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1 – 10 of 874Jessica Holley, James Tapp and Simon Draycott
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical…
Abstract
Purpose
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.
Design/methodology/approach
In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.
Findings
A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.
Practical implications
The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.
Originality/value
There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.
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Nienke Verstegen, Vivienne de Vogel, Michiel de Vries Robbé and Martijn Helmerhorst
Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the…
Abstract
Purpose
Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken.
Design/methodology/approach
Data on inpatient violence in a Dutch forensic psychiatric hospital between 2008 and 2014 were extracted from hospital files on 503 patients.
Findings
More than half of all the patients (n=276, 54.9 percent) displayed verbal aggression on at least one occasion, whereas 27.2 percent of all patients (n=137) exhibited one or more incidents of physical violence. Female patients were responsible for more physically violent episodes than male patients. Patients admitted with a civil court order exhibited more violent behavior than patients with a criminal court order. Violent patients with a civil commitment had a significantly longer length of stay than non-violent patients with a civil commitment. More violence was found to take place on the earlier days of the week.
Originality/value
This study points at important differences between groups of forensic inpatients in frequency and type of inpatient violent behavior and in temporal factors. Interventions aimed at reducing the number of violent incidents should take these differences into account. Further research is necessary to gain more insight into the background of inpatient violence.
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Anna M. Palucka, Poonam Raina, Shi‐Kai Liu and Yona Lunsky
Individuals with intellectual disability (ID), mental health needs and criminal justice system involvement are likely to be admitted to forensic units; however, not all of those…
Abstract
Purpose
Individuals with intellectual disability (ID), mental health needs and criminal justice system involvement are likely to be admitted to forensic units; however, not all of those individuals are served in that system. It is, therefore, important to understand the profile of those admitted to non‐forensic specialized units for individuals with ID and mental health issues. This paper aims to address this issue.
Design/methodology/approach
Demographic, clinical and criminal profiles of individuals discharged over nine years from a specialized dual diagnosis program were reviewed to delineate clinical subgroups.
Findings
A total of 20 out of 84 total discharges were identified as having past or current criminal justice system involvement. The most common offence was assault and 60 per cent of these individuals had admissions longer than one year. Subgroups by psychiatric diagnosis differed in their age, legal status, offence history, and length of hospital stay, as well as in therapeutic interventions and discharge process.
Research limitations/implications
The results suggest that inpatients with ID and criminal justice system involvement present with unique treatment, support and risk management needs based on psychiatric diagnosis. The number of individuals in clinical subgroups was low, thus further research is needed to determine if the observed patterns hold true in bigger samples.
Originality/value
The study delineates the complexity and heterogeneity of treatment and supports needs of individuals with intellectual disabilities and offending behaviour.
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Vivienne de Vogel, Petra Schaftenaar and Maartje Clercx
Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can…
Abstract
Purpose
Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue.
Design/methodology/approach
The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted.
Findings
The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasized the importance of transparent communication, timely discharge planning and education.
Practical implications
Gathering best practices about regional collaboration networks and developing a blueprint based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental health care. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories, even if there are setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed.
Originality/value
Policy programs hardly reach professionals. Professionals see improvements in collaboration as top priority. Patients emphasize the human approach and transparent communication.
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Patients in secure units are at high risk of obesity because of antipsychotic medication, restrictions on freedom, and poor motivation to eat healthily and exercise. The aim of…
Abstract
Purpose
Patients in secure units are at high risk of obesity because of antipsychotic medication, restrictions on freedom, and poor motivation to eat healthily and exercise. The aim of this paper is to investigate how consultant forensic psychiatrists address weight management, particularly with respect to inpatients.
Design/methodology/approach
Based on a review of the literature, a structured questionnaire was developed and piloted locally. After revising the questionnaire, it was sent to all 442 consultant psychiatrists listed by the Royal College of Psychiatrists as having a special interest in forensic psychiatry.
Findings
A total of 183 usable questionnaires were returned (response rate 45.9 per cent). Most respondents monitored patients' weight and had some access to a dietitian. Respondents rated a median of 40 per cent of their inpatients as obese. A total of 68.9 per cent said their patients did not have unrestricted access to food. Use of weight loss drugs such as orlistat was infrequent. A few patients had been referred for bariatric surgery but most had been judged unsuitable.
Research limitations/implications
The responses reported in this paper are based on participants' self‐report and have not been confirmed by independent observation. Further research is needed to determine which weight loss measures are effective for psychiatric patients in real‐life situations.
Practical implications
Obesity appears to be common among forensic inpatients despite weight monitoring, dietetic interventions and exercise programmes. Comprehensive and continuing efforts are needed to help patients lose weight and lead healthier lifestyles.
Originality/value
This survey reports on clinicians' views and clinical practice.
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Karen Humphries, Caroline Clarke, Kate Willoughby and Jake Smithson
The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.
Abstract
Purpose
The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.
Design/methodology/approach
A systematic review of qualitative literature was conducted. The data was sourced from the electronic databases: PsychINFO, CINAHL, Medline and the Web of Science Core Collection using pre-defined search terms. A total of 17 studies, conducted in various countries worldwide and covering high, medium and low secure inpatient settings, were included for review. The analysis involved integrating findings from across the literature and was guided by thematic synthesis.
Findings
A total of eight themes were generated from the data, three of which provided an understanding of the experience of forensic secure care, and the remaining five themes provided an understanding of the factors which may influence the experience of secure care.
Practical implications
Developing understanding of patient experience can lead to service improvements, potentially impacting patients’ motivation and engagement and thus reducing admission times, potential recalls and recidivism.
Originality/value
To the best of the authors’ knowledge, this is the first systematic review to date to exclusively explore the broad topic of the patient experience of secure mental health care.
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Nikki Wood, Kiran Patel, Josephine Skinner and Kirsty Thomson
In 2008 a dual diagnosis service was set up within the forensic services of East London NHS Foundation Trust. This paper provides an outline of the service as it currently stands…
Abstract
In 2008 a dual diagnosis service was set up within the forensic services of East London NHS Foundation Trust. This paper provides an outline of the service as it currently stands, and a description of the multidisciplinary staff roles within the service. Each staff member reflects on the success and challenges over the year that the service has been operational. Pointers to our future plans and strategy development are made.
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Emily Samuels and Nicola Moran
Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general…
Abstract
Purpose
Physical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.
Design/methodology/approach
Face-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.
Findings
Four super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.
Practical implications
Interventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.
Originality/value
This study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.
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Regi Alexander, John Devapriam, Dasari Michael, Jane McCarthy, Verity Chester, Rahul Rai, Aezad Naseem and Ashok Roy
The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour…
Abstract
Purpose
The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals.
Design/methodology/approach
The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored.
Findings
Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law.
Originality/value
This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours.
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Geoff Dickens, Marco Picchioni and Clive Long
The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in…
Abstract
Purpose
The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care.
Design/methodology/approach
The paper uses a retrospective survey of routinely collected incident data from one 207‐bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability.
Findings
In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other‐directed aggression, 31.8 per cent self‐harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self‐harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway.
Research limitations/implications
Incidents, especially those of lower severity, can be under‐reported in routine practice. Information about incident severity was limited.
Practical implications
Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility.
Originality/value
This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.
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