• A retrospective evaluation of a therapeutic community for mentally disordered offenders

      McMurran, Mary; Egan, Vincent (1998)
      This paper reports a retrospective evaluation of a therapeutic community (TC) for mentally disordered offenders in a regional secure unit (RSU). All 85 patients who had passed through the TC since it opened in 1987 were eligible for the study. Information on 81 patients was available in clinical records, providing a descriptive profile of the population. Information on recidivism was collected from the Home Office Offenders Index for 53 patients, providing information on effectiveness of the TC in terms of its impact on crime. Those for whom post-discharge crime information was collected were split into assessment and treatment groups, and short- and long-stay groups. All patients significantly reduced their offending after discharge as compared with pre-admission levels. There was no significant difference between the assessment and treatment groups, or between short- and long-stay groups. Whilst there was a significant overall reduction in offending, this cannot be attributed to the TC programme. Programme design, selection criteria and pre-admission assessment all require further attention to optimize the effectiveness of group treatment for mentally disordered offenders.
    • Alternative therapy or good nursing care? Therapeutic touch with mentally disordered offenders

      Brimsted, Anne; Miller, A.; Robinson, David K. (1998)
      Therapeutic touch (TT) is an alternative therapy that has been used for many years within the general nursing and medical context and is becoming increasingly popular in psychiatry. This paper gives an account of TT in a selected patient and explores its potential as an alternative therapy with patients in forensic psychiatric care.
    • Measuring motivation to change in offenders

      McMurran, Mary; Hogue, Todd E. (1998)
      Measuring motivation to change in offender populations is important both for selection into treatment programmes and for assessing progress in therapy. Two studies are reported in this paper, both looking at the psychometric properties of questionnaires designed to measure stage of change in therapy. The samples used were patients detained in special hospitals under the Mental Health Act (1983) classification of psychopathic disorder. The first study provides norms for this group on the stages of change in psychotherapy questionnaire, plus some additional information on its relationship with self-esteem and self-efficacy measures. The second study looked at a brief version of the stages of change questionnaire, concluding that its psychometric properties were such that further use was contra-indicated.
    • Alcohol and secure hospital patients: I. An examination of the nature and prevalence of alcohol problems in secure hospital patients

      Hodge, John E. (1998)
      The extent and severity of alcohol problems experienced by mentally disordered patients admitted to maximum security hospitals, whilst not included in the criteria for admission, is undoubtedly of relevance and importance in planning the treatment and future disposal of these patients. The study to be described attempts to address such concerns by means of applying an extensive assessment approach with a substantial patient population drawn from three of the four Secure Hospitals within the United Kingdom (n=211). Measures utilised included semi-structured interview, standardised questionnaires and clinical reports contained in case records. Detailed information is provided on weekly consumption levels, problems related to drinking, severity of dependence on alcohol, and use of alcohol at the time of offences. Results highlighted not only the high prevalence, but the extreme severity of alcohol difficulties evident amongst the patient sample, as well as substantial use of alcohol at the time of offences. Future papers will explore further the characteristics of patients with a history of problem drinking and the possible relationship between alcohol and offending. This study represents the first major, detailed and comprehensive assessment of alcohol problems in an extensive sample of secure hospital patients. The implications of these findings for the development of therapeutic services and the future disposal of these patients is emphasised.
    • Angry women mentally disordered offenders: A need to do more?

      Cordall, John (1999)
      Anger is generally viewed as unfeminine and women who display anger are more likely to be unnecessarily labelled as 'psychotic' or 'dangerous'. There appears to be a link between those with a history of abuse and the psychiatric population, particularly among female mentally disordered offenders (MDOs) in high security care. A need exists for this problem to be rendered visible, which is ultimately the responsibility of those healthcare professionals charged with providing care and treatment for this population. This article proposes methodology which is aimed at stimulating and refocusing healthcare professionals' thinking in terms of female MDOs, and the need to provide tangible evidence of high quality forensic care. [References: 30]
    • Sudden death during restraint: A study to measure the effect of restraint positions on the rate of recovery from exercise

      Parkes, John (2000)
      A small number of mental health patients have died suddenly following violent behaviour and restraint by staff. The safety of certain restraint positions has been questioned. This study evaluates two control and restraint (C & R) positions commonly used by health service staff. A repeated measures design was used to study rate of recovery from exercise in volunteer staff, measured by pulse oximetry, comparing the restraint positions with a seated (control) position. It was found that the recovery time for pulse rate of subjects restrained in a face-down position was significantly longer than for subjects restrained in a face-up position. No significant findings were made in terms of comparison between the control position and the restraint positions, and no significant changes in oxygen saturation were noted during restraint. It is concluded that restraint position may be a factor in death during restraint, but only where other factors contribute to the overall situation.
    • The prevalence and frequency of deliberate self-harm among male patients in a maximum secure hospital

      Jackson, Neil (2000)
      Aims: This study was undertaken to ascertain the prevalence and frequency of deliberate self-harm (DSH) among male patients in a high security hospital, to determine whether males who harm themselves are younger than those who do not, and to determine whether the legal category of patients distinguished frequency of DSH. Background: This is the first study to examine whether such differences exist to a statistically significant extent among male patients in a maximum secure hospital. Previous studies on such female patients have found that those who engage in DSH are significantly younger and have had significantly shorter length of stay in the institution than those who do not. Additionally, the frequency of DSH by female patients with psychopathic disorder has been found to be significantly greater than that by those with mental illness. Method: Nursing daily ward report books were examined on four wards for a 30-month period. Results: In a sample of 127 male patients at Rampton Hospital in England, 24 (19% of the sample) engaged in deliberate self-harm. In total, 122 incidents of DSH occurred during the study period. Five patients (4% of the sample) contributed 82 incidents between them (67% of the total). Patients who engaged in DSH were significantly younger than those who did not. This was true for the entire sample considered together, regardless of their Mental Health Act (1983) classification and for patients solely with mental illness and those solely with psychopathic disorder. Although the period of time since admission to the hospital was shorter for those who engaged in DSH, it was not so to a significant extent. There were no differences between the frequency of DSH by psychopathic disorder patients and that by those with mental illness.
    • Review of 'Defining gender issues... Redefining women's services. A report from women in secure hospitals'

      Mosson, Lorraine (2001)
      Reviews the book "Defining Gender Issues... Redefining Women's Services. A Report from Women in Secure Hospitals," by Penny Stafford (1999). This report is based on an analysis of gender differences in the three high secure hospitals in England. Its main focus is the criminal histories of patients, but also includes other research and statistics related to secure psychiatric services. Furthermore, the author asserts that from this work an effective framework can be provided to inform the process of planning, developing and implementing dedicated service structures for women with security needs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • What happens afterwards? A follow-up study of those diverted from custody to hospital in the first 2.5 years of a metropolitan diversion scheme

      Geelan, Steve (2001)
      Background Court-based psychiatric services aim to identify mentally disordered defendants who require help from Mental Health Services, and attempt to arrange the necessary diversion into health care. This study followed individuals through their hospital stay to assess whether the psychiatric facility to which the individual was transferred was able to manage them, assessed whether the individual benefited from diversion into hospital, and examined how and when the individuals were discharged into the community. Method All those diverted from custody to hospital in the first 2.5 years of a metropolitan diversion scheme were followed through their hospital stay for at least 18 months. Results Fifty five people were diverted into hospital, from a total of 180 referrals to the court diversion scheme, In excess of 80 per cent were suffering from some form of psychotic disorder. This group had committed relatively serious offences. If appropriately assessed, and appropriate hospital placements are arranged, successful outcome can be achieved for the majority of people diverted from custody to hospital, in terms of improved mental states and a planned discharge. Conclusions The services provided by general psychiatric services are able to meet the needs of this group.
    • Mentally disordered parricide and stranger killers admitted to high-security care. 2: Course after release

      McCarthy, Lucy; Page, Kim; Baxter, Helen; Larkin, Emmet P.; Cordess, Christopher; Duggan, Conor (2001)
      When deciding to transfer a patient from high-security care, the most important determinant will often be the likelihood of further violence. Despite this, there are surprisingly few data to inform the clinician on the risks posed by particular groups. We compared the outcome of a group of mentally disordered offenders convicted of either parricide (n = 53) or the killing of a stranger (n = 71) after their release from high-security care (mean duration of follow-up = 6 years). All the patients were released still subject to restriction orders under the Mental Health Act 1983. None of the sample committed a further homicide during the follow-up and their history of further violence was also low. These data add further evidence to the widely held view that transfer from high-security care may be unduly restrictive.
    • First admissions to a regional secure unit over a 16-year period: Changes in demographic and service characteristics

      Ricketts, Dale; Carnell, Heidi; Davies, Steffan; Kaul, Adarsh; Duggan, Conor (2001)
      Arnold Lodge Regional Secure Unit has provided medium secure psychiatric care for the Trent Regional Health Authority since July 1983. We examined a series of 504 first admissions to Arnold Lodge in order to explore trends in demographic and service utilization characteristics over 16 years. We found an increase in the admission of more serious offenders; a reduction in the length of stay; a decline in the proportion of psychopathically disordered patients; and a sixfold increase in the ratio of men to women.
    • Working with women in secure environments

      Byrt, Richard (2001)
      1. Women's adverse experiences as patients in secure and other mental health services appear to reflect sexism in wider social and historical contexts. 2. A Women's Service Development Group in a medium secure unit in the United Kingdom has made improvements in services for female patients, including an independent advocacy and befriending service, a Well-Woman Clinic, and other gender-sensitive activities. 3. In general, services were evaluated positively by women. Some dissatisfaction primarily was related to activities, issues concerning seclusion, and the lack of a day area for women only. 4. Women had mixed views about their contact with male staff and patients. Because of this, policies and services in this and related areas should account for individual needs.
    • Mentally disordered parricide and stranger killers admitted to high-security care. 1: A descriptive comparison

      Baxter, Helen; Duggan, Conor; Larkin, Emmet P.; Cordess, Christopher; Page, Kim (2001)
      Parricide is an uncommon crime, so that many of the descriptive studies suffer from methodological shortcomings of small sample sizes and a non-representative ascertainment. We describe a consecutive series of mentally disordered offenders convicted of parricide who were admitted to high-security care and we compare their index characteristics with a group convicted of killing one or more strangers. The main findings were that the parricides were more likely to suffer from schizophrenia but less likely to have had a discrupted childhood and criminal history, as compared with those who had killed a stranger. Those in the parricide group had made a previous attack on their victim in 40% of cases. Overall, the study confirmed some of the differences that one might expect between these two groups of homicides, which had entirely different relationships to their victims.
    • The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: A pilot study in a high security hospital

      Low, Gail; Jones, David; Duggan, Conor (2001)
      Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.
    • Dialectical behaviour therapy as a treatment for deliberate self-harm: Case studies from a high security psychiatric hospital population

      Low, Gail; Duggan, Conor (2001)
      Deliberate self-harm has recently assumed increasing importance in outpatient clinics, accident and emergency units, and psychiatric settings. One approach that has been shown to be effective in randomly controlled clinical trials is Dialectical Behaviour Therapy (DBT; Linehan, 1993). DBT is a cognitive-behavioural approach developed for Borderline Personality Disorder, the criteria of which include suicidal attempts, threats and gestures, as well as impulsive behaviour, including deliberate self-harm. We assessed the efficacy of DBT in a high security psychiatric setting, where deliberate self-harm is particularly common among the women patients. From the group of patients who participated in the therapy (N = 15), three cases were identified which illustrate the application of DBT, and which highlight specific strategies and their uses in different situations. Specific strategies which were most useful involved the skills training of Distress Tolerance, and Emotion Regulation. DBT is an holistic approach, addressing problematic thoughts as well as behaviour, and the package of skills taught can be considered particularly useful in regulating emotions and alleviating some of the distress experienced by individuals who engage in this behaviour. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Are perceptions of parenting and interpersonal functioning related in those with personality disorder? Evidence from patients detained in a high secure setting

      Duggan, Conor; Collins, Mick; Larkin, Emmet P. (2001)
      We explored the widely-held assumption that dysfunctional interpersonal behaviour, a key characteristic of personality disorder, is associated with adverse experiences in childhood in a sample of patients detained in high secure care. We obtained Parental Bonding Inventory (PBI) and Chart of Interpersonal Relations in Closed Living Environment (CIRCLE) data from 79 patients detained at a high secure hospital. This comprised 48 with the legal classification (1983 Mental Health Act) of Psychopathic Disorder (PD) and 31 with the legal classification of Mental Illness (MI). On the PBI, the PD group had significantly lower care scores and increased protection scores compared with the MI group; the latter reported care and protection scores similar to those from published norms. The CIRCLE scores also demonstrated significantly different interpersonal functioning between the PD and MI groups, with each group typically plotted in opposing halves of the interpersonal circle (IPC). Although the PDs showed abnormalities in both the PBI and CIRCLE in the expected direction, there were no clear associations between aspects of abnormal parenting and adult dysfunctional interpersonal behaviour within this group. This finding did not confirm our hypothesis and we discuss possible explanations. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • The relationship between social problem-solving and personality in mentally disordered offenders

      Egan, Vincent (2001)
      Poor social problem-solving skills may account for some criminal behaviours in mentally disordered offenders, and social problem-solving may be mediated by personality traits. We examined the relationship between personality and social problem-solving in 52 mentally disordered offenders, (38 mentally ill and 14 personality disordered) detained in a regional secure unit. Since t-tests indicated no differences between the mentally ill and personality disordered groups, they were pooled into a single sample. Correlations indicated that high neuroticism (N) was related to poor social problem-solving, and high scores on the other five-factor traits were related to good social problem-solving. High N, which is a core feature of personality disorders as well as being a common feature of offenders, may signal emotional reactivity which militates against effective social problem-solving. N is, however, negatively correlated with extraversion (E), conscientiousness (C), and agreeableness (A), therefore partial correlations were conducted controlling for N. Once N is discounted, the main trait associated with problem-solving is openness (O), which is positively related to problem-solving, perhaps due to the relationship of O to intelligence and creativity. A positive correlation between E and a more positive problem orientation remains, perhaps because optimism is a defining feature of high E. © 2001 Elsevier Science Ltd.
    • Medico-legal reports and gatekeeping: One year of referrals to a forensic service

      Gethins, Elizabeth; Larkin, Emmet P.; Davies, Steffan; Milton, John (2002)
      Forensic psychiatrists and the services they provide have been subject to recent scrutiny and high public profile. This study examined part of the work of a regional and district forensic service by looking at a one-year cohort of referrals, and the factors contributing to patient admission, including requests for medico-legal reports. The sample consisted of all referrals to the East Midlands Centre for Forensic Mental Health, Leicester from 1 January 1998 to 31 December 1998. Information on referrals was collected retrospectively using a proforma to collate data from referral letters and the reports prepared by assessing clinicians. Two hundred and eighty referrals relating to 260 individuals were received. The sample characteristics were broadly similar to those reported in previous studies. The finding that 70% of those assessed were referred for medico-legal reports by courts or solicitors, and the fact that only 20% of this group finally entered the forensic service, led us to consider whether this work was legitimate use of National Health Service time. We examined this group more closely, and found that referral for a medico-legal report could be considered as a screening test for entry into the forensic services and there are good arguments for this work continuing.