• A descriptive evaluation of patients and prisoners assessed for dangerous and severe personality disorder

      Jones, Lawrence F.; Moore, Claire; Andrews, Kathryn (2010)
      The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted. © 2010 Taylor & Francis.
    • A structured cognitive behavioural approach to the assessment and treatment of violent offenders using offence paralleling behaviour

      Daffern, Michael (2010)
      Seizing opportunity for effective intervention, evaluating treatment progress and determining readiness for release are critical tasks for mental health professionals involved in the care and treatment of violent offenders. To assist those concerned with these tasks, to enhance integrity and to ensure comprehensiveness, treatment programmes and structured risk assessment methods have been developed and promoted. The offence paralleling behaviour (OPB) framework has emerged as a potential adjunct to these risk assessment methods and structured treatment programmes. The OPB framework is however in its infancy. This chapter introduces the rationale for structured methodology that may be used to examine similarity in aggressive behaviours across situations and in particular whether aggressive behaviours occurring within custody are offence paralleling. Assessment of similarity is central to the OPB framework. Mental health professionals working within institutions must determine whether behaviours observed within institutions can legitimately be referred to as offence paralleling and therefore whether they are relevant to treatment planning and release decision making. Although OPB may occur prior to a criminal act, this chapter focuses on aggressive acts occurring during incarceration subsequent to an act of aggression. This chapter also explores the potential for the OPB framework to be used as an adjunct to structured treatment programmes and risk assessment methods. Before proceeding, there are two important assumptions implicit to the OPB framework and relevant to aggressive behaviour that require scrutiny: 1. Behaviour within institutions is similar, albeit muted by environmental constraints and opportunity, to past aggressive behaviour occurring outside the institution or in an environment of interest (e.g. a less secure psychiatric setting or supported residential facility). 2. It is possible to reliably identify OPB. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)
    • A systematic review of research on the epidemiology of mental health disorders in prison populations: A summary of findings

      Ferriter, Michael (2009)
      Brooker et al. (2002) conducted a systematic review of research into the mental health of prisoners. Their final report included a review of the epidemiology of the prison population, an overview of the interventions used to treat the major mental health disorders in both the general and prison populations, and a review of service delivery and organisation for prisoners with mental health disorders. The review found a high prevalence of mental health disorders in prison populations, with up to 15% of prisoners having four or five co-existing mental disorders. This review has been updated, using the same methodology, to include literature dated from 2002 to August 2006. This paper presents findings from the epidemiology section of the updated review, which includes 18 new studies. The recent studies largely reflect the findings of earlier research. However, some studies in the updated review focus on countries where little of this type of research has previously been conducted. The prevalence of mental health disorders, suicide, and substance misuse remains high in prison populations around the world - demonstrating the need for suitable evidence-based interventions to address these issues. Future research should concentrate on mapping interventions available to prisoners and evaluating their effectiveness. © 2009 Taylor & Francis.
    • Addicted to crime?

      Hodge, John E.; McMurran, Mary; Hollin, Clive R. (1997)
    • Addiction to violence

      Hodge, John E. (1997)
    • Aggressive behaviour in high-risk personality disordered inpatients during prison and following admission to hospital

      Daffern, Michael; Howells, Kevin (2007)
      The frequency of aggressive behaviour before and during admission to a hospital unit designed to treat patients identified as dangerous and as having a severe personality disorder (DSPD) was examined. Accounting for differences in recording procedures and time at risk, results showed a comparable frequency of aggressive behaviour across environments. Although the limited number of patients available to study and methodological issues prevent definitive conclusions, reactions to admission and exposure to the therapeutic context appeared inconsistent, some patients demonstrating stability or improvement, others appearing to worsen or react negatively to admission. Neither psychopathy nor severity of personality disorder interacted with admission and exposure to the new environment to impact on the course of aggressive behaviour. Results emphasise the need for staff to prepare for the inevitability of aggression in this group of patients during the lengthy, demanding and complex treatment process, and to consider the potential for a various reactions to admission, including deterioration, which may mean an increase in dangerousness or an aggravation of the personality disorder.
    • Alexithymia, empathic concern, goal management, and social problem solving in adult male prisoners

      McMurran, Mary (2009)
      Social problem-solving skills training forms a major part of many offender treatment programmes. In this study, we explored the influences of alexithymia, empathic concern and goal management on social problem-solving skills in 79 adult male prisoners in an attempt to identify affective and cognitive factors relevant to offenders' social problem-solving skills. Results showed that alexithymia was associated with less effective social problem solving, whereas empathic concern and perspective taking were associated with more effective social problem solving, but unexpectedly also with a Negative Problem Orientation. Persistence in goal attainment was associated with effective social problem-solving abilities, and inflexibility in adopting new strategies in the face of obstacles was associated with maladaptive problem-solving styles. Implications for developing social problem-solving interventions for offenders are presented. © 2009 Taylor & Francis.
    • Altered emotional decision-making in prisoners with borderline personality disorder

      Milton, John; Duggan, Conor (2007)
      Previous studies have identified neuropsychological deficits in individuals with antisocial personality disorder and/or psychopathy. Few studies have examined neuropsychological functioning in individuals with borderline personality disorder (BPD), and no studies have yet investigated cognitive and emotional function in male prisoners with BPD. In this study, we compared the risky decision-making of 17 participants with a history of serious violent or sexual offenses and a diagnosis of DSM-IV BPD with that of 17 participants with similar offending histories but personality disorders other than BPD. Those with BPD exhibited altered processing of information about potential losses (punishment) when the probability of gains (reward) was high; they also increased their choice of risky options even in circumstances where this was clearly avoidable. These data suggest that individuals with a diagnosis of BPD and a history of serious offenses have problems integrating different reinforcement signals when choosing between risky actions, perhaps reflecting corticolimbic dysfunction as an underlying mechanism in BPD. © 2007 The Guilford Press.
    • Altered memory and affective instability in prisoners assessed for dangerous and severe personality disorder

      Milton, John; Duggan, Conor (2007)
      Background: Previous studies of borderline personality disorder report neuropsychological impairments in several domains, including memory. No studies have compared memory functioning in high-risk prisoners with borderline personality disorder with similar prisoners with other personality disorders. Aims: To explore mnemonic impairments in prisoners undergoing personality assessment as part of the dangerous and severe personality disorder initiative or detained in a medium secure facility. Method: We investigated memory function in 18 prisoners with borderline personality disorder and 18 prisoners with other personality disorders. Results: Prisoners with borderline personality disorder exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance. Conclusions: These data suggest that memory deficits have some specificity in relation to the constituent traits of borderline personality disorder and indicate that neuropsychological assessment may be a source of useful adjunctive information for distinguishing between the cognitive and psychological difficulties of individual prisoners.
    • An overview of the relationship between moral reasoning and offending

      Palmer, Emma J. (2003)
      Through research it has been established that there is a relationship between level of moral reasoning and offending behaviour, with offenders generally reasoning at less mature levels than non-offenders. However, recent research looking at this association in more detail has revealed that it may be only certain moral values that are associated with offending. There has also been little research on the psychological mechanisms that may mediate the relationship between moral reasoning and offending. Therefore, this paper attempts to place moral reasoning theory into a wider theoretical model of delinquency, arguing that the development of moral reasoning and other social cognitive processes are influenced by children's early socialisation experiences. These social cognitive factors, such as social information processing and the cognitions that impact on this (including moral reasoning), are seen as significant in determining individuals' behaviour in social situations. This theory is then used as a basis for suggestions for incorporating moral reasoning into effective interventions with offenders.
    • Approaches to developing OPB formulations

      Jones, Lawrence F. (2010)
      This chapter discusses the offense paralleling behavior model and how it may be incorporated in forensic psychology practice when working with offenders. The model's use has been used for such tasks as risk assessment for recidivism and intervention to prevent re-offending. Offence paralleling behaviour (OPB) is potentially useful for developing formulations relating to risk and for devising interventions targeting idiographically identified criminogenic needs. Clinicians use formulation all the time but may not systematize the way in which they do this. There is an all too common occurrence of practitioners unthinkingly seeing all behaviour as offence paralleling and this needs to be addressed. Recent work on case formulation highlights concerns about the validity and reliability of formulation that have been largely overlooked historically. In this chapter, it is argued that case formulation procedures are similar to qualitative methodologies and that strategies developed to address validity and reliability in qualitative research can be profitably used for the generation of hypotheses in case formulation. Single case methodology can then be used for more systematic exploration of these hypotheses. Practitioners increasingly acknowledge that there are problems with a mechanical reliance on actuarial instruments in risk management. This kind of approach is based on group data and is less helpful for predicting the behaviour of individuals. Recent developments in risk assessment reaffirm the utility of case formulation in risk assessment. The OPB paradigm offers a framework for case formulation. As discussed in Jones, there are problems with reconviction based actuarial assessments, primarily because the reconviction rate does not necessarily index actual rate of offending. This is essentially a problem with construct validity of actuarial assessments. While it cannot be used to make probabilistic statements about risk, OPB offers a useful approach to identifying risk-relevant current behaviour and significant possible risk events. OPB is also clinically relevant and helps to make causal hypotheses about the links between change in current context and possible future performance. Jones identified the utility of Kohlenberg and Tsai's functional analytic psychotherapy (FAP) as an integrative behavioural model for developing OPB formulations. Many interventions addressing offending have focused primarily on developing insight and skills; Kohlenberg and Tsai's work highlights the importance of working on current behaviour reflecting the presenting problem or any change away from it. The OPB paradigm proposes a radical refocus of intervention towards working with offence and change-relevant behaviour in the here and now as well as exploring the past. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • Are Liaison and Diversion interventions in policing delivering the planned input: A longitudinal evaluation in two constabularies?

      Kane, Eddie (2020)
      Liaison and Diversion (L&D) has twin objectives: improving mental health outcomes and reducing re-offending. Early diversion from police custody seems promising, but evidence of benefit is required to sustain such programmes. To test the hypothesis that contact with L&D services while in police custody would lead to improved mental health outcomes and a reduction in type and level of offending, we used a pre-post service use design. National Health Service (NHS) records in two counties were searched for evidence that patients had been involved with L&D services while in police custody during the period July 2009-December 2017. We defined January 2009-July 2014 as the pre-intervention period and any time after contact as the post-intervention period. Data from the Police National Computer were gathered for each period for these individuals, to assess their pre-post L&D contact offending histories. NHS Trust data were similarly gathered to assess their pre-post use of mental health legislation. 4,462 individuals were identified who had used L&D services in police custody. There were statistically significant reductions in the amount of offending following contact with the L&D service (whether one or two contacts), regardless of offence type. Statistically significant reductions were also observed in use of the four most commonly used legislative powers for detaining patients in hospital on mental disorder grounds, regardless of offending status (prolific/non-prolific). Our results indicate positive associations between the L&D interventions and change in offending and use of compulsory hospital detention. Whilst our research does not allow a direct causal relationship to be established in either area, the findings go beyond other impact assessments of L&D which have either been with small samples or relied only on qualitative data or expert opinion.
    • Assessing associations between changes in risk and subsequent reoffending: An introduction to relevant statistical models

      Guo, Boliang (2017)
      Research on recidivism prediction has made important advances, but the same cannot be said of research assessing relationships between risk changes over time or after treatment and subsequent reoffending. In realistic criminal justice situations, data linking changes in risk to recidivism are often fraught with problems due to missing data, irregular intervals in repeat risk assessments, and individual differences such as age and risk levels. Traditional statistical methodologies such as ANCOVA for repeated measures are not suited for analyzing data with these features. We presented four types of statistical modeling techniques that can effectively accommodate these noisier data: conventional regression, conditional regression, two-stage, and joint models. The two-stage models consist of multilevel growth model and conventional regression. The joint models refer to structural equational models. Two example data sets were used to illustrate the application of these methodologies. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • Assessing treatment readiness in violent offenders

      Howells, Kevin (2009)
      Although violent offenders are widely considered to be difficult to engage in therapeutic change, few methods of assessing treatment readiness currently exist. In this article the validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to violent offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work, displayed acceptable levels of convergent and discriminant validity and was able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of treatment readiness in violent offenders.
    • Assessment and management of individuals under the influence of alcohol in police custody

      Lawton, John D. (1996)
      Individuals taken into police custody are commonly under the influence of alcohol. Some of these individuals are dependent on alcohol and suffer from withdrawal symptoms. Morbidity and mortality in this group is high, and deaths have been recorded in police custody. There are no specific guidelines on the assessment and management of individuals under the influence of alcohol taken into police custody. This article outlines the clinical features, assessment, investigations and management of these individuals based on a review of the literature.
    • Breaking barriers and building connections

      Travers, Raymond F. (2005)
      The Primrose Project has been developed, as part of the Dangerous People with Severe Personality Disorder (DSPD) programme in England and Wales, to specifically address the complex needs of women prisoners who pose a significant danger to the public. It has been recognised that the needs of these women prisoners may differ from those of men in the DSPD programme. The Primrose project therefore aims to deliver more effective prison-based healthcare interventions to these dangerous women prisoners to reduce risk to self and others. The Primrose Project expects to initially support up to 12 women prisoners in HMP Low Newton, Durham. These women prisoners will be placed with other 'non-DSPD' women prisoners in the prison and will receive a variety of therapeutic interventions. Overall, the Primrose Project aims to develop into a comprehensive assessment, treatment and management facility and the proposed evaluation aims to facilitate this development. The evaluation will look at the project as a whole, identifying strengths and limitations to overall improve the service for these women prisoners, who have not previously been provided for. The research is based on a list of comprehensive questions, which form the basis of evaluation of the existing four male DSPD sites in England and Wales, which will prove useful when comparisons are later made with the Primrose Project. © 2005 Taylor & Francis.
    • Brief anger interventions with offenders may be ineffective: A replication and extension

      Howells, Kevin (2010)
      Anger-management interventions are widely delivered in the criminal justice and forensic mental health systems. Whilst previous research has generally supported the thesis that anger management is an effective intervention for anger problems in general there remains a need to determine its effectiveness with offender populations. This paper reports the results of a controlled outcome study of a 20 h anger-management program offered to offenders. Those receiving treatment showed improvements in their knowledge about anger, but showed little change on measures of anger and anger expression when compared to waiting-list controls. Scores on measures of treatment readiness and level of need for treatment were however, correlated with post-treatment improvement. These findings are discussed in terms of their implications for the assessment and selection of appropriate participants for offender anger-management programs. © 2009 Elsevier Ltd. All rights reserved.
    • Brief anger management programs with offenders: Outcomes and predictors of change

      Howells, Kevin (2005)
      Anger management interventions with offenders, particularly violent offenders, are a common form of rehabilitative activity. The rationale for addressing anger problems is clear-cut and there is good evidence that anger management can be effective with some client populations. Information relating to effectiveness with serious offenders, however, is sparse. An intervention study is reported in which offenders receiving anger management were compared with waiting list controls on a range of dependent measures. In general, the degree of pre-treatment/post-treatment change was small and experimental versus control differences were not statistically significant. The degree of improvement was found to be predictable from pretreatment measures of anger and treatment readiness. Explanations of the low impact of anger management on violent offenders are discussed and recommendations made for improving outcomes.