Recent Submissions

  • Psychological and physical health impacts of forensic workplace trauma

    Mistry, Dipti; Gozna, Lynsey (2021)
    Purpose: Health-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting. Design/methodology/approach: Semi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital. Findings: Thematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes. Practical implications: The findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events. Originality/value: This research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.
  • Helping with the pressures of the past: Service-user perspectives of the sensory approaches within the National High Secure Healthcare Service for Women

    Wilkinson, Dawn; Beryl, Rachel (2021)
    Purpose This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital. Design/methodology/approach This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis. Findings The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome. Practical implications Participants’ feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings. Originality/value This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting.
  • Development of the FORUM: a new patient and clinician reported outcome measure for forensic mental health services

    Sales, Christian P. (2021)
    Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multi-stakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: 'about me, my quality of life, my health, my safety and risk, my life skills and my progress'. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM's use to track patients' progress over time, and facilitate shared decision-making and care planning, is required.
  • Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population

    Gibbon, Simon D.; McPhail, Emma; Mills, Georgina; McBride, Martin; Storer, Rebekah; Taylor, Nicholas; McCarthy, Lucy (2021)
    Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients' clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.
  • Audit of blood borne virus screening, referral, and hepatitis B vaccination in a high secure hospital

    Holdcroft, Jason; D'Silva, Karen (2021)
    Blood borne virus (BBV) infections are a significant risk for patients and staff in secure settings. Hospital policy is that all newly admitted patients will be offered screening for hepatitis B & C and HIV. All admissions between 2016 and 2019 were audited for BBC screening and follow-up of positive results. 'Where appropriate', patients should be offered hepatitis B vaccination, and the offer/delivery of this was audited. Nearly all new admissions were screened for BBC in this period. The offer and provision of hepatitis B vaccination was inconsistent throughout the Hospital.
  • An item response theory analysis of the Forensic Restrictiveness Questionnaire (FRQ)

    Bartlett, Peter (2020)
    Forensic psychiatric care settings are intended to be more therapeutic than penal settings. More homely, recovery-oriented, person-centered, and less overtly punitive. However, forensic inpatient hospitals are highly secure, risk averse, and can diminish patient autonomy. A body of research is investigating how patients experience care and how these experiences are associated with treatment outcomes. The self-report FORENSIC RESTRICTIVENESS QUESTIONNAIRE (FRQ) is a 15-item measure of patients’ perceptions of the restrictions upon their autonomy. There has been interest in validating the FRQ in several countries. Despite preliminary empirical support for the FRQ, its psychometric properties are not well understood. In this paper we draw on Item-Response Theory (IRT) to investigate the properties of individual FRQ items to identify candidate items for alteration, removal or retention to assist researchers validating the FRQ in new contexts. Results suggest the FRQ is more sensitive to measuring the perceptions of patients that have above average amounts of perceived restrictiveness. Measurement error rises sharply for the approximately 5% highest scoring respondents but is low for the majority of individuals. Users are likely to respond in a dichotomised manner and not use the ‘Not Sure’ option. The response category ‘Not Applicable’ should be removed from a revised FRQ. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
  • Evaluating neuropsychologically informed rehabilitation training for staff within a high secure intellectual disability service

    Annesley, Phyllis; Hamilton, Zoe; Akiens, Sam; Hicks, Rachel; Clarke, Martin (2020)
    Purpose: Neuropsychologically informed rehabilitation (NIR) is one approach to supporting people with intellectual disabilities, cognitive impairment and challenging behaviour. This study aims to evaluate a five-day training course in NIR for staff working with adult male offenders with intellectual disabilities in a high secure hospital. The impacts on both the staff who undertook the training and the patients with challenging behaviour were explored. Design/methodology/approach: Participants were psychology, nursing and day services staff and male patients. The staff completed a post-training questionnaire and three measures at pre-NIR training, post-NIR training and one-year follow-up. Patients completed four questionnaire measures within the same periods. Findings: NIR training was positively evaluated by staff. Staff members’ perceived efficacy in working with challenging behaviour significantly increased post-training which was maintained at follow-up. Thematic analysis showed that the training staff members built their confidence, knowledge and skills. Because of these being high to start with, the study could not evidence statistically significant changes in these. Thematic analysis yielded two main themes, namely, benefits and quality of training, each with their own subthemes. The impacts of the training on patients were difficult to assess related to various factors. Research limitations/implications: The knowledge and confidence measures used were limited in scope with an experienced staff group and required development. Practical implications: NIR training could assist staff in other secure and community settings in working with people with intellectual disabilities and challenging behaviours. Originality/value: This study positively contributes to an area that requires more research. © 2020, Emerald Publishing Limited.
  • The experience of long stay in high and medium secure psychiatric hospitals in England: Qualitative study of the patient perspective

    Vollm, Birgit A. (2020)
    Background: Some forensic patients in England remain in secure care for long, possibly unnecessarily prolonged, periods, raising significant ethical and resource issues. Research focused on the patients in secure care has examined quality of life and service provision but not the perspectives of patients experiencing long stays. This study explored how long stay patients experience secure care, what factors they felt influenced long stay, and its impact upon treatment engagement and motivation to progress. Methods: Embedded within a larger epidemiological study, we conducted semi-structured interviews with a purposive sample of forty long stay patients from two high and six medium secure hospitals. Long stay was defined as a 5 years stay in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure. Transcripts were subject to thematic analysis, and narrative analysis at individual case level to explore the relationship between emergent themes. Results: Four themes emerged illustrating participants' attribution, outlook, approach, and readiness for change. A typology of four long stay stances was developed (dynamic acceptance, dynamic resistance, static acceptance, static resistance). These illustrate differences in the extent to which participants believed being in secure care helped them to get better, and actively work towards progression and leaving secure care. There were considerable differences in how patients adopting these stances attributed the reasons for their long stay, they viewed their future, and their motivation to progress. Negative perceptions arose from excessive restrictions, treatment repetition and changes in therapeutic relationships, leading some patients to exhibiting tokenistic engagement and low motivation to progress. Conclusions: Planning care for long stay patients in secure psychiatric settings should take account of the differing stances patient's adopt towards engagement and progression. Service providers should be mindful of these stances and provide patients with individualised opportunities to progress through the secure care treatment pathway, avoiding treatment repetition and maintaining continuity in key professional relationships. Refocusing on quality of life may be appropriate for some long-term patients who are unwilling or unable to move on. For some long-term patients, purpose designed long stay setting may be appropriate. © 2020 The Author(s).
  • Corrigendum: The forensic restrictiveness questionnaire: Development, validation, and revision

    Bartlett, Peter (2020)
    The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated. Copyright © 2020 Tomlin, Völlm, Furtado, Egan and Bartlett.
  • The forensic restrictiveness questionnaire: Development, validation, and revision

    Bartlett, Peter (2019)
    Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = -0.72) and ward climate (Spearman's ρ = -0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.
  • Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system

    Hui, Ada (2020)
    This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon a national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.
  • A retrospective audit to assess the utilisation of clozapine in a high secure forensic hospital

    Huang, Li-Ying; Holmes, Nikki (2019)
    Poster from the Trent Study Day 2019
  • Excess mortality of patients admitted to medium secure care: Findings from the ALACRITy study

    Clarke, Martin; Westhead, Jodie; McCarthy, Lucy; Gibbon, Simon D. (2019)
    Poster from the Trent Study Day 2019
  • Changes in the Admission Characteristics of patients admitted to a MSU: Findings from the ALACRITy study

    Gibbon, Simon D.; Westhead, Jodie; Clarke, Martin; McCarthy, Lucy (2019)
    Poster from the Trent Study Day 2019
  • Introduction to the updated ALACRITy study; a long-term follow-up of a Medium Secure Unit (MSU) cohort

    McCarthy, Lucy; Westhead, Jodie; Clarke, Martin; Gibbon, Simon D. (2019)
    Poster from the Trent Study Day 2019
  • A long-term follow-up study of patients discharged from a Medium Secure Unit: Preliminary reconviction rates after discharge

    Westhead, Jodie; Clarke, Martin; Gibbon, Simon D. (2019)
    Poster from the Trent Study Day 2019
  • Reconviction & readmission following discharge from a MSU: Findings from the ALACRITy study

    Westhead, Jodie; Clarke, Martin; McCarthy, Lucy; Gibbon, Simon D. (2019)
    Poster from the Trent Study Day 2019
  • Not everything is as it seems: RO DBT and overcontrolled disorders in forensic settings

    Hamilton, Laura; Bacon, Lee; Longfellow, Emma; Tennant, Allison (2018)
    On the night of Sunday, October 1, 2017, 64-year-old Stephen Paddock of Mesquite, Nevada, opened fire on a crowd of concert-goers at the Route 91 Harvest music festival on the Las Vegas Strip in Nevada, leaving 58 people dead and 851 injured. About an hour after Paddock fired his last shot, he was found dead in his hotel room from a self-inflicted gunshot wound. Despite perpetuating the deadliest mass shooting committed by an individual in the United States, police investigators reported that Paddock had no prior criminal record that would indicate he was dangerous. Plus, the shooting was carefully planned (e.g., researching SWAT tactics, renting other hotel rooms overlooking outdoor concerts, and investigating potential targets in other cities). Paddock was twice divorced and single at the time of the shooting, with no known children. His ex-wife described him as intelligent and great with numbers. His doctors described him as "odd" and showing "little emotion". To date his motive remains unknown. Contrary to common assumptions that all (or most) violent acts stem from poor impulse control, emotion dysregulation, and low distress tolerance (i.e. undercontrol), both prior and emerging research has identified an overcontrolled violent offender subtype, for whom acts of violence are rare but seem to be disproportionately more violent and planned compared to undercontrolled offenders. For example, the Congressional Research Service (CRS; Bjelopera, Bagalman, Caldwell, Finklea, & McCallion, 2013) recently released a report that described the most common characteristics and behaviors likely to be seen in perpetrators of public mass shootings based on interviews and data from 78 public mass shootings in the U.S. since 1983. Findings revealed that most perpetrators act alone and carefully planned in advance (see similarities in the description of the Las Vegas shooter above). They reported pervasive feelings of social persecution and ostracism-and were described by others as a loner. Rumination about real or imagined rejections, envy, bitterness, resentment, and revenge were common (CRS; Bjelopera et al., 2013). The Las Vegas gunman (Paddock) described above appears to fit much of this profile. Yet, our understanding of the overcontrolled violent offender and the type of violence associated with moral certitude, excessive inhibitory control, planning ahead, envy, bitterness, and desires for revenge remains poorly understood. The aim of this paper is to outline how recent research in forensic settings may provide a potential way forward to the conundrum posed by the Las Vegas gunman and other violent offenders sharing similar overcontrolled characteristics. The paper outlines how we have used RO DBT to reexamine the diagnostic features of incarcerated offenders and also describes the developmental trajectory our team experienced implementing RO DBT in a maximum-security forensic hospital.
  • Using occupation to deconstruct and reconstruct the 'identity' of high secure forensic patients

    Guite, John; Humpston, Rachael (2019)
    This is a poster from the Royal College of Occupational Therapists 43rd Annual Conference and Exhibition, 17-18 June 2019, Birmingham United Kingdom.
  • Prison vs. hospital for offenders with psychosis; effects on reoffending

    Huband, Nick; Haque, Quasi; Duggan, Conor (2019)
    With research showing a high prevalence of psychosis in prisons, its effective management is essential for clinical and criminal outcomes. In a matched sample of released prisoners and discharged patients with psychosis (124 pairs) we investigated whether group participation (prison vs. hospital) affected the likelihood of reoffending as well as time to reoffending. Statistical analysis was completed using multilevel logistic regression and multilevel survival analysis. We found that prison cases were more likely to commit any offence within a given period of time (1, 2 or 3 years). Moreover, at any particular time 3 times as many patients with psychosis released from prisons reoffended proportionally to their matched controls discharged from hospitals (HR = 2.92, 95% CI = 1.99, 42,9, P < 0.001). In conclusion, release from prison carries higher risk of a future offending and reduced time to reoffending among offenders with psychosis. Notwithstanding limitations inherent in observational study designs, we renovate that in addition to clinical need and the humanitarian argument, offenders with psychosis should be treated in secure hospitals to reduce future recidivism.

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