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The development and future of deaf forensic mental health services
- Authors:
- GIBBON Simon, DOYLE Colin
- Journal article citation:
- British Journal of Forensic Practice, 13(3), August 2011, pp.191-196.
- Publisher:
- Emerald
This paper reviews the need for, and development of, specialist deaf secure mental health services. The authors begin by giving a brief overview of deafness and the relationship between deafness, mental health problems and offending. They go on to summarise the literature and the Department of Health (DoH) guidance and provide a description of the current UK services. In 2001, Young et al. highlighted the needs of deaf mentally disordered offenders and the requirement for specialist forensic mental health services for this group. Since then several DoH guidance documents have been published and there have been substantial service developments.
Factor structure and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a sample of mentally disordered offenders
- Authors:
- HALLINAN Patrick, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 22(4), August 2011, pp.586-602.
- Publisher:
- Taylor and Francis
The Alcohol Use Disorders Identification Test (AUDIT) is a screening instrument designed to identify people with hazardous alcohol consumption. Researchers investigating the factor structure of the AUDIT have to date produced divergent results. The aim of this study was to analyse the factor structure of the AUDIT for a group of Mentally Disordered Offenders (MDOs). The data for this study was collected as part of a larger evaluation of a Belfast-based police-liaison scheme. The sample comprised 2005 MDOs who had completed a battery of tests including the AUDIT. Confirmatory factor analyses revealed that a 2-factor solution (alcohol consumption and alcohol-related consequences) provided the best data fit for AUDIT scores. A 3-factor solution (consumption, dependence, and consequences) provided an equally good fit, but the second and third factors were highly correlated. The 2-factor model was therefore favoured as being more parsimonious. The instrument appeared to perform well amongst a large MDO population with high levels of alcohol consumption.
Factors associated with length of admission at a medium secure forensic psychiatric unit
- Authors:
- SHAH Amar, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 22(4), August 2011, pp.496-512.
- Publisher:
- Taylor and Francis
Despite recommendations that the maximum period of detention for patients in medium secure units (MSUs) should be 2 years, research has shown that between 34% and 66% of patients in MSUs have stays exceeding 2 years. The aim of this study was to identify the characteristics of patients associated with a prolonged length of stay in a MSU. The study included a total of 279 patients discharged between 1999 and 2008 from a MSU in East London. Data for each patient was gathered from the administrative database and clinical notes. A stay of more than 2 years was associated with: diagnosis of psychotic disorder; multiple previous admissions; detention under a hospital order; being on a restriction order; and a history of moderately violent offending. Factors indicating risk of future violence were not found to be associated with length of admission. The findings suggest that beds in this MSU are being blocked by a cohort of patients with specific clinical characteristics and needs. The article concludes that reconfiguration of services is required to provide rehabilitation at lower levels of security.
Embracing the notion that context is crucial in prison mental health care
- Author:
- JORDAN Melanie
- Journal article citation:
- British Journal of Forensic Practice, 12(4), November 2010, pp.26-35.
- Publisher:
- Emerald
Prisons often receive people from the community with mental health problems, and prison culture can adversely affect these problems. This article highlights the mental health of adult male prisoners and the mental health care provided within Her Majesty's Prison Service in the United Kingdom. Currently, the level of mental health need within this population is high, and prison mental health services require additional positive developments. The prison setting is not always conducive to good mental health, and is not often a useful catalyst for mental health care. The article suggests that prison mental health services ought to be increasingly commissioned, provided, managed and practised in direct accordance with the prison social environment, institutional set-up and specific mental health requirements of prisoners/patients. The author outlines the social and institutional structures which pervade the prison setting. The proposition is that situation-specific and culturally responsive mental health care is a must, and the context in which it is provided is crucial.
Blue remembered skills: mental health awareness training for police officers
- Authors:
- CUMMINGS Ian, JONES Stuart
- Journal article citation:
- Journal of Adult Protection, 12(3), August 2010, pp.14-19.
- Publisher:
- Emerald
Police officers can have a key role to play in situations where individuals are experiencing some sort of crisis relating to their mental health. Despite the fact that this is a very important facet of day to day police work, it is an area that is neglected in police training. The Bradley Report has raised a number of important questions regarding the treatment of individuals who are experiencing mental health problems and find themselves in the criminal justice system. One of the key recommendations is that professional staff working across criminal justice organisations should receive increased training in this area. This paper outlines two approaches to the training of police officers in the mental health field. The first is a joint working initiative between Hywel NHS Trust and Dyfed Powys Police. In this training, all student officers receive 2 days training in first aid in mental health, and spend 4 days at the acute psychiatric unit where they become personally involved in the care of individuals who are experiencing acute distress. The second approach comprised a classroom-based training course directed at custody sergeants. The article goes on to consider the most effective models of training for police officers.
Positive psychology and forensic clients: applications to relapse prevention in offending behaviour interventions
- Authors:
- GREDECKI Neil, TURNER Polly
- Journal article citation:
- British Journal of Forensic Practice, 11(4), November 2009, pp.50-59.
- Publisher:
- Emerald
Noting that positive psychology has a number of potential implications for working with forensic clients and the delivery of therapy and relapse prevention blocks, this paper explores the potential application of positive psychology literature to offending behaviour interventions, focusing on the process of relapse prevention and self-management within the framework of the Self-Regulation Model of the Relapse Process. It looks at positive traits and qualities, including optimism and resilience, and barriers to enhancing positive traits and emotions, and concludes that relapse prevention models introduce clients to the process of the relapse while some other models enhance life goals that support the change process with a focus on the client's achievements and strengths, and that facets of positive psychology provide opportunities for clients to develop their relapse prevention skills with the potential to enhance clients' abilities to manage the situations that may take them closer to relapse and offending.
Using the revised Problem Identification Checklist to predict inpatient and community violence: a pilot study
- Authors:
- NAGI Claire, et al
- Journal article citation:
- British Journal of Forensic Practice, 11(3), September 2009, pp.4-13.
- Publisher:
- Emerald
The Problem Identification Checklist is a measure of dynamic risk of antisocial conduct. This study aims to investigate the predictive validity of a modified version of the Problem Identification Checklist (PIC-R) in predicting inpatient and community violence. Historical Scale (H-Scale) of the Historical Clinical Risk-20 (HCR-20) was used to control for static risk factors. The participants were 49 psychiatric patients (25 inpatients and 24 outpatients) from a secure NHS mental health facility in the North West of England. The study employed a retrospective design using comprehensive file reviews to produce ratings of the Historical Scale, and the nursing staff involved in the day-to-day care of the patients to produce ratings of the revised Problem Identification Checklist. The results indicated that, over a 12 month follow-up period, the revised Problem Identification Checklist significantly predicted inpatient violence but did not predict community violence. Conversely, the Historical Scale significantly predicted community violence but did not predict inpatient violence. The authors conclude that the findings suggest that short-term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables than to static ones.
The ethics of forensic psychiatry: moving beyond principles to a relational ethics approach
- Authors:
- AUSTIN Wendy, GOBLE Erika, KELECEVIC Julija
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 20(6), December 2009, pp.835-850.
- Publisher:
- Taylor and Francis
Forensic psychiatry has been described as a 'moral minefield'. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit 'untrustworthiness' of forensic patients shape practitioners' everyday reality. Suspicion colours client-practitioner relationship and fundamental care concepts, such as patient advocacy, take on different nuances in this milieu. Despite the complex ethical demands of this unique practice area, it has received little attention within mainstream bioethics. There is, however, a growing imperative to find a theory of ethics for the specialty. In this article, the ethics of forensic psychiatry is examined, and it is argued that relational ethics is a fitting framework for forensic practice and, further, that forensic settings are the very place to test the validity of such an ethic.
Violence risk assessment: the use of the PCL-SV, HCR-20, and VRAG to predict violence in mentally disordered offenders discharged from a medium secure unit in Scotland
- Authors:
- HO Hilda, THOMSON Lindsay, DARJEE Rajan
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 20(4), August 2009, pp.523-541.
- Publisher:
- Taylor and Francis
Risk assessment tools are increasingly used in the management of mentally disordered offenders in Scotland, but there has been limited research into their validity among this population. This study examined the validity of risk assessment tools in predicting violence following discharge from a Scottish medium secure unit. The PCL-SV, the VRAG, and the historical subset of the HCR-20 were completed on 96 patients. Follow-up information regarding post-discharge violence and clinical factors was collected for two years. Four (4.2%) patients from the sample committed five serious violent offences, while 38 (40.6%) patients committed more than 100 minor violent offences. The risk assessment tools were found to have moderate predictive accuracy for violent outcomes. Thus this study provides useful evidence supporting the validity of risk assessment tools in Scotland. Individual clinical factors such as substance abuse, personality disorder, treatment non-compliance, and symptom relapse are also relevant in risk assessment and management.
A suitable waiting room? Hospital transfer outcomes and delays from two London prisons
- Authors:
- FORRESTER Andrew, et al
- Journal article citation:
- Psychiatric Bulletin, 33(11), November 2009, pp.409-412.
- Publisher:
- Royal College of Psychiatrists
The situation of a group of prisoners who required transfer to mental health units from two London prisons is described. Overall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. The aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million. The results show that both prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.