Search results for ‘Subject term:"personality disorders"’ Sort:
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The evolution of a therapeutic community for offenders with intellectual disability and personality disorder: part one – clinical characteristics
- Authors:
- TAYLOR Jon, et al
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 33(4), 2012, pp.144-154.
- Publisher:
- Emerald
Rampton Hospital is one of three high secure psychiatric hospitals in the UK. The hospital provides a national resource for men with a learning disability who require care and treatment in high security. All admissions to the hospital have to meet specified criteria: an individual must present a grave and immediate danger and suffer from a mental disorder as defined by the Mental Health Act. This paper describes the profile of community members admitted Rampton Hospital. Based on the clinical profile of the men admitted to the service, it seems reasonable to assume that the cohort initially admitted to the community are likely to be more difficult to engage and sustain in treatment than those typically admitted to prison TCs. The combination of high levels of risk, severe personality disorder with problematic interpersonal functioning and behavioural disturbance, in addition to intellectual disability, certainly presents significant challenges to the evolution of a pro-social community culture. Overall, the characteristics of the men admitted to a TC in the National High Secure Learning Disability Service are likely to present considerable challenges to the development and delivery of the service.
Self-harm and the positive risk taking approach. Can being able to think about the possibility of harm reduce the frequency of actual harm?
- Authors:
- BIRCH Sarah, et al
- Journal article citation:
- Journal of Mental Health, 20(3), 2011, pp.293-303.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Self-harm is a common problem in mental health care, and the UK has one of the highest rates in Europe. This is particularly true in psychiatric and prison services, and especially with women. This paper presents findings from an assessment of self-harming across three women's units in England over a period of 6 years. The units used a positive approach to self-harm where the risk that this behaviour presents is considered in an effort to reduce actual harm. Episodes of self-harm were collected from incident forms collected from 2004 to 2009. Results indicated a reduction of self-harm over the course of admission, and analyses revealed that there was a significant difference in the frequency of self-harm during the first and last 3 months of admission. The authors conclude with a discussion within a psychoanalytical framework, with reference to the value of positive risk-taking in a secure setting.
Difficulties in the pathway from high to medium secure services for personality-disordered patients
- Authors:
- TETLEY Amanda Clair, EVERSHED Sue, KRISHNAN Gopi
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(2), April 2010, pp.189-201.
- Publisher:
- Taylor and Francis
A significant proportion of inpatients in high secure hospitals are detained under the Mental Health Act with a diagnosis of personality disorder, and the main route of discharge to the community for these patients is through medium secure units. This study aimed to explore the difficulties encountered in the transfer process from high to medium secure services for personality disordered patients, to identify the success of referrals from high to medium secure services, to determine the delays encountered during the transition process, and to identify the success of personality disordered patients' admissions to medium secure services. Data relating to referrals to medium secure services were collated for previous and current patients from a personality disorder service and a dangerous and severe personality disorder service in the high secure Rampton Hospital. The results showed a poor success rate of referrals to medium secure units and extensive delays encountered in the transfer process, also identifying a poor success rate of patients' period of trial leave at medium secure units. The researchers concluded that these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality disordered patients and that these units lack the infrastructure to treat this patient group
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.
Personality disorder: the definitive reader
- Editors:
- ADSHEAD Gwen, JACOB Caroline, (eds.)
- Publisher:
- Jessica Kingsley
- Publication year:
- 2009
- Pagination:
- 278p.
- Place of publication:
- London
Offers a comprehensive and accessible collection of papers that will be practically useful to practitioners working in secure and non-secure settings with patients who have personality disorders. This book brings together fourteen classic papers, which address the impact that working with personality disorder patients can have on staff. It also offers theoretical explanations for personality disorder, and explores other issues such as the concept of boundaries in clinical practice, psychiatric staff as attachment figures and the relationship between severity of personality disorder and childhood experiences. Each paper is introduced with contextual material, and is followed by a series of questions that are intended to be used as educational exercises. This book will be essential reading for clinical and forensic psychologists, psychiatrists, community psychiatric nurses, social workers and students.
Traumas of forming: the introduction of community meetings in the dangerous and severe personality disorder (DSPD) environment
- Authors:
- MOORE Helen, FREESTONE Mark
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 27(2), Summer 2006, pp.193-209.
- Publisher:
- Emerald
This article presents a perspective on the staff and patient experiences of the introduction of community Meetings into the Rampton Hospital DSPD Peaks Unit, a high-secure setting designed to accommodate "some of the most dangerous people in society" (Home Office, 2004); who are nevertheless a client group who have often lived through deeply traumatic experiences in childhood and young adulthood. Bi-weekly Ward Community Meetings, intended to integrate aspects of Therapeutic Community living into the highly restricted and insitutionalised life of the DSPD Unit, were introduced in 2004 by the first author. In this article the author reflects on her personal experience of introducing, implementing and defending the Meetings - as well as the strong therapeutic ethos behind them. The second author presents a sociological contextualisation of this therapeutic ideal within a 'totally' institutionalised environment, with particular attending to the maintenance of a particular power/knowledge apparatus within the Unit.
Ethnic differences among patients in high-security psychiatric hospitals in England
- Authors:
- LESSE Morvan, et al
- Journal article citation:
- British Journal of Psychiatry, 188(4), April 2006, pp.380-385.
- Publisher:
- Cambridge University Press
Black (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England. The aim was to describe the sociodemographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group. A total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed. Black patients in HSPHs are over-represented by 8.2 times (range 3.2–24.4,95% CI 7.1–9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P<0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40,95% CI 0.06–0.73). Compared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.
Exploring multi-disciplinary team meetings on a personality-disorder ward within a forensic setting
- Authors:
- LEESE Maggie, FRASER Kim
- Journal article citation:
- Mental Health Review Journal, 24(3), 2019, pp.160-170.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand how patients on a low security personality disorder ward experienced multi-disciplinary team (MDT) meetings, in order to suggest improvements that would benefit the patients and clinical teams. Design/methodology/approach: The design was a case study where all patients on a low secure ward that specialised in personality disorders were approached to take part in the research. The study utilised non-participant observations of the MDT meeting (n=11), followed by individual interviews with the patients (n=10). Findings: The data were subjected to a thematic analysis and this illuminated five themes relating to the patients’ experience of the MDT meetings namely, the importance of leave applications, the formality of the meetings, the opportunity to check on progress, decision-making and the importance of communication. Practical implications: The findings suggest that small changes could be made to improve the patients’ experience of the MDT meeting. These included the provision of a less formal setting, ensuring a system where leave can be requested confidentially, greater transparency about the content of progress reports, and clearer communication between the MDT and the patient after the meeting. Originality/value: There is limited research that has explored patients’ experiences of MDT meetings within secure forensic settings, and the use of non-participant observations of the MDT meeting followed by semi-structured interviews meant that the researcher and the patient had a shared experience that formed the basis of the later discussion. (Edited publisher abstract)
Perceptions of therapeutic principles in a therapeutic community
- Authors:
- CAPONE Georgina, et al
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 38(2), 2017, pp.60-78.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore staff and service users’ perceptions of therapeutic principles within a unique male high secure learning disability therapeutic community (LDTC). Design/methodology/approach: A qualitative approach was adopted using deductive content analysis and inductive thematic analysis. In total, 12 participants took part in a semi-structured interview to explore their perceptions of Haigh’s (2013) quintessence principles and any further additional therapeutic features in the environment not captured by the theory. Findings: All five quintessence principles were identified in the LDTC environment. Some limits to the principle of “agency” were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional therapeutic features were identified including; security and risk, responsivity, and more physical freedom which appear to aid implementation of the quintessence principles. Research limitations/implications: The study was performed within a single case study design. Therefore, results remain specific to this LDTC. However, the finding of these principles in such a unique setting may indicate Haigh’s (2013) quintessence principles are evident in other TC environments. Originality/value: This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The research provides empirical evidence for the quintessence principles in a novel TC setting and suggests recommendations for future research. (Publisher abstract)
The benefits of environmental change in a secure service for people with intellectual disabilities
- Authors:
- LONG Clive G., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(5), 2014, pp.309-320.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards. Design/methodology/approach: Ten patients/service users and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards. All participating service users were detained under the Mental Health Act 1983. Not all had committed offences. Findings: The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment. Originality/value: Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care. (Edited publisher abstract)