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Article
Publication date: 26 February 2019

David Murphy and Clare Allely

The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure…

Abstract

Purpose

The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure psychiatric care (HSPC). Key areas of examination include the prevalence of ASD in HSPC, how individuals with an ASD differ from other patient groups in clinical and cognitive characteristics, the views of staff regarding patients with an ASD, an exploration of the experiences and quality of life of patients with an ASD, as well as treatment and interventions.

Design/methodology/approach

A review of the published literature.

Findings

Although individuals with an ASD comprise a relatively small proportion of the total HSPC cohort, they appear to be over represented relative to the general population prevalence. Several research projects suggest that individuals with an ASD present with difficulties and needs different to other patient groups, as well as being viewed by staff as potentially vulnerable and requiring a different care approach. Individuals with an ASD report both positive and negative aspects to life in HSPC.

Practical implications

Suggestions are made with regard to how individuals with an ASD might be better managed in HSPC. Following the spirit of various pieces of government legislation such as the Autism Act (2009) and the Equalities Act (2010) the role of a specialist ASD HSPC service is proposed.

Originality/value

This paper provides a detailed review of the research to date exploring the assessment and management of individuals with an ASD detained in HSPC. It outlines key research findings, highlights limitations with it and provides a personal perspective on future research and clinical targets.

Details

Advances in Autism, vol. 6 no. 1
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 11 March 2019

Marta Mas-Machuca and Frederic Marimon

The purpose of this paper is to define a new and broader concept of spirituality called holistic spiritual capital (HSpC), which encompasses and identifies the dimensions proposed…

Abstract

Purpose

The purpose of this paper is to define a new and broader concept of spirituality called holistic spiritual capital (HSpC), which encompasses and identifies the dimensions proposed by various authors and to propose a metric scale for HSpC and its validation.

Design/methodology/approach

The analysis is based on a survey of 201 residents of Spain administered in May, 2015. Exploratory factor analysis and a subsequent confirmatory analysis were conducted using structural equation modeling (SEM) techniques with EQS software.

Findings

Four dimensions reflect the latent construct of HSpC in different ways: health, creativity, morality and religiosity.

Practical implications

The measurement of HSpC should be considered relevant to organizations, but not merely because it may be a tool to increase productivity. Ethical climate influenced organizational commitment and hence it enhances performance indicators.

Originality/value

The proposed scale encompasses in a unique instrument some dimensions considered previously in the literature independently.

Details

International Journal of Organization Theory & Behavior, vol. 22 no. 1
Type: Research Article
ISSN: 1093-4537

Keywords

Article
Publication date: 3 January 2017

David Murphy and Hannah Mullens

Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and…

Abstract

Purpose

Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and needs. There is also evidence that if detained individuals with an ASD experience particular difficulties within custodial environments as a result of a mismatch between the difficulties associated with their ASD and the environmental demands. The purpose of this paper is to explore the experience of individuals with an ASD admitted to a high secure psychiatric care (HSPC) hospital.

Design/methodology/approach

Using both a semi-structured interview and a quality of life self-report measure (the Lancashire Quality of Life Profile) the experiences and views of seven patients with an ASD detained in one HSPC hospital were qualitatively explored.

Findings

Whilst a diverse range of negative and positive aspects of being within HSPC were identified by patients interviewed, those with prison experience thought HSPC was a less stressful environment with more therapeutic opportunities. As a group, patients with an ASD reported a similar or significantly better quality of life in many domains (global, leisure, financial and living situation) compared to other detained forensic patient groups.

Practical implications

Although most patients with an ASD interviewed reported positive experiences, there are a number of practical improvements that could be made within the hospital to reduce experienced stress levels and perhaps improve therapeutic outcomes.

Originality/value

Within the context of the Department of Health's autism strategy (2010) and subsequent update think autism (2014), the survey highlights continued ASD awareness training for staff as important. In responding to the risks and needs of individuals with an ASD in HSPC there is further support for the development of an ASD specialist service.

Article
Publication date: 11 December 2017

David Murphy, Emma-Louise Bush and Ignazio Puzzo

Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion of patients detained in high-secure psychiatric care (HSPC), previous research…

Abstract

Purpose

Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion of patients detained in high-secure psychiatric care (HSPC), previous research suggests that such individuals present with difficulties and needs significantly different from non-ASD patient groups. However, to date, there has not been any formal examination of how individuals with an ASD are represented in records of key risk management actions (i.e. seclusions and incompatibilities with other patients). The paper aims to discuss these issues.

Design/methodology/approach

An observation of hospital data examining two key risk management actions for a group of individuals with an ASD is detained in one HSPC hospital. These include the number of formal incompatibilities with other patients and the number of, and hours in, seclusion. Both actions require extra staff and security provisions and can decelerate the rehabilitation and recovery process.

Findings

In addition to suggesting an overall increase in the general prevalence of ASD within the hospital compared to previous estimates, individuals with an ASD appear to have a disproportionately higher number of incompatibilities with other patients compared to those patients without an ASD and experience more and longer periods of seclusions.

Originality/value

Although the methodological limitations of the study are acknowledged, explanations for the findings are discussed along with future research and recommendations as to how ASD patients might be best managed in the hospital. It is argued that the findings add further support for a specialist ASD service within HSPC.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 8 no. 4
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 23 September 2019

David Murphy and Josephine Grace Broyd

The purpose of this paper is to evaluate autism awareness training provided to staff working in a high secure psychiatric care (HSPC) hospital.

Abstract

Purpose

The purpose of this paper is to evaluate autism awareness training provided to staff working in a high secure psychiatric care (HSPC) hospital.

Design/methodology/approach

An online survey of staff views who had completed an autism awareness training day.

Findings

All staff who completed the evaluation questionnaire reported that an autism awareness training day had been useful and had increased their knowledge of how to work with individuals who have autism. However, most staff also reported that one day was not long enough and that more case discussion would have been helpful. Although most staff also reported that autism awareness training should be mandatory, motivation to attend such training was considered important. In terms of the number of staff who had completed the training, whilst a wide range of staff groups had attended training, only a minority had done so, with the number of staff completing the training each year remaining relatively constant over a five-year period.

Research limitations/implications

Within the context of promoting Enabling Environments in forensic settings and the recent government consultation paper exploring whether autism awareness training should be mandatory for all those working in health care, further investigation is required into how to increase staff motivation to attend autism awareness training and to explore how it is used during everyday work with patients.

Originality/value

As an initial evaluation of optional autism awareness training delivered in HSPC, the project offers some valuable information in terms of the number of staff who attend such training, what they find useful and how it might be improved for this setting.

Details

Advances in Autism, vol. 6 no. 1
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 21 December 2020

Ishbel McMichael, Olivia Tiley, Josephine Broyd and David Murphy

This paper aims to examine the relationship between neuropsychological functioning as assessed following admission to a high secure psychiatric care (HSPC) hospital and subsequent…

Abstract

Purpose

This paper aims to examine the relationship between neuropsychological functioning as assessed following admission to a high secure psychiatric care (HSPC) hospital and subsequent time spent in long-term segregation (LTS). Evidence from forensic populations suggests neuropsychological functioning difficulties can increase vulnerability to interpersonal violence. However, the impact of this relationship on restrictive interventions used in these settings is poorly understood.

Design/methodology/approach

This study quantitatively examined the neuropsychological profiles of 80 male HSPC patients as assessed during routine admission assessments, comparing data against any subsequent LTS duration during a one-year period, and a non-LTS control (n = 27).

Findings

Analysis found individuals who were willing and able to complete a routine neuropsychological admissions assessment spent significantly less time in LTS than those unable to complete the assessment. Performance within a test of novel problem solving (Key Search Test) was significantly worse in the LTS group than controls. Performance within a visual memory task (Immediate Recall section of the Rey Complex Figure Test) significantly correlated with LTS duration. Additional findings suggest the absence of self-reported planning difficulties as measured by a Dysexecutive Questionnaire (DEX) negatively correlated with LTS duration, while self-reported restlessness was positively correlated with LTS.

Practical implications

This has implications for early assessment of LTS risk and potential use of cognitive interventions to reduce the use of restrictive practices.

Originality/value

The results suggest some aspects of neuropsychological performance as assessed during admission to a HSPC hospital appear to be related to subsequent time spent in LTS.

Article
Publication date: 10 August 2015

David Murphy and Karen McMorrow

Individuals with an autism spectrum condition (ASC) represent a small proportion of patients detained in high-secure psychiatric care (HSPC) with specific difficulties and needs…

Abstract

Purpose

Individuals with an autism spectrum condition (ASC) represent a small proportion of patients detained in high-secure psychiatric care (HSPC) with specific difficulties and needs. To date there has been little exploration of how these needs are viewed by staff or if staff have unmet needs with regard to working with ASCs. The paper aims to discuss these issues.

Design/methodology/approach

A questionnaire examining specific views (on vulnerability, benefits from therapy and making adjustments to practise), knowledge and training needs linked to ASC was distributed to staff who directly worked with patients.

Findings

In total, 206 questionnaires were returned (approximately 60 per cent distributed). Most staff reported making adjustments in their practise and believed patients with an ASC were more vulnerable than other patient groups. Half of staff expressed the view, that whilst patients with an ASC benefited from therapies, they were unaware if an individual’s difficulties were considered in their care. Half of staff believed individuals with an ASC should be managed in a different way. Most staff reported not having adequate skills to work with ASC, a wish for more training and that such training should be mandatory. Other than psychiatrists most staff were unaware of the Autism Act (2009). The need for a specialist ASC ward within HSPC was also highlighted by several staff.

Practical implications

The survey highlights differences in staff experiences of patients with an ASC and view that autism training should be mandatory.

Originality/value

Whilst progress has been made with implementing the government’s Autism Strategy (2010) within HSPC, more awareness training is required in promoting staff confidence to work with this group of patients.

Details

Journal of Forensic Practice, vol. 17 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

Open Access
Article
Publication date: 4 January 2018

Clare S. Allely

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for…

6159

Abstract

Purpose

Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings.

Design/methodology/approach

Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Findings

A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed.

Originality/value

To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.

Details

Journal of Criminal Psychology, vol. 8 no. 1
Type: Research Article
ISSN: 2009-3829

Keywords

Content available
Article
Publication date: 6 January 2020

Eddie Chaplin and Jane McCarthy

258

Abstract

Details

Advances in Autism, vol. 6 no. 1
Type: Research Article
ISSN: 2056-3868

Article
Publication date: 1 January 2013

David Murphy

Integral to the process of formulating and managing the difficulties of mentally disordered offenders is the assessment of risk. However, the opinion held by many clinicians who…

Abstract

Purpose

Integral to the process of formulating and managing the difficulties of mentally disordered offenders is the assessment of risk. However, the opinion held by many clinicians who work with offenders with an autism spectrum disorder (ASD) is that most conventional risk assessment tools fail to capture the underlying reasons why such individuals may offend. This needs to be explored.

Design/methodology/approach

The paper presents a screening study of the HCR 20 risk assessment tool and some other characteristics of ‘high risk’ individuals with an ASD. Also presented is a brief literature review supported by clinical experience of the assessment of psychopathy in ASD and highlighting potential key factors to be included in a risk assessment of offenders with an ASD.

Findings

It was found that nine out of the 20 risk items contained in the HCR 20 are present in 50 per cent or less of the sample. Whilst some conventional risk factors are present, clinical experience and the literature suggests that it is the specific difficulties associated with having an ASD that contribute towards an individual's vulnerability to offend.

Originality/value

Although further examination is required, provisional findings from this small screening study of the HCR 20 profiles of high risk individuals with an ASD questions the usefulness of some conventional risk factors in understanding the difficulties within this population. It is proposed that there is a need for good practise guidelines for assessing risk in individuals with an ASD.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 4 no. 1/2
Type: Research Article
ISSN: 2050-8824

Keywords

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