Clive G. Long, Olga Dolley and Clive Hollin
In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a…
Abstract
Purpose
In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues.
Design/methodology/approach
A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions.
Findings
Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order.
Originality/value
While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.
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Clive Long, Arleen Rowell, Anita Gayton, Elizabeth Hodgson and Olga Dolley
– The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI).
Abstract
Purpose
The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI).
Design/methodology/approach
Electronic patient records were used to determine levels of obesity and weight change over a three-year period. BMI levels were related to status, medication and patient characteristics.
Findings
The incidence of obesity (34 per cent) in the sample (n=351) was higher than in the general population. One-third of patients were on medication for hyperlipidaemia and 10 per cent were diagnosed with type II diabetes. Patients on regular antipsychotic drugs and sodium valproate and who were less active had higher BMIs. Gender differences over a three-year period showed a tendency for women's weight to continue to increase which may be linked to lower levels of engagement in activities of moderate or vigorous intensity.
Originality/value
Previous surveys using secure psychiatric populations have been point in time reviews. The current study tracks changes over a three-year time period and related this to a range of interventions.
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Clive G. Long, Olga Dolley and Clive R. Hollin
The purpose of this paper is to assess the effectiveness of a gender-specific group treatment programme for personality disordered (PD) women in a medium secure psychiatric…
Abstract
Purpose
The purpose of this paper is to assess the effectiveness of a gender-specific group treatment programme for personality disordered (PD) women in a medium secure psychiatric setting.
Design/methodology/approach
In all, 56 consecutive admissions with a primary diagnosis of personality disorder (mostly borderline type) and co-morbidity were assessed according to their participation in, and benefit from, a core set of five manualised group treatments that focused on social and interpersonal deficits, instability of mood and problematic substance use. A single cohort pre-test post-test comparison design was used with evaluation based on global change over an amalgam of self-report group specific outcome measures.
Findings
In all, 70 per cent of patients attended three or more core groups, with attendance for each group ranging from 85 to 53 per cent. Between 65 and 77 per cent of patients showed a significant improvement on pre-group psychometrics. Patients who achieved a significant positive change in one group tended to do so in others. In all, 85 per cent of patients who completed two or more groups had overall positive direction of change scores. Those who benefited from treatment engaged more quickly, were more likely to have been admitted from hospital, to have previously engaged in therapy and to score lower on measures of impulsivity and personality pathology.
Research limitations/implications
In a clinically representative study the absence of a control group limits the extent to which observed changes can be attributed to described interventions.
Practical implications
Findings reflect the importance of providing a broad clinical approach to changing cognitive behavioural functioning with PD patients in secure settings. They also highlight the need to improve ways of engaging patients at an earlier stage of hospital stay and of increasing the acceptability and uptake of relevant group treatments. Further evidence-informed service developments are needed to meet these challenges.
Originality/value
The study adds to a small literature on the clinical impact of a gender-specific group treatment programme for PD women in secure settings.
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Clive Long, Rachel West, Samantha Rigg, Rebecca Spickett, Lynne Murray, Paul Savage, Sarah Butler, Swee-Kit Stillman and Olga Dolley
– The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care.
Abstract
Purpose
The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care.
Design/methodology/approach
A range of interventions (environmental and motivational) designed to increase participation in physical activities were introduced on two secure wards for women. A pre-post design assessed frequency, duration and intensity of physical activity, attendance at physical activity sessions, exercise motivation, exercise-related mood, attitudes to exercise and health and biological indices. Measures collected over a three-month baseline period were repeated six months post-intervention.
Findings
Significant changes occurred in both attitudes to exercise and health, exercise motivation and exercise behaviour following change initiatives. With the exception of resting pulse rate and perceived exertion, the increased level of activity was not reflected in changes in body mass index, body fat or body muscle.
Practical implications
Management led, multi-disciplinary interventions to increase physical activity can have a positive impact on both lifestyle behaviours and physical health.
Originality/value
This study adds to a small literature on increasing physical activity in women in secure psychiatric settings where obstacles to change are formidable.
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Clive G. Long, Geoffrey Dickens and Olga Dolley
The purpose of this paper is to assess the antecedent behaviours and consequences of firesetting for women in a secure psychiatric setting along with treatment engagement factors…
Abstract
Purpose
The purpose of this paper is to assess the antecedent behaviours and consequences of firesetting for women in a secure psychiatric setting along with treatment engagement factors. To explore predictions made about emotionally expressive subtype firesetters by the multi-trajectory theory of adult firesetting (M-TTAF).
Design/methodology/approach
In total, 75 individual firesetting episodes involving 25 female multiple firesetters were assessed using the St Andrew's Fire and Arson Risk Instrument. Assessments were made of treatment readiness, firesetting related self-efficacy, insight and barriers to change.
Findings
Findings support the relationship between recidivist firesetting and the psychological features of psychosis, personality disorder and substance misuse. The reported association of firesetting with suicidal thoughts, depression, interpersonal problems, anger/revenge motivation and lack of planning supports the view that behaviour is used to manage distressing life experience and as a “cry for help”. However, in a quarter of incidents there was an intention to harm others and evidence of premeditation in twelve percent. A small but significant minority lacked insight into their behaviour, were not ready for treatment and had low firesetting related self-efficacy. Predictions made by the M-TTAF about likely clinical features and motivators of emotionally expressive firesetters were largely supported.
Originality/value
The study highlights the importance of a detailed and specific risk assessment of firesetting that leads to identification of individual risk factors and an individualised treatment approach. This is of particular importance given the complex problems presented by women in secure settings and by the diversity of the conditions associated with fires set by each individual.