111-137.
- Publisher:
- Taylor and Francis
Mental health legislation in Britain has traditionally encouraged distinction between personality disordered and mentally ill offenders, but research on co-morbidity indicates that few patients exhibit an Axis I or an Axis II disorder in isolation. This study compared male high-security hospital patients in the English Mental Health Act categories of psychopathic disorder (n= 54) and mental illness n = 61) and the Scottish legal category of mental disorder (n= 60), using structured instruments to assess personality disorders, psychopathy and Axis I disorders. The mental illness and psychopathic disorder categories were not differentiated by personality disorders,psychopathy,or AxisI disorders,except for more lifetime drug abuse and more lifetime and current psychosis among the mentally ill. A majority of patients with mental disorder under Scottish legislation also exhibited personality disorders. Grouping by primary clinical diagnosis of personality disorder or mental illness produced few differences on Axis I or Axis II, and overall there was a relatively strong correlation between the presence of an AxisI and an AxisII disorder. Legal and clinical attempts to separate personality disordered and mentally ill offenders maybe ill-conceived because Axis I and Axis II disorders tend to coexist.
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: annual report: England, Northern Ireland, Scotland and Wales
- Author:
- NATIONAL CONFIDENTIAL INQUIRY INTO SUICIDE AND HOMICIDE BY PEOPLE WITH MENTAL ILLNESS
- Publisher:
- University of Manchester
- Publication year:
- 2014
- Pagination:
- 156
- Place of publication:
- Manchester
This report provides key figures on suicide, homicide and sudden unexplained death in patients under mental healthcare between 2002 and 2012 in the countries of the UK. The report examines rates and trends by country, gender, and diagnostic and treatment profile of patients. There were 18,017 patient suicides between 2002 and 2012 in the UK, 28 per cent of suicides in the general population during this time. The report shows that mental health patients are at their highest risk of dying by suicide in the first two weeks after leaving hospital. Hanging remains a common method for suicide with an increase in this method. Between 2002 and 2012 828 people convicted of homicide in the UK have been confirmed as mental health patients, on average 75 per year. The report highlights areas of mental health care where safety should be strengthened through the contribution of mental health providers, partner agencies, commissioners, education and training bodies and professional organisations. It suggests that care of patients on hospital discharge should be a priority; there should be a re-examination of the portrayal of hanging in the media; mental health services should play a stronger role in protecting victims of domestic violence by ensuring perpetrators receive treatment for mental disorder, including substance misuse; crisis resolution and home treatment should be a priority setting for suicide prevention; services should continue to address patients’ co-morbidities through the use of assertive outreach, and through better provision for alcohol and drug misuse and ‘dual diagnosis’; services should aim to reduce the need for restrictive interventions; and deaths and serious injuries caused by restraint should be considered as an NHS ‘never event’ in England and Wales. (Edited publisher abstract)