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Lived experiences of recalled mentally disordered offenders with dual diagnosis: a qualitative phenomenological study
- Authors:
- O'SULLIVAN Michelle, BOULTER Sara, BLACK Georgia
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 24(3), 2013, pp.403-420.
- Publisher:
- Taylor and Francis
The lived experience of mentally disordered offenders with dual diagnosis was the focus of this study. Interviews with five recalled service users from a medium secure unit in England were subjected to an interpretative phenomenological analysis. Five themes were identified relating to identity, control, autonomy and recovery. Clinical implications include increasing service users’ awareness of available post-diagnosis identities, which meet the needs of individuals’ lived contexts and promotion of recovery-oriented care in forensic settings. (Publisher abstract)
Reflecting on the delivery of a structured alcohol and drug group in a medium-secure forensic unit
- Authors:
- EDWARDS Richard, et al
- Journal article citation:
- Advances in Dual Diagnosis, 4(4), 2011, pp.180-189.
- Publisher:
- Emerald
Co-occurring mental health and substance misuse problems is common among service users within secure psychiatric services. Yet there is a lack of evidence to guide specific psychosocial interventions for this client group. This article details the planning, implementation and evaluation of a 24-session alcohol and drug group for eight service users, based on the Behavioural Treatment for Substance Abuse in Severe and Persistent Mental Illness Model, delivered by a group of multi-disciplinary staff in a medium secure forensic setting. The core components of the BTSAS programme were as follows: a motivational approach where reasons to change were elicited from the attendees, and not imposed; structured goal setting where weekly goals were identified and monitored with a problem-solving approach; drug refusal skills training including role-play; psycho-education with an exploration of previous patterns and effects of use and the implications for physical and mental health; and relapse prevention training with strategies for coping with high-risk situations and cravings. The group programme was well received, although adaptations to meet specific medium-secure needs are required for future group work. The development and implementation of the group raised awareness within the medium-secure setting, facilitating a less punitive and more collaborative response.
Overcoming the challenges of evaluating dual diagnosis interventions in medium secure units
- Authors:
- SWAIN Eleanor, BOULTER Sara, PIEK Nicola
- Journal article citation:
- British Journal of Forensic Practice, 12(1), February 2010, pp.33-37.
- Publisher:
- Emerald
This paper explores the high prevalence of patients with dual diagnosis, defined as having comorbid or co-occurring substance misuse with severe mental illness, in medium secure units in England. Examining the interventions accessible, and the outcome measurements used to evaluate treatment, this article highlights the challenges faced by medium secure units and proposes alternative measures such as measures of motivation, stages of change, beliefs, knowledge, group satisfaction, therapeutic alliance or coping strategies, which the authors suggest may prove more valuable in evaluating dual diagnosis interventions in medium secure units. In conclusion, further research is needed to study users who receive treatment and are discharged into the community, to determine whether these alternate measures are able to predict future levels of abstinence, re-hospitalisation or re-conviction rates.
Changes in diagnoses before admission to a specialist medium secure unit
- Authors:
- SHETTY Amrith, JAYAWICKRAMA Dilum, TAYLOR Pamela J.
- Journal article citation:
- Psychiatrist (The), 36(11), November 2012, pp.404-408.
- Publisher:
- Royal College of Psychiatrists
Some degree of diagnostic variability is routinely seen in clinical practice. There is evidence, from cases in England, that changing diagnoses may be an important factor preceding homicide. However there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. This study explored the frequency of a history of changing diagnoses in patients in a UK specialist unit, and looked at the characteristics of these patients. In total, 38 of 42 study participants had prior contact with psychiatric services. Sixteen (about 40%) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services. The authors conclude that changes in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. It is suggested that they demonstrate the difficulties experienced by service providers in delivering a consistent service.
Addressing substance misuse in a medium secure unit
- Authors:
- OWEN Rossi, et al
- Journal article citation:
- Drugs and Alcohol Today, 8(3), September 2008, pp.17-21.
- Publisher:
- Emerald
Individuals diagnosed with severe mental illness have higher rates of alcohol and substance misuse than the general population. In forensic psychiatry, the effect of comorbid substance misuse on offending behaviour is particularly pertinent. At a regional secure unit in North Wales, a group of inpatients was set up to provide education on alcohol and substance misuse over a course of six informal meetings, and then to evaluate participants' attitudes towards substance misuse. Of the six participants, five reported that their knowledge of substances had increased, and that they had no intention to use drugs again after discharge. Staff and client participants also suggested useful future topics for the group.
Staff drug knowledge and attitudes towards drug use among the mentally ill within a medium secure psychiatric hospital
- Authors:
- BARRY Keith R., TUDWAY Jeremy A., BLISSETT Jacqueline
- Journal article citation:
- Journal of Substance Use, 7(1), March 2002, pp.50-56.
- Publisher:
- Taylor and Francis
The current study presents data from 98 staff, working within a medium secure psychiatric hospital, and compares differences between staff groups in relation to general drug knowledge and attitudes towards both alcohol and illicit substances and the mentally ill patients who use them. Data suggest that, even, for qualified nursing staff had better knowledge of licit and illicit drug use than unqualified nursing staff and non-clinical staff, and also had different beliefs about why people with severe mental illnesses use licit and illicit drugs. However, no significant differences were found between groups for either level of punitive attitude towards people with severe mental illness who use drugs or the impact that certain factors have on severe mental health problems. These results identify the need for training in drug knowledge and drug use in mental illness, for those staff working in the field. The need for ongoing post-registration training in substance use in mental health is emphasized.
Survey of staff perceptions of illicit drug use among patients in a medium secure unit
- Authors:
- DOLAN Mairead, KIRWAN Helen
- Journal article citation:
- Psychiatric Bulletin, 25(1), January 2001, pp.14-17.
- Publisher:
- Royal College of Psychiatrists
This study is a survey of staff perceptions of illicit drug among in-patients in a medium secure unit. Results showed that sixty per cent of staff were aware of drug misuse on the unit. Less than one-third of staff were clear about the unit's policy for dealing with in-patient drug use and few have had adequate training in the management of patients with dual diagnoses. Strategies for dealing with drug misuse appear to focus on security rather than therapeutic issues. Services need to provide adequate training for staff on the management of patients with co-morbid substance misuse, introduce patient education programmes and develop and disseminate clear policies that emphasise both therapy and security.
Access to medium secure psychiatric care in England and Wales: the clinical needs of assessed patients
- Authors:
- METZGER David, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 15(1), March 2004, pp.50-65.
- Publisher:
- Taylor and Francis
The needs of patients in medium secure psychiatric units are well documented, but little is known of the range of clinical and security needs of those assessed but put on waiting lists or not admitted. The aim of the study was to quantify needs for treatment and care of a nationally representative sample of patients assessed for admission to medium secure care. 34 units containing 98% of medium secure beds in England and Wales in 1999 participated. All assessments were logged. A random sub-sample was selected for detailed interviews with assessing clinicians. Higher sampling fractions were used in smaller units. Unit monthly waiting lists averaged 5 patients for each available bed. Common reasons for referral were aggressive behaviour, deteriorating mental state, need for diagnostic assessment, and non-compliance with treatment. 42 per cent of assessed patients needed medium secure care, one-third on a long-term basis. The assessing units refused some patients who needed medium secure care, and accepted some psychotic patients who did not require security. 4 weeks after assessment, 65% of waiting list patients had still not been admitted. The conclusion was that a substantial shortage in medium secure beds existed, especially for long-term placements. A third of those needing medium secure care required it on a long-term basis, but assessing units did not admit many of these patients. Further work is needed on the low levels of assessed need for interventions relating to substance abuse.
Content of command hallucinations predicts self-harm but not violence in a medium secure unit
- Authors:
- ROGERS Paul, et al
- Journal article citation:
- Journal of Forensic Psychiatry, 13(2), September 2002, pp.251-263.
- Publisher:
- Routledge
Evidence to date has supported negative relationships, a null relationship and a positive relationship between command hallucinations and violence or self-harm. This research was designed to determine the relationship between command hallucinations with violent or self-harm content and incidents of violence and self-harm in forensic inpatients. Patients with and without a lifetime history of command hallucinations and resident in a medium-security hospital were identified through clinical and legal records over 51 months. Measures included: staff-observed violence and self-harm; presence and content of command hallucinations; paranoid delusions; previous violent convictions; length of stay; gender; history of alcohol or illicit drug abuse. Statistical analyses used negative binomial regression. Violent command hallucinations and inpatient violence were unrelated. Self-harming command hallucinations and an absence of paranoid delusions were positively associated with self-harm. The processes that determine compliance with command hallucinations remain unclear.