Recent Submissions

  • The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders

    McMurran, Mary (2024)
    BACKGROUND: The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression. METHODS: A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires. RESULTS: Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression. CONCLUSIONS: These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.
  • Violence risk assessment instruments in forensic psychiatric populations: A systematic review and meta-analysis

    Whiting, Daniel (2023)
    BACKGROUND: Although structured tools have been widely used to predict violence risk in specialist mental health settings, there is uncertainty about the extent and quality of evidence of their predictive performance. We aimed to systematically review the predictive performance of tools used to assess violence risk in forensic mental health, where they are routinely administered. METHODS: In our systematic review and meta-analysis, we followed PRISMA guidelines and searched four databases (PsycINFO, Embase, Medline, and Global Health) from database inception to Nov 1, 2022, to identify studies examining the predictive performance of risk assessment tools in people discharged from forensic (secure) mental health hospitals. Systematic and narrative reviews were excluded from the review. Performance measures and descriptive statistics were extracted from published reports. A quality assessment was performed for each study using the Prediction Model Risk of Bias Assessment Tool. Meta-analysis was conducted on the performance of instruments that were independently externally validated with a sample size greater than 100. The study was registered with PROSPERO, CRD42022304716. FINDINGS: We conducted a systematic review of 50 eligible publications, assessing the predictive performance of 36 tools, providing data for 10 460 participants (88% men, 12% women; median age [from 47 studies] was 35 years, IQR 33-38) from 12 different countries. Post-discharge interpersonal violence and crime was most often measured by new criminal offences or recidivism (47 [94%] of 50 studies); only three studies used informant or self-report data on physical aggression or violent behaviour. Overall, the predictive performance of risk assessment tools was mixed. Most studies reported one discrimination metric, the area under the receiver operating characteristic curve (AUC); other key performance measures such as calibration, sensitivity, and specificity were not presented. Most studies had a high risk of bias (49 [98%] of 50), partly due to poor analytical approaches. A meta-analysis was conducted for violent recidivism on 29 independent external validations from 19 studies with at least 100 patients. Pooled AUCs for predicting violent outcomes ranged from 0·72 (0·65-0·79; I(2)=0%) for H10, to 0·69 for the Historical Clinical Risk Management-20 version 2 (95% CI 0·65-0·72; I(2)=0%) and Violence Risk Appraisal Guide (0·63-0·75; I(2)=0%), to 0·64 for the Static-99 (0·53-0·73; I(2)=45%). INTERPRETATION: Current violence risk assessment tools in forensic mental health have mixed evidence of predictive performance. Forensic mental health services should review their use of current risk assessment tools and consider implementing those with higher-quality evidence in support. FUNDING: Wellcome Trust.
  • Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents

    Seun-Fadipe, Champion T. (2023)
    STUDY OBJECTIVES: This study aimed to determine the sleep quality of in-school Nigerian adolescents and its association with their schooling and mental health outcomes. METHODS: The study was a descriptive cross-sectional study. It was conducted among adolescents attending public and private secondary schools within Ife Central Local Government, Osun State, southwestern Nigeria. A multistage sampling technique was employed to select study participants. The Pittsburgh Sleep Quality Index, Patient Health Questionnaire (PHQ) - 9 and General Anxiety Disorder (GAD) - 7 questionnaires were used to determine sleep quality, depression and anxiety respectively. RESULTS: We studied 448 adolescents aged between 10-19 years with a mean age of 15.0±1.8 years. The majority of our respondents (85.0%) had poor sleep quality. More than half of the respondents (55.1%) had insufficient sleep during weekdays while only 34.8% had insufficient sleep during weekends. The school closing time and school type showed a statistically significant association with sleep quality (p= 0.039 and 0.005 respectively). The odds of having poor sleep quality increased by two-folds among adolescents in private schools when compared with those in public schools (aOR=1.97, 95%CI=1.069 - 3.627). Using multiple linear regression, only depression showed a statistically significant association with sleep quality at 95% CI (p<0.001) such that for every unit change in depression scores (PHQ-9), there will be a corresponding increase of 0.103 in sleep quality. CONCLUSIONS: Sleep quality is poor and is associated with the mental health of adolescents adversely. This should also be addressed in the development of appropriate interventions.
  • Delays in transferring patients from prisons to secure psychiatric hospitals: An international systematic review

    Sales, Christian P.; Tully, John (2023)
    BACKGROUND: Transfer to a psychiatric hospital of prisoners who need inpatient treatment for a mental disorder is an important part of prison healthcare in the UK. It is an essential factor in ensuring the principle of equivalence in the treatment of prisoners. In England and Wales, delays in transferring unwell prisoners to hospital were identified by the 2009 Bradley Report. There has been no subsequent systematic review of progress in so doing nor a corresponding appraisal of transfer arrangements in other parts of the world. AIM: To conduct a systematic review of international literature about transfers of mentally unwell individuals from prison to hospital for the treatment of mental disorder since 2009. METHOD(S): Eight databases were searched for data-based publications using terms for prison and transfer to hospital from 1 January 2009 to 4 August 2022. Inclusion criteria limited transfer to arrangements for pre-trial and sentenced prisoners going to a health service hospital, excluding hospital orders made on the conclusion of criminal hearing. RESULT(S): In England, four articles were identified, all showing that transfer times remain considerably longer than the national targets of 14 days (range, 14 days to >9 months); one study from Scotland found shorter mean transfer times, but more patients had been transferred to psychiatric intensive care units than to secure forensic hospitals. There were only two studies that investigated prison to hospital transfers for mental disorder from outside the UK and only one reported time-to-transfer data. CONCLUSION(S): Findings from this literature review highlight failures to resolve transfer delays in England and provide little evidence about the problem elsewhere. Given the lack of data, it is unclear whether other countries do not have this problem or simply that there has been no research interest in it. A possible confounding factor here is that, in some countries, all treatment for prisoners' mental disorders occurs in prison. However, the principle that prisons are not hospitals seems important when people need inpatient care. Prospective, longitudinal cohort studies are urgently needed to map transfer times and outcomes. Copyright © 2023 John Wiley & Sons Ltd.
  • Training for line managers should focus on primary prevention of mental ill-health at work

    Bartle, Craig (2023)
    This article focuses on the mental health of working-age adults who are not being treated by statutory mental health services. It proposes preventive approaches to mental ill-health through line manager training and support.
  • Self-compassion, mental health shame and work motivation in German and Japanese employees

    Kotera, Yasuhiro (2023)
    In Germany, more than two-thirds of employees report mental health issues, while in Japan, more than half of the country's workforce are mentally distressed. Although both countries are socio-economically developed in similar ways, their cultures differ strongly. This article investigates mental health constructs among German and Japanese employees. A cross-sectional design was employed in which 257 German and 165 Japanese employees completed self-report scales regarding mental health problems, mental health shame, self-compassion and work motivation. T-tests, correlation and regression analyses were conducted. Results show that German employees have significantly higher levels of mental health problems, mental health shame, self-compassion and work motivation than Japanese employees. While many correlations were similar, mental health problems were associated with intrinsic motivation in Germans, but not in Japanese. Shame was associated with both intrinsic and extrinsic motivation in Japanese, but not in Germans. Self-compassion - defined as a complex of compassion, humanity, care and unconditional, compassionate love - was associated with gender and age in Japanese, but not in German employees. Lastly, regression analysis uncovered that self-compassion was the strongest predictor of mental health problems in Germans. In Japanese employees, mental health shame is the strongest predictor of mental health problems. Results can guide managers and psychologists in internationalised organisations to effectively approach employee mental health.
  • A community of women in prison: More than a voice – therapeutic use of visual and psychodramatic arts

    Gavin, Vicky (Routledge, 2022)
    This chapter explains the context of the only women's democratic therapeutic community (DTC) in the English prison estate, at Her Majesty's Prison (HMP) Send. Following a brief history, it highlights the importance of recognising distinctive contextual factors reflected in the experience of women–as residents, visitors and staff–by contributions in their own words. Based on staff reports and self-reporting by women like Amaal, the introduction of psychodrama as a core creative therapy (CCT) and its short-term use to support the art therapy frame opened up new therapeutic possibilities for women who feel drawn to drama and embodied ways of working, and also for those to whom this implies a step out of the comfort zone. Psychodrama and art therapy enabled past maladaptive life experiences to be adaptively revisited, through creative experiences with a positive impact on the present and future of DTC residents. Creative warm-up for therapy was deemed important: contained spontaneity was enhanced by these, and potential protagonists were encouraged to take back to their small talking groups the themes they named in the initial part of the psychodrama sessions, or depicted in their art work. Whether these themes were worked through in action or not, art and psychodramatic warm-up exercises, as well as both protagonist and auxiliary role-taking seemed to warm up the women for further therapeutic work in talking groups, enhancing their self-confidence, self-reflection and prosocial relating. CCTs seemed to allow for affirmative adaptive experiences, which reinforced new adaptive ways of thinking, managing emotions and behaving. Adequate support and supervision of the psychodramatist and her participation in staff meetings was deemed crucial for creative group work to flourish in a safe, contained, sustained way, built on and built by the DCT living-learning experience as a whole. The CCT model presented in this chapter is neither static nor prescriptive. The combination and format of the CCTs offered to women in prison have been evolving. The approach adopted, incorporating practice-based evidence and residents’ experiences and reflections, adds to the existing work from male DTCs demonstrating the role of CCTs in enhancing practice and improving outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: create)
  • The characteristics, convictions, and incidents of risk of women in the national high secure healthcare service for women

    Clarke, Martin; Williams, Marie; Siddall, Yasmin; Lewis, Jessica (2023)
    Purpose: A service evaluation was conducted to characterise all admissions to the National High Secure Healthcare Service for Women (NHSHSW).Design/methodology/approachData were obtained from computerised records, case notes, and the hospital’s Risk Department. Data collected included the date of incident, incident type, location of incident and name of aggressor. The severity of incidents were reported from 2010 onwards. Some data are presented in three time bands: 2007, 2008–2011, and 2013–2015 in order to illustrate changes. Some data is presented in three age bands based on age at admission: under 30 years old, 30–39 years old and 40 years and over.Findings105 women were admitted into the service between January 2007 and 30 June 2015. The majority of women had a diagnosis of personality disorder (81.0 per cent), a history of trauma (e.g. it was documented that 71.4 per cent had experienced sexual abuse) and had received a criminal conviction (90.5 per cent). A total of 8934 risk incidents were reported and the majority of women (N = 101, 96.2 per cent) were involved in at least one incident during their admission. The majority of recorded incidents involved self-harm (70.9 per cent).Originality/ValueLittle has been published about the NHSHSW population. This article outlines the characteristic profiles of women detained in high secure care.Practical implicationsThe complex background and clinical characteristics highlight the need for trauma-informed practice. Continuous monitoring is required to ensure effective practices.
  • Long-term outcomes after discharge from medium secure care: still a cause for concern?

    Gibbon, Simon D.; McCarthy, Lucy; Clarke, Martin (2023)
    People admitted to medium secure psychiatric care are recognised to still be at risk of experiencing adverse outcomes upon discharge. However, little is known about the outcomes of patients admitted more recently to medium secure care or the long-term outcomes of people many years after discharge. The aim of this study was to assess the mortality, conviction and readmission outcomes of a cohort of first admissions discharged from an English medium secure psychiatric unit between July 1983 and June 2013. Data on background characteristics were obtained from medical records. Outcome data were obtained from multiple sources for 843 patients discharged prior to the census date of 30 June 2013. The risk of death from both natural and unnatural causes was much higher than that of the general population. Of those patients that were discharged, 369 patients (43.8%) were convicted of an offence during the follow-up period, two-thirds of which were convicted within the first 5?years following discharge. Five hundred and ten patients (61.6%) were readmitted to psychiatric care. Patients discharged from medium secure care are at long-term risk of experiencing premature death, conviction and readmission to secure and non-secure psychiatric care.
  • Six nations: A clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

    Barlow, Stephan (2022)
    This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
  • Impact evaluation and economic benefit analysis of a domestic violence and abuse UK police intervention

    Kane, Eddie (2023)
    This study evaluated the impact and economic benefit of Cautioning and Relationship Abuse (CARA), an intervention which aims to reduce re-offending of first-time low-level domestic violence and abuse perpetrators. The analysis was based on two samples drawn from separate UK police force areas. CARA’s impact was assessed using a matched sample of similar offenders from a time when CARA was not available. The matching was based on a host of offender and victim characteristics and machine learning methods were employed. The results show that the CARA intervention has a significant impact on the amount of recidivism but no significant reduction in the severity of the crimes. The benefit-cost ratio in both police force areas is greater than one and estimated to be 2.75 and 11.1, respectively, across the two police force areas. Thus, for each pound (£) invested in CARA, there is an economic benefit of 2.75–11.1 pounds, annually.
  • “sharing in people's pain is not an easy thing to do”: Cognitive behavioural therapists' understandings of compassion in the workplace

    Mistry, Dipti (2023)
    Objectives Compassion is central to the aim of improving patient care and staff well‐being within healthcare systems. To inform service development, explorations of experiences and meanings of compassion are needed. This study explored cognitive behavioural therapists' understandings of compassion within their work environment. Design A qualitative study was conducted using semistructured interviews and interpretative phenomenological analysis (IPA). Methods Data were obtained from five practicing cognitive behavioural therapists. Results Two superordinate themes were developed, each with two subordinate themes. CBT therapists reported entering the profession with intrinsic motivation to care for others. They further developed an interest in compassion with exposure to clients and ongoing professional development in compassion‐focused therapy (CFT). Compassionate work environments helped to facilitate compassionate practice; however, for many, workplaces were perceived to lack compassion. Challenges were encountered when negative workplace interactions left therapists feeling fatigued, distressed and demoralised. There was a desire for recognition and to be seen as more than a “work machine,” the experience of which was a threat to retaining therapists within the profession. Conclusions Current recruitment and training processes are producing staff with skills and motivation to deliver compassionate care. However, lack of compassion within workplaces can be a barrier to actioning these skills and motivations. Research needs to focus on how to effectively implement and run systems that are compassionate for both staff and clients. To provide compassionate care, staff need work environments that show compassion to them. These findings provide some insights into and practical suggestions regarding how this can be achieved. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract)
  • A realist evaluation of a multifactorial falls prevention programme in care homes

    Robertson, Kate (2022)
    BACKGROUND: falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation. METHODS: this is a multi-method process evaluation informed by a realist approach.Data include fidelity observations, stakeholder interviews, focus groups, documentary review and falls-rate data. Thematic analysis of qualitative data and descriptive statistics are synthesised to generate care home case studies. RESULTS: data were collected in six care homes where a falls programme was trialled. Forty-four interviews and 11 focus groups complemented observations and document review.The impact of the programme varied. Five factors were identified: (i) prior practice and (ii) training may inhibit new ways of working; (iii) some staff may be reluctant to take responsibility for falls; (iv) some may feel that residents living with dementia cannot be prevented from falling; and, (v) changes to management may disturb local innovation.In some care homes, training and improved awareness generated a reduction in falls without formal assessments being carried out. CONCLUSIONS: different aspects of the falls programme sparked different mechanisms in different settings, with differing impact upon falls.The evaluation has shown that elements of a multifactorial falls programme can work independently of each other and that it is the local context (and local challenges faced), which should shape how a falls programme is implemented.
  • Impact of a dietitian in general practice: Paediatric food allergy

    Freeman-Hughes, Amy (2022)
    BACKGROUND: Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. METHOD(S): Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other is a more traditional dietetic community service where patients are referred predominantly by the GP or secondary care. RESULT(S): In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received less referrals from the GP; 36% vs 67% (p<0.001), GP appointments for allergy-related conditions prior to dietetic referral were lower; 3 vs 6 visits (p=0.001) and input from secondary care was also lower; 8 vs 25 patients (p=0.002) compared with dietetic community care. Children referred to dietetic-led care were younger; 78% <6 months vs 40% (p<0.001) in dietetic community care. CONCLUSION(S): Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working; offering a solution to reducing GP workload whilst maintaining or improving patient care. This article is protected by copyright. All rights reserved.
  • Developing a trauma-sensitive, compassion focused substance misuse treatment intervention for prisoners

    Fehrman, Elaine (2022)
    The aim of this paper is to present a newly developed substance misuse treatment intervention, which has been devised from an extensive review of the literature relating to the prevalence and repercussions of trauma amongst people who use forensic services and use substances. The clinical utility and applicability of integrating Compassion Focused Therapy (CFT) within the context of delivering this new intervention is discussed. As the first pilot is preparing to launch at a high secure site, this paper provides a descriptive, theoretical account of the programme and the rationale for the various components.
  • Systematic review and meta-analysis of the effectiveness of teacher delivered interventions for externalizing behaviors

    Aldabbagh, Reem; Glazebrook, Cris; Sayal, Kapil; Daley, David (2022)
    This systematic review and meta-analysis explores the effectiveness of teacher interventions supporting children with externalizing behaviors based on teacher and child outcomes. A systematic search was conducted using 5 electronic databases. From 5714 papers, 31 papers that included interventions delivered directly to teachers and aimed to benefit either teachers and/or children with externalizing behaviors were included. The review focused on qualified teachers working with children aged 2-13. The results of the current meta-analysis revealed a positive effect of teacher intervention on teacher and child outcomes, including the increased use of teacher-appropriate strategies, as well as significant and moderate improvements in teacher-child closeness, and small reductions in teacher-child conflict. For child outcomes, the interventions reduced externalizing behavior problems and ADHD symptoms and enhanced prosocial behavior. Only one fully blinded analysis for conduct problems was possible and revealed a moderate but significant reduction in favor of intervention. These findings provide evidence to support the role of teacher interventions for both teachers and children with externalizing behaviors. Future research should include more PBLIND measurements so that MPROX findings can be confirmed. More research should be done to evaluate the influence of teacher interventions on teachers' well-being.
  • Protocol for a feasibility randomised controlled study of a multicomponent intervention to promote a sustainable return to work of workers on long-term sick leave — PROWORK: PROmoting a Sustainable and Healthy Return to WORK

    Bartle, Craig; Marwaha, Steven; Newman, Kristina L.; Thomson, Louise (2022)
    The cost of sickness absence has major social, psychological and financial implications for individuals and organisations. Return-to-work (RTW) interventions that support good quality communication and contact with the workplace can reduce the length of sickness absence by between 15 and 30 days. However, initiatives promoting a sustainable return to work for workers with poor mental health on long-term sickness absence across small, medium and large enterprises (SMEs and LEs) are limited. This paper describes the protocol of a pilot randomised controlled trial (RCT) to test the feasibility of implementing a RTW intervention across SMEs and LEs across all sectors.
  • Knife crime offender characteristics and interventions – A systematic review

    Green, Kathleen (2022)
    Knives and sharp objects are tools used in a wide range of violent offences. However, knife offending may have different risk factors than general violence, thus requiring tailored interventions. This systematic review aims to synthesise evidence on the characteristics of knife offenders and interventions aimed at the reduction of knife crime. After screening 1352 titles and abstracts, 344 articles were fully considered of which 21 papers met the inclusion criteria and were quality assessed. These consisted of 15 offender characteristic studies and six intervention studies. Findings suggested that knife crime may be associated with illicit drug use, exposure to any violence as a witness, victim or perpetrator and mental health problems. Males were more at risk of engaging in knife crime in the community and females in domestic settings. Different risk factors were found between gang involved and non-involved knife offenders. Primary prevention strategies, such as stop and search, knife amnesties, media campaigns and curfews did not show a significant impact in reducing knife crime. By contrast, increasing offenders' access to tailored support regarding housing, education, and employment showed an impact in reducing weapon carrying. Further research is required in the area to support the reliability of outcomes.
  • Managing minds at work: Development of a digital line manager training program

    Vaughan, Benjamin; Bartle, Craig; Thomson, Louise (2022)
    Mental ill-health is the leading cause of sickness absence, creating a high economic burden. Workplace interventions aimed at supporting employers in the prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work is a digital intervention aimed at supporting line managers in promoting better mental health at work through a preventative approach. This intervention was developed as part of the Mental Health and Productivity Pilot, a wider initiative aimed at supporting employers across the Midlands region of the United Kingdom to improve the future of workplace mental health and wellbeing. The aim of the study is to describe the design and development of the Managing Minds at Work digital training program, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). An agile methodology was used to co-create intervention content with a stakeholder virtual community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. It was considered by stakeholders to be appropriate for any type of organization, irrespective of their size or resources. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that the program was perceived to be useful, relevant, and easy to use by managers across sectors, organization types, and sizes. We identified positive impacts on manager attitudes and behavioral intentions related to preventing mental ill-health and promoting good mental wellbeing at work. The next step is to explore the feasibility and acceptability of Managing Minds at Work with line managers in diverse employment settings. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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