Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: The British Journal of Forensic Practice, Volume 13, Issue 3
Welcome to the latest edition of the British Journal of Forensic Practice. In this edition, we have aimed for an eclectic mix of papers, and which we hope represent the diverse range of forensic practice. This issue begins with an excellent invited paper by Theresa A. Gannon, Tracy King, Helen Miles, Lona Lockerbie and Gwenda M. Willis, summarising sex offender treatment in a mentally disordered population, and using the principles of the Good Lives approach to offender rehabilitation. This paper offers an excellent balance of theory, research and case study. It emphasises the humanistic approach to therapy intervention, and considers the initial applicability of the Good Lives approach to a mentally disordered population. Whilst their paper makes use of a small sample size, it nonetheless considers the needs of such individuals, and further argues the importance of focusing on the function of behaviours, as opposed to assuming that individuals who have committed sexual offences and who have a mental disorder are inherently different to those who do not have a mental disorder. In fact, they consider the importance of function as opposed to an over-focus on the mental disorder itself, particularly if there is no clear link between their offending and mental disorder. The paper helpfully talks the reader through the structure of a group sex offender therapy, and helpfully uses a case study approach, enhancing the humanistic approach to such therapies.
Vidyah Adamson and Louise Braham follow with a thought provoking paper on the possible pathways to self-harm in individuals who have mental illness and who are based in a high secure hospital. This paper initially recognises the lack of research exploring pathways to episodes of deliberate self-harm in such clients, and attempts to explore some of these possible pathways across their life. This paper reinforces the value of the qualitative approach, using grounded theory to explore in detail the experiences of seven clients. The authors note two pathways; relief and the response to mental health problems. The relief pathway consisted of two inter-related functions; relief and an expression of self-hatred. The response to mental health problems pathway appeared more influenced by auditory hallucinations and delusional beliefs. Whilst they note the importance of these pathways, they further identify the need to explore this in more detail. This research adds to the field, and can assist clinicians in the understanding of their clients self-harm. Whilst it focuses on individuals in high-secure, it could arguably have applicability to other settings of forensic practice. It further identifies a range of implications for practice, most notably offering clinicians a theoretical framework to enhance formulations. They strongly, and quite correctly, argue the need to ensure that an individualised approach to deliberate self-harm is considered; that the functions may be different from one individual to another, with even each episode having a variety of possible functions within it.
An entirely different paper is then presented by Camilla Haw and Jean Stubbs. This is a very timely piece, focusing on the importance of weight management in patients. It notes that patients in secure units are at high risk of obesity due to their medication, restrictions on freedom and poor motivation for healthy eating and exercise. Using a questionnaire, they contacted a large number of consultant members of the Royal College of Psychiatrists Forensic Faculty. They had a very good return rate, leading to a valuable opportunity to consider the issue in detail. They noted that most respondents indicated to monitor patients’ weight and had some access to a dietician. Respondents rated a median of 40 per cent of their inpatients as obese, with a total of 68.9 per cent stating that their patients did not have unrestricted access to food. They further noted that the use of weight-loss drugs was infrequent, with a few patients being referred for bariatric surgery, but most being judged as unsuitable. This is a very thought-provoking paper, highlighting the need for further research, focusing on determining the most effective methods for healthy weight loss in psychiatric patients. They note two key points in their paper. First, that obesity is prevalent among forensic inpatients despite efforts to monitor weight, dietetic interventions and exercise programmes. Second, antipsychotic medication and poor patient motivation appear major obstacles to successful weight management. As such, they note a number of implications for clinical practice. First, they argue that the majority of inpatient units restrict patients’ unlimited access to food, although a few units view such measures as unethical and an unacceptable restriction of patients’ rights. Second, non-pharmacological measures to manage weight are in widespread use, but are reported to be relatively ineffective. Drugs for weight loss are not widely used and in any event are not considered effective.
Simon Gibbon and Colin Doyle’s paper follows, exploring the development and future of deaf forensic mental health services. They describe the current provision and need for specialist deaf secure mental health services, describing the changes and developments that have already taken place in relation to such services and the likely future development of these. They conclude that the mental health care of deaf people in all settings is now receiving increased priority and recent legislative and commissioning changes should help to ensure that this expansion continues. They further argue that the ongoing development of deaf forensic services brings opportunities for improved training, research, staff development and peer support to provide a high-quality service to meet the needs of offenders who are deaf and have a mental disorder. In summary, they note a number of practice implications. For example, they identify that people who are deaf, and with (suspected) mental health problems often require specialist assessment and treatment, that they are overrepresented in secure settings, and are at increased risk of suffering from some types of mental health problems.
Anna Williams, Estelle Moore, Gwen Adshead, Anthony McDowell and James Tapp’s paper focuses on “including the excluded”. They consider the high security hospital user perspectives on stigma, discrimination and recovery. They argue that service users from Black and Ethnic Minorities are known to have higher drop-out rates and poorer treatment outcomes in non-forensic therapy settings. They further argue that such service users are over-represented in forensic services and often disengage, because their views and feelings are poorly understood. As such, they argue the need for specific attention to the perspectives of all service recipients on the impact of illness and their recovery. Their paper summarises succinctly a thematic analysis that was applied to a sample of electronically stored running records of group sessions, in which experiences of care, discrimination, hope, despair and recovery were shared. They focused on a three-year period, with eighteen forensic patients who participated in the group. They note a number of themes, including isolation and distance, as well as strategies for coping “against the odds”. They identify a number of implications for practice. These include the recognition that stigma and discrimination have substantial and enduring impacts on the lives of service users with a history of offending, as well as any lack of acknowledgement of the significance of these “real effects” being likely to undermine the process of engagement for forensic service users regarding meaningful engagement in the activities on offer in the secure environment.
Clive G. Long, Vikki Langford, Rebecca Clay, Lorraine Craig and Clive R. Hollin complete this issue. They focus on architectural change and the effects on the perceptions of the ward environment. They discuss how architectural design can affect mood, health and wellbeing. As such, their paper aims to describe the architectural design considerations and effects of moving patients from an adapted “Victorian” Medium Secure Unit to a purpose built facility.
Carol A. Ireland, Neil Gredecki