Forensic Mental Health Services

10th Anniversary National Conference
Research in
Forensic Mental Health Services
Institute of Psychiatry, 14th March 2013
The FANS Teaching Unit
at the Institute of Psychiatry
Conferences & Workshops
The Forensic and Neurodevelopmental Sciences (FANS) Teaching Unit runs conferences, workshops and
seminars for mental health professionals of all disciplines.
Our multidisciplinary team of trainers has extensive experience in using, and delivering training in, risk
assessment tools; providing expert evidence; working with people with learning disability; and assessing
and managing developmental disorders. All our risk management trainers have been trained by the
authors of the risk assessment tools we use.
We offer training in the following risk assessment tools:
• HCR-20 - v3
• Structured Assessment of Protective Factors (SAPROF)
• Short-Term Assessment of Risk and Treatability (START)
• Risk of Sexual Violence Protocol (RSVP)
• Managing Risk of Violence in Adolescence (Structured Assessment of Violence Risk in YouthSAVRY)
We also provide Advanced Workshops for Instructors: for experienced practitioners in using risk
assessment tools.
Other events include:
• Courtroom Skills and Report writing for psychiatrists
• Improving Skills in working with Mentally Disordered Offenders with Learning Disabilities
• Autism Spectrum Disorders (ASD) in Adults: Assessment and Management
….and many other conferences and seminars on Forensic and Neurodevelopmental topics
All our events can also be delivered in-house.
For further information or to be included in our mailing list please contact
Alessandra Scotti on forensic.teachingunit@kcl.ac.uk
10th Anniversary National Conference
Research in
Forensic Mental Health Services
Institute of Psychiatry, 14th March 2013
Welcome
We are delighted to welcome you to the Tenth National Conference of Research in Forensic Mental Health Services. This event
has been a long standing collaboration between the Institute of Psychiatry (IoP) and Partnerships in Care (PiC). The primary
aim of this event is to encourage services to produce high quality research through collaboration and also to provide a forum for
significant research findings to be translated and implemented within services. This conference is one of the largest events of its
kind in Europe and we believe that its success in this tenth anniversary year is due to the active participation of the broad range of
professional groups working across forensic mental health services.
Over the years this conference has been able to attract high calibre key note speakers from the UK and internationally. This year
is no exception and we anticipate that the key note speaker presentations will generate much discussion and reflection. Again, we
have been impressed by the volume and quantity of papers submitted this year. We are encouraged to have received submissions
from healthcare services across different levels of security, prison settings and across the life span. The Scientific Organising
Committee has found it very challenging to limit the number of accepted papers. The book of abstracts therefore also includes
details of the poster submissions that are on display during the conference.
We also hope to provide some inspiration for junior researchers to continue with their endeavours. In 2012 we launched a special
award for the best paper presented by a junior researcher at the conference. The worthy winner was Lauren Herlitz. We look
forward to announcing a winner at this year’s conference.
Finally, we wish to thank our colleagues in the Organising Committee and senior administrators at the Institute of Psychiatry and
Partnerships in Care for helping to organise this conference. We hope you enjoy it!
Professor Tom Fahy
Consultant Psychiatrist & Clinical Director
Forensic Services, SLaM NHS Foundation Trust
and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry
Dr Quazi Haque
Group Medical Director
Partnerships in Care and Honorary
Lecturer, Department of Forensic and
Neurodevelopmental Sciences, Institute of Psychiatry
Scientific Organising Committee
Dr Adrian Cree, Regional Clinical Director, Partnerships in Care South East Services
Honorary Senior Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL
Professor Conor Duggan, Head of Research and Development, Partnerships in Care
Professor Tom Fahy, Consultant Psychiatrist & Clinical Director Forensic Services, SLaM NHS Foundation Trust
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL
Dr Quazi Haque, Executive Medical Director, Partnerships in Care
Honorary Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL
Dr Shubulade Smith, Consultant Psychiatrist, SLaM NHS Foundation Trust
Senior Lecturer & Teaching Unit Co-Director, Department of Forensic and Neurodevelopmental Sciences, Institute of
Psychiatry, KCL
Administrative Support
Alessandra Scotti and Maddy Pickles, Forensic and Neurodevelopmental Teaching Unit, Institute of Psychiatry, KCL
Debbie Larkin and Susan Ramwell, Communications Team, Partnerships in Care
Programme
09.00
09.30
Registration
Introduction
09.35
Keynoteaddress-Howcriminalcareerresearchcanhelpinformspecificinterventions
Professor Alex R. Piquero, Ashbel Smith Professor, University of Texas at Dallas, and Key Centre
forEthics,Law,JusticeandGovernance,GriffithUniversity,Australia
Questions & discussion
10.20
10.35
Professor Tom Fahy, Institute of Psychiatry and Dr Quazi Haque, Partnerships in Care
11.00
Key note address - Violence by military personnel deployed to Iraq and Afghanistan: a new forensic
population?
Dr Deirdre Macmanus, Institute of Psychiatry, King’s College London
Questions & discussion
11.10
Morning break - viewing posters
11.40
Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved
Research presentations
12.50
Premise in South London
Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services
Dr Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study
of adult schizophrenia patients and attending physicians in forensic and civil psychiatry
Key note address - Risk assessment in females; violence, psychopathy and self-injury
Professor Nicola Gray, Pastoral Healthcare, Ty Catrin, Cardiff
Questions & discussion
13.00
Lunch - viewing posters
13.50
14.15
Key note address - Crime and mental illness: clinical implications of new research
Dr Seena Fazel, University of Oxford and Oxford Health NHS Foundation Trust
Questions & discussion
14.25
Gareth Hopkin, Critical Time Intervention for Severely Mentally Ill Released Prisoners: Pilot and
14.40
Dr Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/
criminaljusticeinterface:preliminaryfindingsfromacase-linkagestudy
Dr Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study
Afternoon break - viewing posters
11.55
12.10
12.25
14.55
15.10
15.35
Research presentations
Randomised Control Trial
16.15
Key note address - What Works for Sex Offenders? A Review of the Evidence
Professor Conor Duggan, Partnerships in Care and University of Nottingham
Young Scholar Award
16.25
Close
Key Note Biographies
Professor Conor Duggan BSc, PhD, MD, FRCPsych, OBE, Partnerships in Care and University of
Nottingham
Conor Duggan is Emeritus Professor at the University of Nottingham and Head of Research and
Development at Partnerships in Care. He was until recently an Honorary Consultant Psychiatrist at Arnold
Lodge, Regional Secure Unit in Leicester where he shared responsibility for a 22-bedded in-patient unit
that treats men with personality disorder and a history of serious offending. His research interests are
treatmentefficacyinpersonalitydisorderedoffenders,theirlong-termcourseandtheneuropsychological
basis of psychopathy.
He was until recently Editor of The Journal of Forensic Psychiatry and Psychology and chaired a NICE Guidence Committee on
Antisocial personality Disorder. He was awarded an OBE for his services to mental health in June 2012.
Dr Seena Fazel, University of Oxford and Oxford Health NHS Foundation Trust
Seena Fazel is a Wellcome Trust Senior Research Fellow in Clinical Science in the Department of Psychiatry, University of Oxford.
He is also an Honorary Consultant Forensic Psychiatrist for Oxford Health NHS Foundation Trust, and works clinically in a local
prison. His research interests are primarily in the relationship between mental illness and crime, and the mental health and suicide
risk of prisoners.
Professor Nicola Gray, Pastoral Healthcare, Ty Catrin, Cardiff
Professor Nicola Gray received her PhD from the Institute of Psychiatry for her work on the neuropsychology
of schizophrenia. She completed her MSc in Clinical Psychology before taking up a joint position at Caswell
Clinic (the medium secure unit for South Wales) and Cardiff University where she was awarded a Personal
Chair. She is now Head of Psychology for Pastoral Healthcare and has helped set up a new Personality
Disorder service in Cardiff (Ty Catrin). She is a honorary professor at Swansea University and the Director of
the Welsh Applied Risk Research Network (WARRN).
Professor Gray’s research interests are in risk assessment and management, Personality Disorder, sexual offending and
neuropsychology. She regularly trains professionals on Structured Professional Judgment for the assessment of future risk
and management (e.g., HCR-20, RoSP) and other risk assessment schemes. She has published widely in the areas of risk
assessment, psychopathy, implicit cognitions and schizophrenia.
Dr Deirdre Macmanus, Institute of Psychiatry, KCL
Dr MacManus is a clinical lecturer in forensic psychiatry and currently acting as consultant psychiatrist for the
London Trauma Service for Veterans. She trained in Medicine in Edinburgh and came to the Maudsley for
higher specialist training in forensic psychiatry. In recent years she has been funded by the Medical Research
Council to carry out her PhD research into the risk factors for violence among UK military personnel deployed
to Iraq and Afghanistan.
6
Key Note Biographies
Professor Alex R. Piquero, Ashbel Smith Professor, University of Texas at Dallas, and Key Centre
forEthics,Law,Justice,andGovernance,GriffithUniversity,Australia
Alex R. Piquero is Ashbel Smith Professor in the Program in Criminology in the School of Economic,
Political, and Policy Sciences at the University of Texas at Dallas, Adjunct Professor Key Centre for
Ethics,Law,Justice,andGovernance,GriffithUniversity,FacultyAffiliate,CenterforViolenceandInjury
Prevention George Warren Brown School of Social Work Washington University in St. Louis, and CoEditor of the Journal of Quantitative Criminology. Prior to arriving at UT-Dallas, he was on the faculties of
Florida State University, University of Maryland, John Jay College of Criminal Justice/City University of
New York, University of Florida, Northeastern University, and Temple University. He has published over 240 peer-reviewed
articles in the areas of criminal careers, crime prevention, criminological theory, and quantitative research methods, and has
collaborated on several books including Key Issues in Criminal Careers Research: New Analyses from the Cambridge Study
in Delinquent Development (Cambridge University Press, co-authored with David P. Farrington and Alfred Blumstein) and
Handbook of Quantitative Criminology (Springer, co-edited by David Weisburd). His work has been cited over 10,000 times
and he has been ranked as the #1 criminologist in the world since 1996 in terms of scholarly publications in elite criminology/
criminal justice journals. In addition to his membership on over a dozen editorial boards of journals in criminology and
sociology, he has also served as Executive Counselor with the American Society of Criminology, Member of the National
Academy of Sciences Panel Evaluating the National Institute of Justice, Member of the Racial Democracy, Crime and Justice
Network at Ohio State University, and Member of the MacArthur Foundation’s Research Network on Adolescent Development
& Juvenile Justice. Professor Piquero has given congressional testimony on evidence-based crime prevention practices in
the area of early-family/parent training programs, and has provided counsel and support to several local, state, national, and
international criminal justice agencies. Professor Piquero is past recipient of the American Society of Criminology’s Young
Scholar and E-Mail Mentor of the Year Awards, Fellow of both the American Society of Criminology and the Academy of
Criminal Justice Sciences, and has also received numerous teaching awards including the University of Florida’s College of
Arts & Sciences Teacher of the Year Award and the University of Maryland’s Top Terp Teaching Award, and was recently
awarded the University of Texas at Dallas Diversity Award.
7
Dr Lynne Callaghan
Research Manager, University of Plymouth
Since completing her research training in psychology Lynne has supported and led a range of research projects and
programmes across educational, statutory and third sector organisations in the areas of community, social, and health
psychology. Current projects include attrition in cases of adult rape, evaluation of educational and support programmes for
victims of domestic abuse and an assessment of the sexual health and social needs of sex workers. Her current role as
fundholder and research manager for the Interface Project has brought together her particular interests in inter-agency working
and forensic psychology.
Speakers’ Biographies
Verity Chester
Research Assistant, Partnerships in Care
Verity obtained her BSc in Forensic Psychology from the University of Leeds in 2009. Since then she has worked as a Research
Assistant within the Medical Department at Partnerships in Care Learning Disability Services, where she has contributed to
numerous research projects and peer reviewed publications. Verity obtained her MSc in Forensic Psychology from London
Metropolitan University in 2012, where her thesis focused on Relational Security within Secure Services. Her research interests
include autistic spectrum disorders, fire setting, and health inequalities, particularly as they apply to forensic intellectual disability
populations.
Friederike Höfer
Managing Director, Centre for Forensic Psychiatry Rheinau, University Hospital of Psychiatry Zurich
Friederike X. E. Höfer studied medicine at the Charité Medical Centre Berlin, a joint institution of the Free University Berlin and
the Humboldt University Berlin. During her studies, Friederike Höfer was a tutor for medical interviewing skills. From 2006 until
2007, she studied abroad at the Faculty of Medicine, Buenos Aires, Argentina for eight months. Friederike Höfer obtained her full
registration to practice in 2010. Since 2011 she has been working at the University Hospital of Psychiatry Zurich. In October 2012
Friederike Hofer started working at the Department of Forensic Psychiatry within the same institution. Ms Höfer is currently a
specialty registrar in psychiatry. Her MD thesis will be on ‘The impact of legal coercion on the therapeutic alliance’.
Gareth Hopkin
Research Worker / PhD Student, Institute of Psychiatry
Gareth Hopkin is a researcher and PhD student working on the Critical Time Intervention project. Gareth graduated from Cardiff
University with a BSc in Applied Psychology in 2012, having completed a year conducting research at Broadmoor Hospital
as part of the undergraduate programme. Shortly after graduating, he joined the Health Services and Population Research
department of the Institute of Psychiatry as a research worker and has subsequently enrolled as a PhD student.
8
John Morgan
Consultant Clinical Forensic Psychologist, Cornwall Partnership Foundation Trust
John Morgan is a chartered forensic and clinical consultant psychologist with experience of delivering services to mentally
disordered offenders in settings ranging from the community to maximum security. He represents the Trust at the Strategic
Management Board for Public Protection Arrangements. His interests are multi-agency approaches to clinical risk management,
mental health service delivery and public health impact. John has played a pivotal role in the development and implementation
of a range of new service initiatives in Cornwall including the recent Custody Liaison and Diversion Service and is an Interface
Project fund holder.
Speakers’ Biographies
Dr Siân Oram
Researcher, King’s College London, Institute of Psychiatry
Siân Oram is a post-doctoral researcher at the Section for Women’s Mental Health, Institute of Psychiatry, King’s College London.
Her research interests include the associations between mental disorder and violence (including domestic violence and human
trafficking) and policy and service responses to the health and social needs of people who have experienced violence. She
joined the Institute of Psychiatry in 2010 to work on the NIHR-funded “PROVIDE” project, conducting a series of systematic
reviews on domestic violence and mental health, and is currently working on research funded by the Department of Health Policy
Research Programme to inform the NHS response to human trafficking.
Samantha Russell
Forensic Mental Health Practitioner, South London and Maudsley NHS Foundation Trust
Samantha is a Forensic Psychologist in Training. She obtained her Bachelor Science (Honours) Degree in Psychology in 2003
followed by a Master of Science Degree in Forensic Psychology in 2005. She has been enrolled on the Diploma in Forensic
Psychology since 2006, during which time she held positions of employment with HM Prison Service and the Institute of
Psychiatry, King’s College London. Samantha has been employed by South London and the Maudsley NHS Trust since 2009
working in a Forensic Personality Disorder Community Service.
9
Dr Lynne Callaghan
Research Manager, University of Plymouth
John Morgan
Consultant Clinical Forensic Psychologist, Corwall Partnership Foundation Trust
Exploring inter-agency decisions at the mental health/criminal justice interface: preliminary findings
from a case-linkage study
Oral Presentations
The Interface Project is a case-linkage study examining current practice relating to the management of individuals with enduring
moderate to severe mental health needs (EMHN), specifically at those points where they interface with the NHS and criminal
justice system (CJS). It is well recognised that interagency working continues to be challenging (Rutherford, 2012) and that
despite serious case reviews and subsequent enquiries (e.g. Laming 2009; IPCC 2010), difficulties remain at this interface.
This research, therefore, utilises routinely collected NHS and Police data to qualitatively explore inter-agency decision-making
and the impact of these decisions on both service users and the agencies delivering these services with a view to enhancing
practice.
Section 251 support was received from the National Information Governance Board to access the mental health records of
100 mental health service users without consent. 538 service users of a Trust in the South West of England were identified as
having interacted with the police in the second quarter of 2011 through an audit covering this period. Examination of mental
health service use showed that 277 (51.49%) were regularly on caseload either through sustained long term (n=159) or multiple
short-term referrals (n=118) over the time of police contact. Cases for qualitative analysis were proportionately sampled to
mirror the prevalence of CJS contact type in the wider sample. All relevant mental health and police records for 12 months
following the date of first identified police contact have been processed to provide a unique linked data corpus. Discussion will
include preliminary findings of qualitative framework analysis (Smith & Firth, 2011) with regard to type of inter-agency decisions
and impact of decisions on both practice and service user outcome, as well as consideration of early implications for policy and
practice.
S J Lea 1, L Callaghan 2, J Morgan 3, I Grafton 4, M Bolt 4, G Thornicroft 1, A Patel 1, D Rose 1, S Eick 2 *
Institute of Psychiatry, KCL
Faculty of Health, Education and Society, Plymouth University
3
Forensic Psychology Service, Cornwall Partnership NHS Foundation Trust
4
Devon and Cornwall Constabulary
*Authors in descending order of contribution
1
2
10
Verity Chester
Research Assistant, Partnerships in Care
An Evaluation of Measures of Relational Security used within Secure Services
Background
Relational security is the knowledge, and therapeutic relationships between staff and patients within secure services, and the
way this knowledge, and relationships are used in order to manage security and risk. Until recently, there have been no direct
measures of relational security to assist practitioners in this area. However, two measures of relational security have been
introduced. The psychometric properties of these measures have not been evaluated.
Oral Presentations
Aims
This study aims to evaluate the psychometric properties of two measures of relational security, namely; internal consistency,
construct validity, contrasted groups validity and principal components analysis. In addition, the study will examine the clinical
utility of such measures, from the viewpoint of staff working in secure services.
Method
The Relational Security Explorer (DH, 2010) and the See, Think, Act scale (Tighe & Gudjonsson, 2012) were administered to n
= 89 members of staff working within a secure intellectual disability service. Internal consistency of the two tools was examined
using Cronbach’s a and CITC coefficients. Construct validity was assessed using Pearson’s r. MANOVA were used to explore
differences between groups upon scores on each of the two measures. A questionnaire investigated staff opinion regarding the
Relational Security Explorer. Thematic analysis was used to explore this qualitative data.
Results
CITC and Cronbach’s a indicated that both measures had acceptable internal consistency. MANOVA analyses revealed
significant differences on scores on subscales of the Relational Security Explorer and the See, Think, Act scale, as predicted by
relevant theory.
Conclusions
This study provides preliminary data regarding the psychometric properties of two measures of relational security. The measures
appear sensitive enough to detect differences between groups on scores of relational security. The study highlights a number of
strengths and weaknesses of relational security measures, as reported by staff members.
V Chester¹, W Morgan²
¹Research Assistant, Partnerships in Care Learning Disability Services
²Chartered Forensic Psychologist & Principal Lecturer, London Metropolitan University
11
Friederike Höfer
Managing Director, Centre for Forensic Psychiatry, Rheinau, University Hospital of Psychiatry, Zurich
The impact of legal coercion on the therapeutic alliance: cross-sectional study of adult schizophrenia
patients and attending physicians in forensic and civil psychiatry
Abstract
Objective: The Quality of the therapeutic alliance (TA) was found to play a key role concerning symptom reduction and
medication adherence. Legal coercion is suspected to have a negative impact on the TA: We aimed to identify factors that
impact on the quality of the TA by examining the doctor-patient relationship in schizophrenic patients in forensic and civil
psychiatry.
Oral Presentations
Methods
114 male inpatients with schizophrenia were examined in 3 settings: 1. Inpatients treated on own initiative (n=40), 2. Inpatients
under forced admission (n=36) and 3. Forensic inpatients (n=37). Using the STAR (Scale To Assess Therapeutic Relationship),
patient and attending physician were examined. Disease severity was measured by BPRS (Brief Psychiatric Rating Scale).
Results
The overall correlation between patient and therapist ratings of TA quality was statistically nonsignificant (r = .07, p = .22, onesided). This outcome remained stable when controlling for the severity of symptoms: partial r = .03 (p = .39, one-sided). Patient
groups differed in their mean ratings TA quality. This outcome was due to a significantly higher mean rating of the voluntary
patients (M = 2.8) compared to the involuntary patients (M = 2.5); forensic patients gave an intermediate rating (M = 2.7).
According to the clinicians, the ratings of TA quality were weakly and inversely associated with the patients’ BPRS total scores
(r = -.15, p = .06, one-sided). Among the patients, the ratings of TA quality showed medium-sized negative correlations with the
BPRS total (r = -.34) and hostility scores (r = -.41, both p < .001, one-sided).
Conclusion
TA is not as negatively affected by legal detention as expected. It is not involuntary admission but hostility, which has a major
impact on TA. This factor should be focused on. The implementation of feed-back-mechanisms reducing the discrepancy
between patient’s and doctor`s perception of TA should be considered.
Literature
Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. (2012): The influence of therapeutic alliance and insight on medication adherence in schizophrenia.
Nord J Psychiatry
Cookson A, Daffern M, Foley F. (2012): Relationship between aggression, interpersonal style, and therapeutic alliance during short-term psychiatric
hospitalization. Int J Ment Health Nurs.
Donnelly V, Lynch A, Mohan D, Kennedy HG. (2011): Working alliance, interpersonal trust and perceived coercion in mental health review hearings.
National Forensic Mental Health Service. Int J Ment Health Syst.
McGuire-Snieckus R, McCabe R, Catty J, Hansson L, Priebe S. (2007): A new scale to assess the therapeutic relationship in community mental health
care: STAR. Psychol Med.
Gairing SK, Jäger M, Ketteler D, Rössler W, Theodoridou A.(2011): Evaluation of the German version of the STAR scale. Psychiatr Prax.
F X E Höfer1* MD, S Lau1 MD, A Mokros1 PhD, E Habermeyer1 PhD, S K Gairing2 MD MSc
1
Centre for Forensic Psychiatry, Rheinau, University Hospital of Psychiatry, Zurich, 8462 Rheinau, Switzerland
2
Psychiatric University Hospital, Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
*Corresponding author: Friederike X. E. Höfer, MD, friederike.hoefer@puk.zh.ch
12
Gareth Hopkin
Research Worker / PhD Student, Institute of Psychiatry, KCL
Critical Time Intervention for Severely Mentally Ill Released Prisoners: A Randomised Control Trial
Aims
Transition between prison and community is characterised by drop out from mental health services. An initiative that aims
to improve continuity of care and promote engagement, Critical Time Intervention (CTI), has been found to be feasible and
effective in similar client groups and has potential in this transitional period. The research aims to establish whether the CTI
is feasible in a group of mentally ill prisoners, whether it is effective in improving engagement with services and whether it is
beneficial in terms of cost.
Oral Presentations
Method
CTI is a time limited, comprehensive case management model targeted at the ‘critical time’ of transition from institution to
community. It involves providing practical support to address a number of issues (e.g psychiatric treatment, housing, substance
abuse, finances) prior to and on release. A pilot randomised control trial (RCT) has been completed and given encouraging
results, a large scale, multi site RCT is being conducted with 200 mentally ill prisoners being recruited from prison. The primary
outcome is engagement with services at six weeks post discharge and a longer term follow up recording wider variables such
as hospital admission and contact with the criminal justice system.
Results
The pilot study found that a higher proportion of the CTI group were in contact with mental health services (73%) than those in
treatment as usual (TAU; 50%) and in other outcomes, registration with a GP (87 v. 38%) and access to medication (80 v. 38%)
were significantly higher in the CTI group than in TAU.
Conclusions
Initial findings suggest that CTI is feasible in this group of clients and that it leads to increased engagement with mental and
physical health services. Due to limitations of the pilot study, a larger RCT is being conducted and will allow further analysis with
more definitive conclusions.
G Hopkin1, C Stevenson2, M Jarrett1, Dr A Forrester3, Professor G Thornicroft1,
Professor J Shaw2
1
Health Service and Population Research Department, Institute of Psychiatry, KCL
2
School of Community Based Medicine, University of Manchester, Manchester
3
South London and Maudsley Foundation Trust, London
13
Dr Siân Oram
Researcher, King’s College London, Institute of Psychiatry, KCL
Intimate partner homicide and mental disorder: a population-based descriptive study
Aims
(1) To examine the prevalence of current and lifetime mental disorder and contact with mental health services among convicted
perpetrators of intimate partner homicide; (2) to investigate the distribution of characteristics associated with intimate partner
homicide with and without mental disorder at the time of offence.
Oral Presentations
Method
A consecutive case series of all convicted intimate partner homicide perpetrators in England and Wales (1997-2008). Information
on socio-demographic, clinical and offence characteristics was gathered from the Home Office, the Police National Computer,
psychiatric court reports and, for psychiatric patients, questionnaires completed by supervising clinicians. Descriptive statistics
were calculated for the socio-demographic, behavioural, clinical, service use and offence characteristics of intimate partner
homicide perpetrators. Pearson’s chi-squared tests and were used to compare characteristics between perpetrators with and
without mental disorder at the time of offence.
Results
Between 1997 and 2008, 1180 perpetrators were convicted of intimate partner homicide in England and Wales. 19% of
perpetrators had mental disorder at the time of offence. 14% of all intimate partner homicide perpetrators, and 30% of intimate
partner homicide perpetrators with mental disorder at the time of offence, were in contact with mental health services in the
year prior to homicide. Perpetrators with mental disorder at the time of offence were less likely than perpetrators without mental
disorder to have previous violence convictions or a history of alcohol abuse.
Conclusions
A significant minority of intimate partner homicide perpetrators had mental disorder at the time of homicide. Most perpetrators,
including those with mental disorders, were not in contact with mental health services in the year prior to offence. Risk-reduction
could be achieved through initiatives to encourage individuals with mental health problems to access mental health services; and
to develop closer interagency working, including between mental health services, police, social services and domestic violence
services.
S Oram PhD1β, S Flynn MA 2, J Shaw PhD FRCPsych2, L Appleby MD FRCPsych2,
L M Howard PhD MRCPsych1
1
Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry,KCL
2
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Manchester
14
Samantha Russell
Forensic Mental Health Practitioner, SLaM NHS Foundation Trust
Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London
Background
High risk offenders residing in approved premises (AP’s) demonstrate elevated rates of violent recidivism, personality disorder
(PD) morbidity and mortality. Innovative partnership working to reduce reoffending and increase psychological wellbeing
amongst this population is imperative. Whilst there has been a surge of intervention models piloted across the UK, very little is
known about the effectiveness of these in AP’s.
Oral Presentations
Aim
To evaluate the effectiveness of a novel partnership intervention - Psychologically Informed Practice (PIP) – in improving staff
performance and reducing antisocial behaviour in high risk offenders residing in an AP.
Method
Two AP’s in South London were indentified and matched on a number of criteria (e.g., bed capacity, staffing-resident ratios,
catchment area, offender demographics). One acted as a waiting list control whilst the other received intensive PD training
(6 days) followed by supervision and support from a specialist team. A battery of questionnaires measuring knowledge,
attitudes, capabilities and burnout were completed at baseline, at the end of training, and at 3 and 6 months post-training. Staff
performance (e.g., resident complaints, sickness) and resident antisocial behaviour (e.g., recalls, warnings) during the 6 months
prior to training and 6 months post training was also collected and compared.
Results
Significant improvements were observed following intensive PD training on a number of staff measures and these appeared to
be maintained at each of the follow-up periods. Furthermore, there was a reduction in rates of staff sickness, offender recalls,
warnings, and complaints over the 6 month post-training period for the AP receiving the intervention.
Conclusions
Psychologically Informed Practice (PIP) is a novel partnership intervention which appears to demonstrate positive outcomes for
both staff and high risk offender residents. These preliminary findings will inform larger, multi-centre, randomised controlled trials
evaluating PIP.
M Bruce1, S Russell1, R Kerr1, A E Cullen2
1
SLaM NHS Foundation Trust
2
Institute of Psychiatry, KCL
15
Lara Arsuffi
Forensic Psychologist, Northamptonshire Healthcare NHS Trust
Is contingency reinforcement and harm reduction key? Evaluating and comparing the effectiveness of
the Behavioural Treatment of Substance Abuse (BTSA)
BTSA is currently used in community and inpatient settings across SLaM as a method for treating substance abuse among forensic
clients. Unlike other psychological methods used in SLaM, such as Substance Awareness, BTSA employs a harm reduction approach
and contingency reinforcement. NICE guidelines recommend that contingency reinforcement be used in the treatment of substance abuse,
though this does not appear to have been routinely adopted by services dealing with the treatment of substance abuse despite a number
of promising studies supporting the use of contingency reinforcement, particularly in patients with SMI and co-occurring substance abuse/
dependence problems (Bellack, Bennet & Gearon et al, 2006; McDonell, Srebnik & Angello et al, 2013). Similar findings have been shown
for harm reduction methods over an abstinence based approach in those with SMI (Bellack, Bennett & Gearon, 2007).
The current study aims to evaluate the efficacy of BTSA amongst a population of male forensic psychiatric patients. Research has focussed
on the use of contingency reinforcement and harm reduction in general psychiatric patients with SMI but no Axis II co-morbidity. However,
the population in forensic psychiatry is qualitatively different, with greater presentation of co-morbid Axis II diagnosis (particularly Antisocial
and Borderline Personality Disorder). Subsequently, findings from general psychiatric studies are not easily generalisable. This study will
explore the use of contingency reinforcement and harm reduction in a forensic psychiatric population. It is hoped that if BTSA is effective in
reducing substance misuse, this will, in turn, reduce rates of violence as findings consistently support that substance use increases the risk
of violence, particularly in those with SMI (Rasanen, Tiihonen, Isohanni, et al, 1998; Steadman, Mulvey, Monahan et al, 1998). This study
also aims to compare the efficacy of BTSA within this population to the Substance Awareness programme (SA). SA is a treatment currently
employed with forensic psychiatric patients with co-occurring substance abuse problems at another medium secure unit in SLaM. Many
of the treatment techniques such as motivational interviewing and relapse prevention work are employed in SA and BTSA. However, SA
does not provide contingency reinforcement as recommended by NICE and the National Treatment Agency for Substance Abuse (NTA).
Furthermore, the focus of SA is to achieve abstinence rather than a harm reduction approach used in BTSA.
Kelly Cocallis
Assistant Psychologist, Croydon Health Services, South London and Maudsley Trust
Poster Abstracts
Initial outcomes of a recovery-oriented treatment programme within a medium secure unit
Aims
Contemporary mental health services are in an era where recovery approach principles are a primary goal. Recovery-oriented practice has
been associated with improvements in outcomes. However to date, no studies have investigated recovery-oriented group interventions in
forensic mental health services in the United Kingdom. The present study examined whether participation in a recovery-oriented treatment
programme was associated with significant positive change in recovery-oriented outcomes for service users in a medium secure unit.
Method
A descriptive cohort with repeated measures was employed. Sixty-five service users completed self-report outcome measures to assess
hopelessness, global distress, self-esteem, anxiety, depression, locus of control, and motivation, before and after intervention.
Results
Analyses of pre- and post-treatment scores revealed a significant decrease in service users’ self-reported global distress, and a significant
shift from an external toward a more internal locus of control. A significant decrease in self-reported anxiety and depression was found when
examining service users whose scores before intervention fell within ‘borderline’ and ‘definite’ ranges. No significant changes were found for
hopelessness, motivation and self-esteem.
Conclusions
This study, which is the first of its kind, has shown promising early results. Research should continue to investigate recovery-oriented
group interventions such as that described in the present study, to determine their potential as a treatment option for forensic mental health
service users. Confirmation of the effectiveness of recovery-oriented group interventions has the potential to enhance and promote recovery
practice in the United Kingdom.
K Cocallis, T Green, S Haddad
16
Lydia Evans
Forensic Psychologist in Training (Doc.For.Psy), Nottinghamshire Healthcare NHS Trust and University of Nottingham
A systematic review of the relationship between self report psychopathy measures and the PCL-R
Background and aims
Assessment of psychopathy in offender populations has become important for institutions, services and policy makers. Most of the research
into Psychopathy in offender samples has utilised the Psychopathy- Checklist Revised (PCL-R, Hare 2003), which has dominated this field
of assessment. However there has been recent growth in other measures such as self report measures of psychopathy. There have been a
small number of individual studies exploring how self-report measures of psychopathy compare to the PCL-R, but to date there has been no
systematic review. As the use of self-report measures in research and practice is increasing, a review will allow further understanding of how
well the current measures stand compared to a well validated tool, and inform clinicians of the suitability of self report measures for application
in forensic settings.
Method
A systematic method was used to examine the relationship between self-report measures and the PCL-R in adult male offender populations
and the quality of this research was reviewed. Electronic databases were searched and an inclusion and exclusion criteria applied. Studies
found to examine relationships between the PCL-R or PCL and self-report psychopathy measures in adult male offenders were included.
Experts in the field were also contacted for further relevant studies.
Results
The results are currently being collated and will be completed by March. This will detail the hits, duplications and irrelevant publications. Of
those included, a data extraction exercise will summarise the correlations between the measures and the quality of the included studies will be
scrutinised.
Conclusions
These are pending, and will focus on the implications for assessment and conceptualisations of psychopathy.
Vidya Fatania
Student, Institute of Psychiatry, KCL
The Influence of a Relational Security Programme on Social Climate in a Medium Secure Service for
Men with Learning Disability
Method
A quasi experimental design was adopted to investigate the change in perception of social climate using the Essen Climate Evaluation Schema
(EssenCES) (Schalast, Redies, Collins et al 2008) and the frequency of untoward incidents through collection of frequency data using the
Trust electronic datix system. Assessment occurred prior to (Time 1) and 14 months following (Time 2) the introduction of a relational security
programme.
Results
Patients’ perception of the extent to which the unit was supportive of their therapeutic needs was significantly reduced at Time 2 compared to
Time 1 (β= -0.429, t= -2.93, p=0.006). At Time 1 patients had a more positive perception than staff of the social climate (p=0.016). At Time 2
patients felt safer in the unit from the threat of violence (p=0.03), but conversely felt that the unit was less able to meet their therapeutic needs
(p=0.007) than staff perceived the unit to. In addition, the frequency of untoward incidents increased significantly at Time 2 compared to Time
1(U=751, p=0.001, r=.58).
Conclusion
The introduction of a relational security programme positively increased some aspects of social climate in a forensic intellectual disability
setting. A significant increase in incidents inevitably impacted on the perception of safety by staff, however this appears to have impacted less
on patients. Despite this, although patients felt safer than staff they also felt that staff were less available to meet their therapeutic needs.
This highlights the importance of maintaining a good balance between safety, treatment and support, which is central to the relational security
programme. In this study no factors other than the type of ward (treatment or admissions) was controlled for. To determine the true extent of
which a relational security programme can improve social climate, further research would need to be conducted.
V Fatania, Dr J Henry
17
Poster Abstracts
Aim
The study aims to investigate the following: • Does the introduction of a relational security programme change the perception of social climate?
• Is there a difference between staff and patient perception of social climate?
• Does the introduction of a relational security programme have an impact on the number of untoward incidents?
Sharonie Fitzhugh
Senior Staff Nurse, St Andrews Healthcare
An audit of anti-psychotic monitoring in forensic psychiatry in-patients
Aims
Patients with schizophrenia die 15-20 years earlier representing a unique cardiovascular disease high risk cohort.
Patients are exposed to the obesogenic complications of psychotropic medicines that in forensic services are often prescribed multiply and at
high doses. Monitoring of side effects is advised in practice guidelines, including the NICE guidelines for schizophrenia 2009.
Our aims were to:
• establish the performance of a typical forensic in-patient service at identifying those on anti-psychotic medicines and those on high dose or
multiple anti-psychotics
• establish clinical practice of side-effect monitoring
• compare the service’s practice compliance with relevant local and national guidelines.
Method
Retrospective data collection from electronic notes of male in-patients in medium, low and locked services between September 2012 and
January 2013. Audit standards were based on local and national guidelines.
Results
59 out of 64 (92.2%) patients were prescribed at least one anti-psychotic, of them 9 (15.3%) were prescribed two. 23 (39.0%) were additionally
prescribed a mood stabiliser, and 18 (30.5%) an antidepressant.
Mean daily antipsychotic dose in chlorpromazine equivalents was 348.5mg (range 0 to 1060mg). 15 patients (25.4% of those on antipsychotics)
were on combined doses that exceeded BNF maxima, up to 200%. 12 of these patients had warning notes on their medication charts, but only 8
had accompanying care plans to manage monitoring.
60 (100%) patients had weight and height data recorded and 54 (91.5%) pulse and blood pressure. 46 (77.9%) patients had blood glucose
reacorded and 32 (54.2%) a fasting lipid profile. 44 (74.6%) had an ECG, the QTc interval ranged from 378 to 483ms. No patients had side
effects recorded using an objective scale.
Conclusions
Patients taking antipsychotics should be regularly monitored for side-effects. This is an essential part of good quality physical health care.
Clinical audit can identify local short-comings in physical health monitoring.
Poster Abstracts
S Fitzhugh, Dr M Picchioni
Amanda Gilman, MSW
Doctoral Candidate and Research Assistant, Social Development Research Group, School of Social Work, University of Washington
Patterns of Juvenile Incarceration and Mental Health-Related Consequences in Adulthood
Aims
Researchers have found numerous negative consequences of incarceration in various domains, including mental health functioning. However,
the experience of juvenile incarceration is likely to be more varied than is captured in the often-utilized “incarcerated vs. not” measure. This
study examines whether there are different patterns of juvenile incarceration and, if so, whether the long-term mental health consequences vary
by these patterns.
Methods
Data were drawn from the Seattle Social Development Project, an ethnically diverse, gender-balanced longitudinal study of 808 youth
oversampled from high risk neighborhoods in Seattle, Washington. Within this sample 13.4% had an official incarceration record during
adolescence. Latent class analysis was used to identify different patterns of incarceration experiences using age, duration, offense type and
chronicity as indicators. These classes were then used to predict mental health-related consequences in adulthood (depression, generalized
anxiety, and post-traumatic stress).
Results
Four classes were identified: (1) limited incarceration for nonviolent offenses (32% of incarcerated juveniles), (2) limited incarceration for
substance-related and violent offenses (19%), (3) moderate exposure for a variety of offense types (27%), and (4) high chronicity incarceration
for more violent offenses (21%). Regression analyses revealed that mental-health-related adult consequences vary based on these different
patterns of juvenile incarceration. For example, youth in class 2 showed the highest rates of mental health symptoms in adulthood, and although
both classes 1 and 2 experienced limited incarceration, they presented different mental health outcomes in adulthood.
Conclusions and Implications
These results indicate that distinct patterns of incarceration exist among youth who are often analyzed as a homogenous group, and that the
long-term mental health consequences of incarceration may vary by these patterns. These findings echo prior research which has found that
incarceration can have long-lasting mental health consequences, but also finds that these consequences can be worse for certain youth.
A B Gilman, K G Hill, J D Hawkins
18
Dr Neel Halder
Consultant Psychiatrist, Alpha Hospitals Ltd
Seclusion Reduction within Secure Women’s Services
Aims
To establish any changes to the number of incidents which led to seclusion over a period of time within a medium secure women’s service. To
identify what factors may have helped towards a reduction in the incidence of seclusion episodes.
Method
By analysing electronic seclusion data, we looked at the number of incidents of seclusion for 12 months prior to November 2011 and for
12 months post November 2011. We chose this time frame as the organisation was engaged in various strategies (detailed below) around
November 2011 which specifically highlighted seclusion issues.
Results
During the 12 months prior to November 2011, there were 75 seclusion episodes across Women’s services (from a total of 16 patients). During
12 months post November 2011 (November 2011 – November 2012) there have been 41 episodes of seclusion. 7 of the 16 were discharged but
2 were admitted during Nov 2011 to Nov 2012 who accounted for seclusion episodes.
Discussion
Improving staff awareness and knowledge of seclusion through policy, procedure and training with the emphasis of reducing seclusion
may contribute towards a reduction in practice. Other variables could include, better monitoring systems, support and involvement of other
professionals and even the nature and presentation of specific patients. 52 of the 75 episodes pre November 2011 are from patients who are
still at the hospital now.
Conclusion
Whilst there were already robust monitoring systems and changes in the audit process for seclusion prior to November 2011, during this month
there was a focussed drive to do a number of other things including; a further revision of the hospital policy, ensuring that trainers incorporate
pertinent aspects of the policy into training more effectively, a greater emphasis on using seclusion as a last resort and all the preventative/
alternative strategies available to staff.
Perhaps November’s (2011) efforts were another ‘spoke in the wheel’ (supporting other current systems in place) that contributed to the
decrease in seclusion episodes within Women’s services.
J Drabble, Dr N Halder
PhD Student, St Andrews Healthcare
Service user involvement in planning for the prevention and management of aggression and violence:
An audit
Introduction
NICE guidelines state that patients should be involved in planning for the short-term management of their own disturbed/violent behaviour. One
measure of audit suggested in NICE guidance is that each patient’s care plan should contain an advance directive describing their preferred
management strategies in the event of a violent incident.
Aims
1. To determine if patients have been involved in creating their Prevention and Management of Aggression and Violence (PMAV) care plan. 2.
To ascertain whether, in the event of an incident, the recorded management plan was followed.
Method
The sample for this audit is all mental health inpatients in adult mental health care pathways at St Andrew’s Healthcare. A list of all patients
involved in incidents recorded on RiO event forms and classified as: abuse/aggression – verbal, abuse/aggression – physical, abuse – sexual,
property damage or self harm & suicide will be obtained. Data from individual incident event forms, from this list will be compared with data in
the PMAV care plan using an audit tool designed for this purpose. Every incident and perpetrator of that incident in a six month period (July –
December 2012) will be included in the audit. Data to be collected in January 2013.
Results and Conclusions
Based on previous figures we expect to present results from about 1000 incidents perpetrated by approximately 200 patients. The results
will describe i) whether documentation suggests that patients were involved in creating their PMAV care plan, and ii) the extent to which any
advance directives or preferences in the care plan were enacted during a violent incident. Important areas where care plans are not adhered to
will be discussed, and recommendations made.
N Hallett; J Huber, G Dickens
19
Poster Abstracts
Nutmeg Hallett
Stephanie Harris
PhD Student, Institute of Psychiatry, KCL
Stroop task performance in violent and non-violent patients with schizophrenia
Background
There is an established link between schizophrenia and violence that may be mediated in part by a variety of co-morbidities such as
substance misuse. It remains unclear however what factors specific to schizophrenia may drive this association. Many patients with
schizophrenia exhibit a range of cognitive deficits, though the links between these impairments and violence in schizophrenia remain poorly
understood. Emerging evidence suggests that greater neurocognitive deficits in these patients may be associated with violence. It has been
proposed that reduced response inhibition and cognitive inflexibility may lead to an increased risk of reactive violence. Methods
33 patients with schizophrenia and 38 healthy controls participated in the study. Patients were subdivided on the basis of prior violence
histories, into ‘violent’ (n=24) and ‘non-violent’ (n=9) groups. Three of the healthy control participants had been previously violent.
Participants completed the 45 second version of the Colour/Word Stroop task which is composed of three subtests: Word reading, Colour
naming and Interference.
Results
The patients were outperformed by controls for both the word reading and colour naming subtests. There was a trend towards better colour
naming in the violent patient groups compared to the non-violent group, though this did not reach statistical significance. Violent patients
however showed the greatest interference effect, performing worse than both the non-violent patient and healthy control groups, who in turn
did not differ significantly.
Conclusions
Our data suggests that patients with schizophrenia are impaired on the Colour/Word Stroop task. Furthermore, we tentatively suggest that
patients with a history of violence may show greater impairments on this task than their non-violent counterparts. This is consistent with
previous findings implicating poor cognitive flexibility and inhibition of irrelevant stimuli as a risk factor in violent patients. Our data are limited
by relatively small sample sizes, particularly in the non-violent group.
S Harris, Dr C Oakley, Dr A Reichenberg, Professor D Murphy, Dr M Picchioni
Eve Hepburn
Poster Abstracts
Forensic Psychologist in Training and Post Graduate Research Student (Doc.For.Psy), Nottinghamshire Healthcare NHS Trust &
University of Nottingham
Delusional experiences in a Personality Disordered population
Objectives
A wealth of literature investigating the links between delusions and violence in people with a history of psychosis/schizophrenia exists,
however this has not yet been explored in a personality disordered (PD) population and is what this study seeks to explore. Given the
symptomalogical overlap between schizophrenia and certain types of PD you might expect there to be a difference in the incidence of
delusions by type of PD. On the basis of the theoretical links between delusions and violence it could be hypothesised that delusional
experiences might relate to the severity of PD and/or history of violence.
Method
Forensic clients (n=70-120) receiving treatment for their diagnosed personality disorder in High Secure, Medium Secure or Community
Healthcare settings were administered the Peter’s Delusion Inventory (PDI) along with measures capturing drug/alcohol history and
impulsivity (UPPS). The IPDE and PCL-R (along with a severity scale used for ‘DSPD’) were used to explore an individual’s type and severity
of interpersonal difficulty and a history of violence was extracted from healthcare records. A history of psychosis/ schizophrenia or an IQ
below 70 excluded clients from participating.
Results
Correlational analyses has identified weak (.3-.5), but significant relationships between the presence of delusions and: a number of aspects
of personality; how early/severely people used alcohol; the level of violence in their history of convictions and their impulsivity. A factor
analysis is providing dimensions of delusions which could tell us more about the nature of delusions in these sub groups. The overall
presence of delusions and conviction with which they are held (Means/SD’s), appears to be similar to that found in the general population
previously.
Conclusions
Results may have implications for the risk assessment and management of violence and further our understanding of the role ‘Delusions’
play in the process of decision making.
E Hepburn, Dr N Khalifa, R Howard, Professor K Browne
20
Andy Inett
Forensic Psychologist, Forensic Learning Disability Service, Kent & Medway NHS Partnership Trust
Predictive validity of the START with intellectually disabled offenders
Purpose
Offenders with intellectual disability (ID) have been largely neglected in past forensic literature on assessment of dynamic risk factors. The
present study evaluated the predictive validity of The Short Term Assessment of Risk and Treatability (START), in a sample of males with
intellectual disabilities in a low-secure hospital (n=28).
Design / Methodology / Approach
A prospective analysis was conducted, with START scores as the predictor variables, and the number of recorded aversive incidents as the
outcome measure.
Findings
ROC analysis demonstrated that total START risk scores had a significant high predictive accuracy for incidents of physical aggression to
others (AUC = .710, p<.001) and property damage/theft (AUC = .730, p<.001), over a 30 day period, reducing to medium predictive validity
over a 90 day period. Medium predictive validity was also identified for incidents of verbal aggression, suicide, self harm, and stalking and
intimidation. START strength scores were also predictive of overt aggression (AUC = .716), possible reasons for this are explored.
Originality / value
This study represents the first attempt to examine the predictive validity of the START with ID offenders, and a step forward in the
understanding of dynamic risk factors for violence in this population. The significant predictive relationship with incidents of physical aggression
and property damage offers clinicians a preliminary evidence base supporting its use in low secure settings. However, the small sample size
limits the generalisability of the findings, and further research is required.
Dr Kate Law
Consultant Clinical and Forensic Psychologist, Farmfields Hospital, The Priory Group
Validating the Development of a New Substance Abuse Assessment Tool
Given the high levels of denial associated with using self-report measures to diagnose Substance Dependency Disorders (SDD), this study
sought to validate the use of an observational measure to help identify those who may continue to demonstrate problems with substance use.
The observational SMPB checklist was conducted by staff alongside the participants completing two psychometric measures of substance
abuse, the adult Substance Abuse Subtle Screening Inventory-3 and the Drug Use Disorders Identification Test. The SMPB checklist was
conducted for each participant over a seven day period on two occasions approximately fourteen days apart to allow a reliability test-retest to
be performed.
The SMPB checklist was found to have good test-retest reliability r=0.943; the internal consistency of the checklist items was α=0.89 and
an exploratory factor analysis identified a four factor construct for the checklist. A multiple regression reported no significant relationship
between the psychometric measures and the checklist scores F (3, 20) = 4.02, P>0.5 however only 12.5% of the sample were documented
as not displaying any SMPBs. This provided preliminary support for the need for further examination into the probable relationship between
SMPBs displayed in secure settings where access to illicit substances is restricted and an undetected or prolonged preoccupation with these
substances. The findings of the current study showed support for the existence of SMPBs in secure settings. The use of a larger sample size
may have allowed for statistically significant relationships to be identified between the checklist and the already well established psychometric
measures used.
K Law, S-M Campbell
21
Poster Abstracts
An independent sample observational study was performed to assess the reliability and validity of a Substance Misuse Paralleling Behaviours
(SMPB) checklist using a sample of 24 men in private forensic mental health units. Previous research has suggested that individuals who have
previously been addicted to using illicit substances may display patterns of behaviours in hospital similar to those associated with the addiction.
These behaviours are thought to serve a psychological need which could be responsible for maintaining an addiction.
Ilaria Lega, MD, Psychiatrist
Researcher, Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health,
Rome, Italy
Setting-up a psychiatric case register of the population of the Italian Forensic Hospitals while Forensic
Hospital closure is approaching
Aims
A research project aimed at setting-up a psychiatric case register of the population of the Italian Forensic Hospitals (IFH) was launched in
March 2012. The project is coordinated by the Italian National Institute of Health (INIH) and founded by the Italian Ministry of Health. The
main objective of the project is to activate a forensic mental health information system, based upon reliable and accurate data.
The closure of the six IFH is approaching and the Italian Mental Health Departments are becoming increasingly responsible of the
psychiatric care of mentally ill offenders. The assessment of individual clinical characteristics and needs is a necessary step in planning for
the aftercare of the 1200 current inpatients.
Method
The baseline assessment of the patients will include: 1) axis-I psychiatric diagnosis based on the SCID- I RV; 2) personality disorder
diagnosis based on the SIDP-IV; 3) clinical severity and psychosocial functioning by means of the 24-item version of the Brief Psychiatric
Rating Scale (BPRS) and the Global Assessment of Functioning scale (GAF), respectively; 4) cognitive evaluation based on Mini Mental
State Examination and Raven Standard Progressive Matrices; 5) assessment of needs based on the CANFOR-R; 6) an ad hoc standardized
form to record sociodemographic, psychiatric, medical, and forensic data complete the case assessment.
The 6 month follow-up evaluation will be based on BPRS, GAF and CANFOR-R.
Eighteen clinicians, at least two for each IFP, came to the INIH to attend a 2-day course in the use of SCID-I, BPRS, and GAF.
A web based software system was created for cases reporting from the Forensic Hospitals to the central database at INIH.
Results and Conclusions
As described above the preliminary phase of the project has been completed. The assessment of the inpatient will start in March 2013.
I Lega, V Calevro, A Ciraolo, R Liardo, M Pennino, G Rivellini, F Scarpa, D Del Re, I Cascavilla, A Di Cesare, L Leoncini, L Castelletti, M Forghieri,
E Centrone, P Cuzzola, T Frigione, C Perrotta, G Ditta, A Fioritti, A Gigantesco, L Magliano, A Picardi, T Di Fiandra
Dr Clive Long
Poster Abstracts
Associate Director of Psychology and Psychological Therapies, St Andrew’s Healthcare
Women Fire Setters Admitted to Medium Secure Psychiatric Settings: Characteristics and treatment
needs
Aims
Knowledge and practice in relation to female fire setters is undeveloped. A survey of the characteristics of fire setters admitted to a secure
service was undertaken to inform the development of assessment and intervention strategies for this group.
Method
90 consecutive admissions to a secure women’s service in the period from 2002-2010 were assessed. Data was collected from mental
health (n= 68 beds) and learning disability (n=24 beds). Patients with a conviction of arson and/or fire setting were identified. Each subject
was categorised as a first time or multiple fire setter. Basic demographic data was collected along with primary psychiatric diagnosis
and forensic history. Fire setting behaviours were analysed along with scores on routinely administered psychometric measures of
symptomatology, impulsivity, self efficacy, general functioning and need. Comparisons were made between those convicted of arson and
other fire setters; between fire setters in the mental health and learning disability pathways; and between single and multiple firesetters.
Results
Of 90 consecutive admissions, 49 (54% of women) had a firesetting history. This group was more likely than other admissions to be
diagnosed with personality disorder and schizophrenia and to be more impulsive. Characteristics of firesetters are described along with fire
setting behaviours. Fire setters did not differ from other women in terms of psychopathology and no differences were found between fire
setters and those convicted of arson. They tended to act alone and choose targets within or close to their place of residence.
Conclusions
Implicit in descriptions of group treatments for fire setters is the assumption that they represent a distinct group of offenders. Current findings
indicate the importance of an individualised approach to treatment based on a sophisticated functional analysis which draws on both
individual therapy and manualised cognitive behavioural group treatments.
22
Annette McKeown
Chartered & Registered Forensic Psychologist, Primrose Programme, Tees Esk and Wear Valleys NHS Foundation Trust
Female Domestic Violence Perpetrators in Prison:
Characteristics, explanations and potential treatment pathways
Aim
The aim of this study was to explore the prevalence, characteristics, and explanations of domestic violence experienced and perpetrated by
female prisoners. There is a lack of research considering female domestic violence using prison populations and this research sought to inform
this area.
Method
In this study, female prisoners (n = 92) completed measures of psychological and physical aggression (The Revised Conflict Tactics Scales
(CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996); attachment (Experiences in Close Relationships Revised Revised; Fraley, Waller, &
Brennan, 2000) and personality (Personal and Relationships Profile; Straus, Hamby, Boney-McCoy, & Sugarman, 1999)
Results
Results indicated high levels of psychological aggression and physical assaults both experienced and perpetrated by female offenders both in
current and previous relationships. Physical assaults tended to be severe and high levels of mutual violence were reported both in current and
previous relationships.
Insecure attachments were associated with being victimised as opposed to perpetrating domestic violence in recent relationships. Borderline
and anti-social personality dimensions were significantly associated with offenders being perpetrators and victims of domestic violence. Personality dimensions were also found to mediate relationships between attachment anxiety and victimisation in offenders’ most recent
relationships.
Conclusions
This study highlights the prevalence of domestic violence within female prisoners. It indicates particular treatment needs related to domestic
violence in female offenders including attachment and personality dimensions. It also begins to consider potential treatment pathways for such
offenders.
A McKeown, Dr S Cooper
Dr C Morrissey
Lead Psychologist, National High Secure Learning Disability Service, Rampton Hospital
Therapeutic community approaches have not previously been applied in forensic learning disability services. The National High Secure
Learning Disability Service introduced a therapeutic community milieu intervention for patients with personality disorder in June 2010. Data
was obtained on seclusion hours, incidents, and a range of informant and self report psychometric measures for 13 patients allocated to the
therapeutic milieu and 12 patients receiving treatment as usual. The results are encouraging, with TC patients showing improvements in a
range of domains relative to controls.
C Morrissey, J Taylor, C Bennett
Dr Clare Oakley
Clinical Research Worker, St Andrew’s Academic Centre, Institute of Psychiatry, KCL
Childhood trauma in violent patients with schizophrenia: the VISA Study
Aim
This component of the VISA study sought to investigate differences in the rates of childhood trauma in violent patients with schizophrenia and
their relationship with prior conduct disorder.
Method
Male patients with schizophrenia were recruited from secure psychiatric units and community mental health teams and healthy men from
the local community. Diagnoses of schizophrenia and conduct disorder were established using the SCID and histories of childhood trauma
assessed using an amended version of the CECA-Q. Data were analysed using Stata11.
Continued on page 24
23
Poster Abstracts
12 month evaluation of a therapeutic community intervention in a high secure LD service
(continued from page 23)
Results
Seventy-six participants were placed into four groups, patients with schizophrenia and a history of violence with and without childhood
conduct disorder, non-violent patients with schizophrenia and finally healthy controls. Histories of both physical and sexual abuse were more
common in patients with schizophrenia than the healthy control participants. Physical abuse in childhood differed significantly between the
four groups, with the highest rates in the violent patients with schizophrenia and conduct disorder. Among the patients, conduct disorder,
physical abuse and being in a children’s home were associated with a greater number of incidents of major violence in adulthood.
Conclusions
This data indicates that childhood trauma, particularly a history of physical abuse, differs among patients with schizophrenia on the basis
of prior conduct disorder. It suggests that a history of physical abuse and conduct disorder are both associated with the risk of future major
violence in men with schizophrenia. Further work is needed to elucidate the nature of the interactions between these factors in promoting a
risk of violence in schizophrenia.
Dr C Oakley, S Harris, Professor T Fahy, Professor D Murphy, Dr M Picchioni
Laura O’Shea
Research Assistant, St Andrew’s Academic Centre
All things being equal? Predictive validity of the HCR-20 among heterogeneous groups of secure
psychiatric inpatients
Aims
The HCR-20 (Webster, Douglas, Eaves, & Hart, 1997; Webster, Eaves, Douglas, & Wintrup, 1995) has good predictive validity for inpatient
violence and is widely used in secure mental health care (Khiroya, Weaver, & Maden, 2009). However, previous research has utilised
relatively small and homogeneous samples and little is known about whether its predictive ability varies between different clinical and
demographic groups (O’Shea, Mitchell, Picchioni & Dickens, 2012). We aimed to address these issues by examining the largest and most
heterogeneous known dataset of risk assessment and inpatient aggression data relating to secure psychiatric inpatients.
Methods
Demographic (age, ethnicity, gender), clinical (diagnosis) and risk assessment data (HCR-20) were collated. Data for frequency and severity
of incidents of verbal and physical aggression were collated for the 12 months following assessment.
Poster Abstracts
Results
386 of 640 patients were still present at 12 months follow-up. 261 (67.6%) had demonstrated physical aggression and 290 (75.1%) verbal
aggression during the follow-up period. The HCR-20 total, Clinical scale and Risk Management scale were all predictive of both physical
and verbal aggression; the Historical scale was not a significant predictor of either type of aggression. The HCR-20 demonstrated
superior efficacy for women compared with men, older people (≥39 years) compared with younger people (<39 years), and for those
with a personality disorder compared with those with mental retardation, schizophrenia, schizotypal or delusional disorder or co-morbid
schizophrenia/ personality disorder for both physical and verbal aggression.
Conclusions
This study provides further evidence about the predictive validity of the Clinical and Risk Management scales for inpatient aggression.
However, it also reveals differences in efficacy between groups. Further development and optimisation of the HCR-20 may be required. An
alternative explanation is that interventions to prevent aggression are more effective among some groups. Future research should address
these important issues.
L O’Shea, Dr F Mason, Dr M Picchioni and Dr G Dickens
Jane Padmore
Consultant CAMHS Nurse and Doctorate in Healthcare Student, South London and Maudsley NHS Foundation Trust and Kings
College London
The Mental Health Needs of Young People Involved in Street Gangs
Aims
To gain a greater understanding of the mental health needs of young people who are involved in street gangs.
Method
This was an exploratory study looking at the difference between the mental health needs of young people in three categories:
• those not involved in a gang nor involved in offending behaviour
• those not in a gang but involved in offending behaviour
• those involved in a gang
24
Continued on page 25
(continued from page 24)
Method
The research sampled 11-17 year old children from two schools in one UK inner city borough and one Young Offender Institution. An adapted
Eurogang Youth Survey [EYS] and the Strengths and Difficulties Questionnaire [SDQ] (Goodman, 2001) were completed by participants. Three
categories of young people were then compared in relation to their mental health needs- gang members, non-gang members who offend and
non-gang members who do not offend.
Results
507 questionnaires were returned of which 310 (260 community and 50 YOI) were complete and included in the full analysis. The small sample
size within the YOI made it inappropriate to analyse alone. The results can be summarised as follows:
• Young people who were gang members were significantly more likely than the general population and offenders not in gangs to
experience hyperactivity symptoms and conduct problems.
• Offenders, both in gangs and not in gangs, had significantly more emotional symptoms and difficulties with pro-social behaviour than the
general population, but being in a gang or not did not show a significant difference.
• Offenders not in a gang showed significantly more difficulties with peer relations when compared to both the gang members and the
general population.
Conclusions
Gangs have become an increasingly significant, and controversial, phenomena in both the academic and media worlds, and yet the impact of
gang involvement, especially on the mental health of the young people involved, remains under explored. Despite policy and media concern
about gangs and youth violence, it rarely considers the mental health needs of these young people.
Although this research tells us that there is an increase in hyperactivity symptoms and conduct problems in gang members, it does not tell us
if this increase is a cause or an outcome of being involved in a gang, or if there is a complex interaction between the two variables. Currently
services for young people involved in gangs are commissioned on a short term basis and rarely are they supported by evidence or targeted
at mental health needs. This research supports the need for further, more detailed research in this area as well as services targeted for this
groups mental health needs. A feasibility study for the R&R2 programme has been funded to explore this further.
J Padmore, Professor I Norman and Dr N McCrae
Rachel Quinn
The Validity of the Short Term Assessment of Risk and Treatability (START) in a UK Medium Secure
Forensic Mental Health Service
Aims
To evaluate the validity of the START within a UK Medium Secure hospital, which holds both male and female mentally disordered offenders
(MDOs) (n=83) across a variety of wards (from Intensive Care through to Pre-Discharge).
Method
The START had recently been implemented within this service and the researchers undertook a file-review to collect all completed START
assessments over an 18 month period (n=665), as well as all aversive incidents reports (n=664). In particular, this study evaluated the
construct, predictive, discriminative and concurrent validity of START scores (Strength and Vulnerability totals) and the clinician’s risk ratings.
A validation analysis comparing the number of aversive incidents pre- and post-START implementation was also conducted. The researchers
further assessed the presence of gender differences among START scores and conducted a cost-analysis and staff interviews to gain a
perspective on the START’s cost to the service and usability.
Results
START scores were appropriately significantly correlated with aversive incidents; they were the most predictive of total aversive incidents at
1 month, decreasing to small/medium effects at 6 months. The START could discriminate between male/female MDOs at different stages
of their forensic care pathway (with the exception of Rehabilitation and Pre-discharge males) and females were rated as having significantly
less strengths and more risks compared to males. The START holds concurrent validity with the HCR-20 total and C-Scale scores, and both
scales of the HoNOS Secure and no significant differences were found between the number of incidents pre- and post-START implementation.
Moreover, the START was found to be a cost-effective tool although staff viewed the START negatively but agreed it was a useful tool.
Conclusion
The results suggest that the START can be validated within this population and, after improvements are made to its usability, the START is a
viable choice when assessing the short-term risk of MDOs.
R Quinn, Dr H Miles, Dr C Kinane
25
Poster Abstracts
MSc Student, Assistant Psychologist, Kent Forensic Psychiatry Service
Masuma Rahim
MSc Student, Institute of Psychiatry, KCL
Cognitive skills training for male mentally disordered offenders: the effect of co-morbid antisocial
personality disorder
Aims
Amongst mentally disordered offenders (MDOs) treated in secure forensic settings, co-morbid antisocial personality disorder (ASPD) is
common and may complicate treatment outcomes. Whilst cognitive-behavioural programmes such as the Reasoning and Rehabilitation (R&R)
programme can lead to improvements in social cognitive skills and antisocial behaviour amongst MDOs, it is unclear whether MDOs with comorbid ASPD benefit equally from treatment. In this exploratory study, we used data from the first randomised trial of R&R in a forensic secure
setting and conducted subgroup analyses to compare treatment outcomes amongst MDOs with and without ASPD.
Method
Forty-four male MDOs were recruited from forensic secure units and randomly allocated to receive R&R. Treatment outcomes, including blame
attribution, social problem-solving, criminal thinking, anger expression, and antisocial behaviour were compared amongst those with ASPD
[(MDO+ASPD (n=20)] and those without ASPD [MDO-ASPD (n=24).
Results
Within-group analyses indicated that the MDOs-ASPD showed significant improvements on three subscales of criminogenic thinking during the
treatment period whilst the MDOs+ASPD group demonstrated significant improvements in impulsiveness only. Between-group analyses were
used to compare scores on social-cognitive measures completed at the end of treatment after adjustment for baseline scores. Relative to the
MDO-ASPD group, MDOs+ASPD were more likely to attribute blame for their index offence on external factors; however, after adjusting for the
number of sessions attended, the MDO+ASPD group demonstrated better social problem-solving ability than the MDO-ASPD group. Incidents
of verbal aggression during the treatment period and the 12-month follow-up period were significantly higher amongst MDOs with ASPD
relative to those without ASPD; incidents of physical violence were significantly higher amongst the MDO+ASPD group during the 12-month
follow-up period only.
Conclusions
Although MDOs with ASPD showed improvements in social-cognitive skills during treatment, these findings tentatively suggest that ASPD may
diminish the effect of cognitive-skills programmes on antisocial behaviour in this population.
M Rahim, A E Cullen, A Y Clarke, K Dean, T Fahy
Dr Chantal Scaillet
Poster Abstracts
Head of Psychology, Cygnet Healthcare
Enhancing Psychological mindedness on in-patient settings by facilitating coaching of psychosocial
skills to front line staff
Aims
1. To improve the quality of care of all The Service Users across wards
2. To enhance psychological mindedness via the facilitation of psychosocial skills
3. To improve staff confidence in delivering psychosocial skills
Method
Audit of The Service Users treatment Needs
Data from across the four wards (n= 43) was collected by an audit of The Service Users’ case notes. The Symptom Check List 90 Revised
(SCL-90-R) was completed for all the Service Users to provide more information of their treatment needs. All service users were female who
presented with varying Axis I and II diagnosis.
Audit of the Staff Skill Confidence Self-Appraisals
Data (n = 16) was collected by completing semi-structured interviews with staff.
The process included conducting a semi-structured interview. Staff were prompted to provide an appraisal of their confidence level in
completing certain psychologically informed interventions. Confidence levels were on a 0-10 scale, where 0 was no confidence at all and 10
was the most confident. The process included a prompt sheet for the student in guiding staff to elect a confidence level.
Results
Each ward yielded unique Service User treatment needs. A wide range in staff responses (perceived confidence levels and ability level) existed
across and within the wards – suggesting a variation in staff’s self-efficacy beliefs.
Staff are not making the link (generalising) between generic competency skills and how these may relate to the delivery of psychologicallyinformed practice; thus undermining their confidence.
Conclusion
Staff across the wards perceived their level of confidence in delivering psychological minded care as low. Concordance between perceived
Advanced ability range and perceived high confidence – suggesting that strength of belief in one’s ability leads to higher self-efficacy.
Results suggest that staff are not making the link between their existing skills and how these skills may relate to the delivery of psychologicallyinformed practice. An opportunity to make this link more robust and overt would enable staff to raise their own level of confidence, thus
impacting positively on overall delivery of psychological-informed care.
26
Mareike Suesse
DClin Psych student, St Andrews Healthcare
Patient characteristics and secure in-patient ward atmosphere
Aims
Better in-patient ward atmosphere is associated with greater patient satisfaction and improved patient outcomes. This study aimed to explore
relationships between patient characteristics and ward atmosphere in specialist secure in-patient wards.
Method
Clinical data were gathered from 63 adult participants across 13 medium and low secure wards. We examined information on: gender; risk
assessment; psychopathology; risk-related incidents; subjective recovery; session attendance; and leave status. Staff- and patient-rated ward
atmosphere (Essen Climate Evaluation Schema) was examined at three longitudinal time-points. Multiple linear regression was used to explore
relationships between patient characteristics and atmosphere.
Results
The main findings were that:
• lower-secure and female wards were more cohesive and felt safer
• wards containing patients rated lower at risk-assessment were experienced as more cohesive
• wards containing more individuals with personality disorders or psychosis felt safer
• lower-secure wards, or wards with lower session attendance, felt more therapeutic; subjective recovery was not related to therapeutic hold
• ward atmosphere was stable over time
• staff tended to rate the atmosphere as more therapeutic; patients as safer.
Discussion
The nature of the relationship of patient characteristics with ward atmosphere might be more complex than thought. Previous work on the
stability of ward atmosphere using this measure despite patient and staff turnover, and despite ongoing active attempts to improve ward
atmosphere, was replicated. Staff had overly positive views of the therapeutic climate of the ward compared to patients. The study was limited
by its cross-sectional design, and inability to capture causality. Prospective studies are needed to establish determinants of ward atmosphere
and effectively monitor improvement attempts. M Suesse, P Snyman, M Picchioni
Dr John Tully
Outcome measures on four years of admissions to female MSU: a new approach
Aims
In the last decade, there has been a six-fold increase in the number of women admitted to Medium Secure services. Despite this, very few
studies have reported outcome measures using structured tools and there is very little reporting of quality of life assessment. Our study aimed
to address these issues by assessing the characteristics and outcomes of 45 consecutive admissions to the female MSU ward of the South
London and Maudsley Foundation Trust, since its opening in 2008.
Methods
Ethical approval was obtained from the trust Ethics Committee. Data on demographics, length of stay, rates of self-harm, HoNOS-Secure
and HCR-20 assessments on 45 consecutive admissions between April 2008 and May 2012 were prospectively collected and subsequently
analysed. Completed WHO-QoL-BREF surveys, which were offered to all patients prior to discharge, were also analysed.
Results
Our sample consisted of 45 consecutive admissions. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult
abuse and low socioeconomic status. 62.2% percent of the patients had Schizophrenia, 57.8% had multiple diagnoses. The median length of
stay was 465.5 days. There were significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 clinical and risk item
scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties.
Conclusions
This is one of a small number of studies to report outcome measures in a female MSU using structured tools and the first of which we are
aware to use HCR-20 scores in doing so. It is also the first to attempt to establish quality of life using a validated scale. MSU admission was
associated with reduced self-harm, improvements in well-defined clinical outcomes and relatively good quality of life scores. These data
suggest an ongoing need for a specialised service for this group of complex patients.
Dr J Tully, Dr R B Ribeiro and Dr M Fotiadou
27
Poster Abstracts
Specialty Doctor and Researcher in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust
Presentations
A Piquero, How criminal career research can help inform specific interventions
28
A Piquero, How criminal career research can help inform specific interventions
Presentations
29
Presentations
A Piquero, How criminal career research can help inform specific interventions
30
A Piquero, How criminal career research can help inform specific interventions
Presentations
31
Presentations
Alex Piquero, How criminal career research can help inform specific interventions
32
Alex Piquero, How criminal career research can help inform specific interventions
Presentations
33
Deirdre Macmanus, Violence by military personnel deployed to Iraq and Afghanistan: a new forensic population?
Summary
There is growing concern about violent offending among Iraq and Afghanistan conflict veterans and considerable public
debate about the proportion of ex-military personnel in the Criminal Justice System. Whilst the psychological impact of these
conflicts is well documented, the potential legacy of violent offending has yet to be established. This presentation will review
the findings from on-going work which has linked approx. 14,000 UK military personnel with official criminal records. The
impact of deployment, combat and post-deployment mental health and behaviour problems, such as Posttraumatic Stress
Disorder, alcohol misuse and self-reported aggressive behaviour, on violent offending relative to pre-existing risk factors will
be discussed and patterns of offending compared with the general population.
(the PDF of the presentation will be available after the conference)
Presentations
Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved
Premise in South London
34
Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London
Presentations
35
Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London
Presentations
Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services
36
Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services
Presentations
37
Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services
Presentations
Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study
of adult schizophrenia patients and attending physicians in forensic and civil psychiatry
38
Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study
of adult schizophrenia patients and attending physicians in forensic and civil psychiatry
Seena Fazel, Crime and mental illness; clinical implications of new research
Summary
Presentations
Dr Fazel’s presentation will review latest epidemiological research on mental illness and violence, and discuss clinical
implications, particularly for risk assessment and the treatment of mentally disordered offenders. A particular focus will be
on risk factors for violence, and recent meta-analytic evidence will be presented.
(the PDF of the presentation will be available after the conference)
39
Presentations
Gareth Hopkin, Critical Time Intervention for Severely Mentally Ill Released Prisoners: Pilot and Randomised Control Trial
40
Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/criminal justice interface:
preliminary findings from a case-linkage study
Presentations
41
Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/criminal justice interface:
preliminary findings from a case-linkage study
Presentations
Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study
42
Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study
Presentations
43
Presentations
Conor Duggan, What Works for Sex Offenders? A Review of the Evidence
44
Conor Duggan, What Works for Sex Offenders? A Review of the Evidence
Presentations
45
Presentations
Conor Duggan, What Works for Sex Offenders? A Review of the Evidence
46
Conor Duggan, What Works for Sex Offenders? A Review of the Evidence
Presentations
47
Presentations
Conor Duggan, What Works for Sex Offenders? A Review of the Evidence
48
Index
The FANS Teaching Unit, Institute of Psychiatry, KCL
Welcome
Programme
Page
2
4
5
Key note speakers biographies
Professor Conor Duggan BSc, PhD, MD, FRCPsych, OBE
Dr Seena Fazel
Professor Nicola Gray
Dr Deirdre Macmanus
Professor Alex R Piquero
6
6
6
6
7
Speakers’ biographies & oral presentations
Dr Lynne Callghan
Verity Chester
Friederike Höffer
Gareth Hopkin
John Morgan
Dr Siân Oram
Samantha Russell
8/10
8/11
8/12
8/13
9/10
9/14
9/15
Poster abstracts
Lara Arsuffi
Kelly Cocallis
Lydia Evans
Vidya Fatania
Sharonie Fitzhugh
Amanda Gilman
Dr Neel Halder
Nutmeg Hallett
Stephanie Harris
Eve Hepburn
Andy Inett
Dr Kate Law
Llaria Lega
Dr Clive Long
Annette McKeown
Dr Catrin Morrissey
Dr Clare Oakley
Laura O’Shea
Jane Padmore
Rachel Quinn
Masuma Rahim
Dr Chantal Scaillet
Mareike Suesse
Dr John Tully
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
23/24
24
24/25
25
26
26
27
27
Presentations
Alex Piquero
Deirdre Macmanus (PDF of presentation will follow after conference)
Samantha Russell
Verity Chester
Friederike Höfer
Seena Fazel (PDF of presentation will follow after conference)
Gareth Hopkin
Lynne Callaghan and John Morgan
Siân Oram
Conor Duggan
28-33
34
34-36
36-38
38-39
39
40
41-42
42-43
44-48
About Partnerships in Care
Partnerships in Care (PiC) is the largest independent provider of secure and step down facilities
across the UK, with 1200 beds across 23 hospitals. We have over 27 years experience in
providing specialist care.
We provide:
Medium Secure, Low Secure, Locked Rehabilitation, Open Rehabilitation and Community Housing
to support patients’ safe and positive re-integration into the community
Individually-tailored measurable and evidence-based treatment programmes with clearly specified
goals and timescales
Forensic specialisation with focus on risk reduction, relapse prevention and independent living skills
Specialist care pathways for prisoners with mental illness and challenging behaviours
Specialist services for vulnerable adults, aged 50 and over
Medium
Secure
Low Secure
Risk reduction
Safety management
Locked
Rehab
Social integration
Open Rehab/
Community
Placements
Life skills
Cognitive skills
National care pathways with Partnerships in Care
Get in touch
Group Medical Director:
Dr Quazi Haque - Quazi.Haque@partnershipsincare.co.uk
Read about us:
PiC Quality Account www.partnershipsincare.co.uk
Join the IoP/PiC debate:
“This House believes that most sex offenders don’t show meaningful benefit from psychological treatments
to address risk to others” London, 16th May 2013 iop.debates@partnershipsincare.co.uk
Partnerships in Care Mental Health Group
Mental
Illness
Personality
Disorder
Learning
Disability
Autistic
Spectrum
Disorder
Brain
Injury