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Integrating treatment for offenders with an intellectual disability and personality disorder
- Authors:
- TAYLOR Jon, MORRISSEY Catrin
- Journal article citation:
- British Journal of Forensic Practice, 14(4), 2012, pp.302-315.
- Publisher:
- Emerald
The authors provide an overview of the rationale for appropriate treatment for offenders with personality disorder co-morbid with intellectual disability (ID). They also describe a specific approach to treatment which has drawn upon this evidence. The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is then summarised. A treatment pathway used in a large high-secure hospital catering for high–risk male offenders with ID in central England is described. This integrates adapted cognitive behavioural programmes with a social milieu approach adapted for those with mild ID. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.
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 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.