Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: The British Journal of Forensic Practice, Volume 13, Issue 4
Welcome to the final edition of the British Journal of Forensic Practice for 2011. This year we have published a wide range of papers covering a number of areas of forensic practice. This issue again reflects the diversity of the matters associated with forensic practice as evidenced by the inclusion of papers addressing a wide range of issues which we hope will inform practice and prompt debate.
As we have noted in previous editions, a focus of the journal has been to increase the number of invited papers from eminent figures within the field of forensic psychology and this year we have had a number of exciting papers covering a range of issues. This edition starts with an invited paper from Dr Kerry Sheldon on the subject of internet offending which is relevant for so many clinicians working in the field. The paper provides a review of the literature regarding males who engage in sexual offending via the internet, specifically those men who access, download and circulate child abuse images across the internet. The paper is particularly timely given the significant increase over the last two decades in professional and public awareness of the use of communication technologies in the commission of child sexual abuse. The paper is particularly helpful in addressing a number of misconceptions associated with this behaviour.
Dr Sheldon’s paper reviews the extent to which internet offenders display some of the criminogenic factors thought to be associated with the multi-factorial theories of sexual offending. As such, it has the ability to guide practitioners both in terms of their assessment and treatment of individuals convicted of offending using the internet, particularly in terms of formulation. In summary, the paper provides a number of reflections on the possible implications for practice. That is, internet offenders are psychologically very similar to contact offenders against children and any claims that treatment is irrelevant do not stand up to careful examination. Despite having similar psychological characteristics to those people who offend against children, the paper argues that many internet sex offenders do desist, at least for some time, from hands-on offending and as such, desisting needs to be better understood. Finally, in terms of treatment, it is postulated that there appears to be some damaging affect of abusive childhoods for some offenders and as such, therapy should do more to address the deficits in the upbringings of offenders, although this does not condone their behaviour.
The next paper by Samuel L. Browning and colleagues from the USA reflects on the reality that police officers are frequently called upon to deal with situations involving individuals with mental illness despite having limited training in this area. In turn, they argue that this has resulted in there being negative outcomes and as such they discuss the implementation of specialised responses to mental health emergency calls in the USA. This includes the use of the Crisis Intervention Team (CIT) which involves a collaborative relationship with local mental healthcare providers, policy makers, and mental health consumers, as well as specialized training for officers in the area of mental health issues, crisis management/intervention, and de-escalation skills. The findings of this approach are promising in that the preliminary evidence suggests that CIT is effective in keeping individuals with mental illness out of prison, reducing violence, decreasing injuries to both officers and individuals with mental illness, and connecting service users with mental illness to healthcare services they need.
The next paper by Lisa Maltman and Laura Hamilton comments that given the prevalence of personality disorder in prisons, prison staff should have access to appropriate training. This is on the understanding that the absence of dedicated training results in staff relying upon layperson knowledge and moral judgements to help conceptualise and manage challenging personality-disordered prisoners. The paper considers the impact of an introductory personality disorder awareness workshop on trainees’ attitudes towards personality-disordered prisoners and concludes that the training resulted in participants feeling less fearful, anxious, manipulated, uncomfortable, helpless, outmanoeuvred and exploited by personality-disordered offenders. The findings indicate that personality disorder awareness training should initially engage with trainee’s perceptions of their personal security and vulnerability when working with this client group, rather than aiming to increase liking, enjoyment and acceptance of such offenders. As such, the paper is helpful in considering approaches to the development of training which leaves staff feeling supported and more secure in their role when dealing with personality-disordered prisoners.
With a change of focus, the next paper by Lee Hollins and Brendon Stubbs provides a discussion around the management of risk associated with physical intervention. Despite violence in the work setting being on the rise, displays of such behaviour are known to occur over two and a half times more frequently in mental healthcare settings, including forensic units, than in general healthcare settings. Of interest is the acknowledgement that in forensic setting there are often fewer violent incidents compared other mental health settings, but when aggression does occur is often of greater intensity, therefore, increasing the likelihood that physical intervention is employed. As clearly argued in this paper, it is essential that suitable preventative and protective measures are put in place, with there being a need for staff to be provided with appropriate training to deal with such behaviour. This paper is of relevance to all professionals working in forensic settings and developing strategies for the management of aggression in this setting has the ability to enable healthcare professionals to better identify and manage aggressive behaviour which in turn seeks to cater for the often complex needs of individuals with serious mental illness.
This paper is followed by an interesting research paper by Dr Simon Gibbon and colleagues which explores “real world outcomes” of Risperidone Long-acting Injection (RLAI) in high-secure hospitals in the UK. The authors note that in a naturalistic study such as this is not possible to determine the extent to which any clinical changes were due to either RLAI or other factors. However, in a high secure patient group, RLAI appeared to be effective in a third of patients. It was also well-tolerated and did not have any significant effect upon body mass index. Of those who failed to respond to RLAI, a third went onto be treated with clozapine. These results are similar to those obtained using RLAI in general psychiatric settings. As such, the authors conclude that RLAI was shown to be effective in about a third of patients who were prescribed this and that it was well-tolerated. Overall, RLAI was most likely to be effective with patients who have previously shown a good response to oral antipsychotics, but for whom there were concerns about long-term compliance with oral medication, and for whom treatment with an atypical antipsychotic was preferred. The findings of this paper are promising in terms of the use of long-acting injections, namely Risperidone, in a complex high secure population where issues around treatment compliance are relevant given the levels of risk presented by this population.
The final paper in this edition by Camilla Haw and Arleen Rowell considers how people with severe mental illness are at increased risk of dying prematurely from cardiovascular disease. Obesity is an important contributory factor and in this sample, high rates of obesity were found. Specifically, it was noted that female patients were particularly at risk of developing obesity and that patients on antipsychotic medication are particularly at risk of becoming overweight or obese and require careful monitoring. Obesity rates were found to be rising in the sample despite coordinated attempts to address this. As such, the authors note the requirement for the development of other ways in engaging patients in enjoying healthier lifestyles, including the use of drugs to help patients to lose weight. In addition, mandatory training for all clinical staff in promoting a healthy lifestyle could assist staff in serving as role models and motivators for patients. Again, this reflects the content of earlier papers in this edition which call for the appropriate training of staff to deal with the specific and often complex needs of clients in forensic settings.
Carol A. Ireland, Neil Gredecki