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Outcomes from the National High Secure Learning Disability Service: findings and challenges
- Authors:
- MORRISSEY Catrin, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(3), 2015, pp.116-1233.
- Publisher:
- Emerald
Purpose: The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service. Design/methodology/approach: Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013. Findings: The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment. Research limitations/implications: There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies. Originality/value: There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures. (Publisher abstract)
Trauma and post-traumatic stress disorder (PTSD) in a high secure forensic learning disability population: future directions for practice
- Authors:
- BRAKENRIDGE Irene, MORRISSEY Catrin
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 4(3), September 2010, pp.49-56.
- Publisher:
- Emerald
Based at the National Centre for High Secure Learning Disability Services, for England and Wales, this service evaluation used a range of methods, such as reviewing already filed information and self-reports of individual Rampton Hospital residents (n=40) for evidence of post-traumatic stress disorder (PTSD). Records were often found lacking in detail and missing some structured measures, such as the Posttraumatic Stress Diagnostic or Lancaster and Northgate Self Report and Informant Trauma scales (n=22). Findings indicated that most individuals had suffered lifetime trauma, typically of multiple types of abuse, but there was often were little information recorded about the traumatic events themselves, few trauma-specific assessments of exposure or symptoms and PTSD was rarely diagnosed and treated. Some could not talk about their past at all. The authors advise that the service under study at Rampton aims to provide trauma-specific training to staff and to conduct routine structured assessments, offering adapted evidence-based psychological interventions where appropriate for patients who may have experienced abuse and trauma.
Evaluation of a therapeutic community intervention for men with intellectual disability and personality disorder
- Authors:
- MORRISSEY Catrin, TAYLOR Jon, BENNETT Charlene
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 3(1), 2012, pp.52-60.
- Publisher:
- Emerald
This study evaluated a planned therapeutic community (TC) service intervention in Rampton Hospital, England, for 11 men with mild intellectual disabilities and personality disorder over a period of 12 months. The TC intervention group was compared on repeated measures of violent incidents, seclusion hours, and informant and self-report clinical outcome measures collected six months prior to, six and 12 months post the start of the intervention. Clinical changes in the predicted direction were evident, with the TC group showing comparatively less pathology. The mean number of violent incidents did not reduce over time. There was nevertheless a strong trend towards reduction in seclusion hours, with significant differences between groups also being observed at the six and 12 months stage. The authors concluded that this preliminary evaluation was promising in terms of the TC approach being a potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.
Adapted dialectical behaviour therapy for male offenders with learning disabilities in a high secure environment: six years on
- Authors:
- MORRISSEY Catrin, INGAMELLS Bridget
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(1), January 2011, pp.8-15.
- Publisher:
- Emerald
Dialectical behaviour therapy (DBT) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. Standard DBT is an integrated model combining a range of cognitive and behavioural approaches with aspects of Eastern philosophy, including mindfulness meditation, and has several treatment modes. The model has previously successfully been used to address violence and aggression in a forensic setting. The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning disabilities in 2004, and the programme has been developed over a period of 6 years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain. It concludes that adapted DBT is a promising approach to address self-harm and aggression in hospitalised forensic populations with learning disability and personality disorder, but much creativity and adaptation is necessary. Manualised approaches need to serve as a guidance rather than being rigidly prescriptive.
Predictive validity of the PCL-R in offenders with intellectual disability in a high secure hospital setting: Institutional aggression
- Authors:
- MORRISSEY Catrin, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 18(1), March 2007, pp.1-15.
- Publisher:
- Taylor and Francis
Psychopathy has emerged as one of the constructs most predictive of violence risk in the forensic field. The Psychopathy Checklist-Revised (PCL-R) has previously been found to have acceptable reliability and validity in a sample of offenders with intellectual disability, but its predictive validity in this group has yet to be established. This prospective study examined the relative ability of the PCL-R and two other instruments, the Historical Clinical Risk-20 (HCR-20) and the Emotional Problem Scales' Behaviour Ratings Scale, to predict officially recorded institutional aggression. A sample of 60 offenders with intellectual disability in a high security forensic psychiatric setting was followed up for a period of 12 months. The PCL-R 20-item total, the PCL-R 13-item total, and PCL-R Factor 1 and Factor 2 scores did not significantly predict any type of aggressive behaviour. In contrast, the two more clinically based measures significantly predicted both interpersonal physical and verbal/property aggression. A primary justification for using the PCL-R in forensic settings is the evidence for its association with violence. Further studies examining the relationship between psychopathy, aggression, and violent recidivism in broader samples of offenders with ID are therefore imperative.
Treatment outcomes from forensic intellectual disability services: the perspectives of patients and their family/carers
- Authors:
- CHESTER Verity, GEACH Nicole, MORRISSEY Catrin
- Journal article citation:
- Journal of Intellectual Disabilities, 23(4), 2019, p.473–485.
- Publisher:
- Sage
- Place of publication:
- London
Introduction: Research investigating the treatment outcomes of forensic intellectual and developmental disability (FIDD) services has largely focused on the perspectives of clinicians and researchers. This study sought the perspectives of patients and family/carers on the outcomes important to them. Methods: Semi-structured consultation groups were conducted with patients in FIDD services (n = 21) and family carers (n = 6). Interview data were content analysed, and outcomes identified fell into three main domains (effectiveness, safety and patient experience). Results: The consultations identified outcome domains not considered in the published literature. Patients and carers also had differential perspectives on treatment outcomes commonly reported within literature. Illustrative quotes are used to evidence the domains. Discussion: This study is the first to investigate the outcomes of relevance to patients and their families. These views have been incorporated into an outcomes framework which will form the foundation of future prospective outcome studies. (Publisher abstract)
The association between self-report and informant reports of emotional problems in a high secure intellectual disability sample
- Authors:
- LEWIS Claire, MORRISSEY Catrin
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 4(2), June 2010, pp.44-49.
- Publisher:
- Emerald
The study explored the relationship between self and informant reports of emotional problems in a forensic intellectual disability sample. The instrument used was the Emotional Problems Scales (EPS), which comprises a Self Report Inventory (EPS-SRI) and an informant Behaviour Rating Scale (EPS-BRS). This was routinely administered to 30 men with intellectual disability in a secure forensic setting, as part of a standard clinical assessment procedure over a 1 year period. The patients were assessed using the EPS-SRI by interview over 1 or 2 sessions. Members of the nursing staff completed the EPS-BRS based on observations over the last 30 days. It was hypothesised that there would be a moderate relationship between corresponding scores on the EPS-SRI and EPS-BRS. However, there were no significant relationships between corresponding scales of the EPS-SRI and EPS-BRS, apart from the scales measuring anxiety. The results continued to be non-significant, even when positive impression management was controlled for. The findings suggest little relationship between self and informant ratings in a forensic intellectual disability sample, and it appears that nursing staff may over-report these problems. The results support the need to gather information from multiple sources when assessing such individuals.
Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: treatment progress
- Authors:
- MORRISSEY Catrin, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.125-133.
- Publisher:
- Taylor and Francis
Among mainstream offenders, the severe personality disorder of psychopathy has considerable importance as a construct. The disorder has long been associated with failure to make treatment progress. The present study aimed to compare the predictive power of the Psychopathy Checklist - Revised (PCL-R) in relation to treatment progress with a more general assessment of violence risk, the HCR-20. A sample of 73 residents in a high security intellectual disability service, who had previously been assessed using the PCL-R and the HCR-20, were followed up at 2 years post-assessment, and their outcome determined in terms of two distinct dichotomous variables reflecting definite positive treatment progress and definite negative treatment progress respectively. In line with predictions, the PCL-R Total score and Factor 1 score (Interpersonal and Affective aspects of psychopathy) and the HCR-20 Total score were significantly inversely associated with a positive move from high to medium security hospital conditions within 2 years of assessment. However against prediction, the PCL-R Total score had incremental validity over the HCR-20. The PCL-R Total and Factor 1, but not the HCR-20 Total score, were also significantly associated with negative treatment progress in terms of a move to more restricted treatment conditions. Psychopathy, and in particular its interpersonal and affective manifestations, is a construct which appears to be associated with indirect measures of treatment progress in this high security ID group. However, caution should be applied in the use of a construct with potentially negative connotations in an already devalued population.