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Comparing co-production approaches to dynamic risk assessments in a forensic intellectual disability population: outcomes of a clinical pilot
- Authors:
- MORRIS Deborah J., et al
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 12(1), 2021, pp.23-36.
- Publisher:
- Emerald
Purpose: A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID) services, yet these approaches are under-evaluated in forensic settings. This study aims to explore and compare the feasibility of two approaches to co-production in the completion of dynamic risk assessments and management plans in a secure setting. Design/methodology/approach: A convenience sample of adults admitted to a secure specialist forensic ID service (N = 54) completed the short dynamic risk scale (SDRS) and drafted risk management plans under one of two conditions. In the first condition, participants rated the SDRS and risk management plan first, separately from the multidisciplinary team (MDT). In the second condition, participants and MDTs rated the SDRS and risk management plan together. Findings: In total, 35 (65%) participants rated their risk assessments and 25 (47%) completed their risk management plans. Participants who rated their risk assessments separately from the MDT were significantly more likely to complete the SDRS (p = 0.025) and draft their risk management plans (p = 0.003). When rated separately, MDT scorers recorded significantly higher total SDRS scores compared to participants (p = 0.009). A series of Mann-Whitney U tests revealed significant differences between MDT and participant ratings on questions that required greater skills in abstraction and social reasoning, as well as sexual behaviour and self-harm. Originality/value: Detained participants with an ID will engage in their dynamic risk assessment and management plan processes. The study demonstrates the impact of different co-production methodologies on engagement and highlights areas for future research pertaining to co-production. (Edited publisher abstract)
Validation of the Security Needs Assessment Profile (SNAP) by a national survey of secure units in England
- Authors:
- DAVIES Steffan, COLLINS Mick, ASHWELL Chris
- Journal article citation:
- Psychiatrist (The), 36(10), October 2012, pp.366-371.
- Publisher:
- Royal College of Psychiatrists
Assessing a patient’s need for secure psychiatric services is a key competence in forensic psychiatric training. For individual patients, proper understanding of their full range of security needs will allow a correct initial placement and appropriate progress through the various levels of security. The Security Needs Assessment Profile (SNAP) was developed in the Trent region of England to provide a detailed description of individual patient’s security requirements. This paper describes a national survey of secure units undertaken to examine the content validity of the item structure of SNAP and revise the item definitions to reflect more broadly based clinical practice. In addition, a follow-up survey sought views on the usefulness of SNAP in clinical practice. The survey participants were 35 secure units from National Health Service and independent sector providers. No new security items were generated. All the item definitions were reviewed, many amended, and a small number revised extensively. Units’ security profiles were rated on the original and revised instruments. The revised SNAP was shown to be generalisable across secure services in England; 92% of respondents agreed or strongly agreed that SNAP would be useful in providing a structured security needs assessment.
A survey of older adult patients in special secure psychiatric care in Scotland from 1998 to 2007
- Authors:
- LIGHTBODY Elizabeth, GOW Rona L., GIBB Robert
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(6), December 2010, pp.966-974.
- Publisher:
- Taylor and Francis
One area in which the needs of older adults may not be being met is in the field of forensic psychiatry. The aim of this survey was to gather information about the number and the needs of older adult patients in special secure forensic psychiatry care in Scotland. Inpatients of The State Hospital, Carstairs aged 55 or over throughout a 10-year period were included. Thirty-six patients were identified: 22 reached the age of 55 during their admission, and 14 were new admissions after the age of 55. This population has heterogeneous and complex needs. The most common diagnoses are of psychotic illnesses. Most patients are admitted from other secure psychiatric facilities or prison and the duration of admission is long. There are high rates of physical illness, mobility impairment, sensory impairment and polypharmacy. Offences tend to be at the severe end of the spectrum, including homicide, sexual offences and other violent offences. Most patients are single males and socioeconomic classes IV and V are over-represented. The article concludes that, given the complex needs of older mentally disordered offenders, their management would benefit from old age and forensic mental health services jointly working together.
Jailhouse blues
- Author:
- NORRIS Rebecca
- Journal article citation:
- Health Service Journal, 19.06.08, 2008, pp.26-28.
- Publisher:
- Emap Healthcare
Faced with huge numbers of mentally ill offenders, London's forensic services are struggling to cope. This article reports on the current situation
Factors associated with stalking behaviour in patients admitted to a high security hospital
- Authors:
- WHYTE Sean, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 18(1), March 2007, pp.16-22.
- Publisher:
- Taylor and Francis
Many stalkers suffer from mental disorder, and this may bring them into contact with psychiatrists before their stalking behaviour is identified. This study set out to identify information obtained during a forensic psychiatric assessment which might indicate the presence of stalking behaviours and prompt further assessment. Thus 362 consecutive admissions to Broadmoor Hospital were comprehensively assessed, including an assessment of stalking behaviours. Using both univariate analyses and multivariate logistic regression, associations were found between stalking and: committing sexual offences or having a sexual motive for offending; a lack of physical contact with the victim immediately before the index offence; lacking a pattern of theft and other minor acquisitive offences; and, among those who kill, having diminished responsibility. These factors may help in the assessment of patients who might be stalkers.
A concept analysis of 'forensic' nursing
- Author:
- KETTLES Alyson McGregor
- Journal article citation:
- British Journal of Forensic Practice, 8(3), September 2006, pp.16-27.
- Publisher:
- Emerald
Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. This article uses the strategy of concept analysis to explore the term 'forensic nursing' and find a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and define it more clearly. Forensic nursing is found to derive from practice. A proposed definition of forensic nursing is given.
The prevalence of early onset alcohol abuse in mentally disordered offenders
- Authors:
- LUMSDEN John, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), December 2005, pp.651-659.
- Publisher:
- Taylor and Francis
The alcohol consumption histories of 563 male patients resident at Broadmoor Hospital over the period 1997–2002 were ascertained from inspection of patients' case files. Information regarding alcohol consumption was obtained from patients' forensic and psychiatric reports and, for a sub-set of the sample (n = 101), from reports of drug and alcohol assessments. Patients were grouped according to whether or not they had abused alcohol (consumed greater than 50 units per week) and, if so, by age of onset of their alcohol abuse: prior to age 19, 19–21, or over 21 years. Forensic and psychiatric reports indicated that 47.4% of the sample had abused alcohol and 22.0% started to abuse before the age of 19. The 70.3% of patients who underwent drug and alcohol assessment were found to have abused alcohol and 48.5% had abused alcohol under the age of 19. These findings underline the high prevalence of early onset alcohol abuse among high-security mentally disordered offenders, and indicate the need for studies that address the intervening variables that mediate the link between teenage alcohol abuse and adult antisocial behaviour.
Psychologists’ understanding of the factors influencing successful treatment in a secure forensic environment
- Authors:
- GALE Jessica, CLARBOUR Jane, RAYNER Kelly
- Journal article citation:
- Journal of Forensic Practice, 20(3), 2018, pp.167-178.
- Publisher:
- Emerald
Purpose: Literature suggests that mentally disordered offenders are considerably more difficult to treat and slower to respond to psychological treatment. Less is known about the particular factors that can contribute to this resistance. A more comprehensive understanding of the factors that treating psychologists feel can promote or inhibit progression through rehabilitative treatment may increase the likelihood of positive clinical outcomes. This paper aims to discuss these issues. Design/methodology/approach: Four practising psychologists employed within a male medium- and low-secure forensic unit in the North East of England took part in a semi-structured interview. Their views, opinions and experiences regarding patient progression through treatment pathways were recorded, transcribed and analysed. Findings: This thematic analysis identified that numerous patient-specific parameters influenced perceived progression, and environmental and external factors had a significant impact on the patients’ expressed attitude towards treatment. Practical implications: Alongside issues of motivation and engagement, participants identified external factors that influence perceived treatment success with their forensic patients. Originality/value: Additional research is needed to identify the factors that are the most influential in promoting or inhibiting perceived and actual progress. This will hopefully optimise treatment engagement and the motivation to change problematic behaviours in mentally disordered offenders. (Edited publisher abstract)
In search of a family: the contribution of art psychotherapy to a collaborative approach with a man residing in a forensic learning disability setting
- Authors:
- CAVENEY Domanic, WASSALL Shaun, RAYNER Kelly
- Journal article citation:
- British Journal of Learning Disabilities, 46(1), 2018, pp.17-23.
- Publisher:
- Wiley
Background: Clients with attachment issues are over-represented in learning disability services. Forensic inpatient services are no exception. Treatment pathways comprise multidisciplinary interventions, and skills-based treatments are considered vital to recovery and maintenance of prosocial and adaptive behaviour and reduction in risk. An important aspect of treatment is the psychological intervention to enable clients to understand their early experiences and the way this may have impacted on later relationships and behaviour. Without exploring the difficult early lives that many clients in forensic inpatient services have experienced, skills-based treatments and attempts to facilitate discharge may not be effective. Materials and methods: This case study presents the theoretical background of attachment, autism, learning disability and sexual offending that informed the collaborative multidisciplinary psychological treatment offered to one man with learning disabilities and autism in a secure forensic setting. Results: The introduction of Art Psychotherapy enabled the client to explore his history and the potential internal barriers to his therapeutic progress. Issues of safety and belonging, previously unexplored with this man, were uncovered and these themes were incorporated into his risk formulation and treatment plan. Conclusions: The paper reflects on the specific contribution of Art Psychotherapy in specialist services, and the importance of the collaborative relationship between the Art Psychotherapist and the ward Multi-Disciplinary Team. (Publisher abstract)
Does formulation of service users' difficulties improve empathy in forensic mental health services?
- Authors:
- WILKINSON Helen, et al
- Journal article citation:
- Journal of Forensic Psychology Research and Practice, 17(3), 2017, pp.157-178.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
The culture and values of the National Health Service and the staff that work within it have received much attention over recent years. The erosion of empathy and compassionate care toward service users has been highlighted. Psychological formulation may be one way that clinicians can understand their service users more fully, which could lead to an improvement in the empathy they express toward them. The current study investigates the effect of presenting client information in a psychological formulation on self-reported empathy in staff in medium and low secure forensic mental health services. One hundred and fifty-four staff were recruited via convenience sampling to complete self-report questionnaires measuring burnout (Maslach Burnout Inventory), state (Adapted Interpersonal Reactivity Index), and trait (Empathy Quotient) empathy. No significant difference in state empathy scores was observed among the staff in the formulated group when compared with the unformulated group. Linear multiple stepwise regressions demonstrated that trait empathy and burnout significantly predicted variance in state empathy, but the information format was not significant. It was concluded that mode of presentation in this instance did not influence the degree of empathic concern staff expressed toward a hypothetical client in a vignette. General levels of empathy and degree of burnout superseded this effect. Further research is needed on how adjusting client information formats might enhance empathy among professionals. (Publisher abstract)