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Article
Publication date: 9 November 2010

Geoff Dickens, Philip Sugarman, Marco Picchioni and Clive Long

In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental…

Abstract

In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness and men with learning disability in a secure care pathway. Total and individual HoNOS‐secure item ratings made by multi‐disciplinary teams across the course of a period of admission (mean 15 months) for 180 men were examined. There was significant positive change on the clinical and risk‐related scales of HoNOS‐secure for patients in the learning disability care pathway (N = 48) between initial and final ratings. In the mental health care pathway (N = 132 patients) an apparent lack of change masked a more complex picture, where initial decline in HoNOS‐secure ratings was succeeded by significant improvement. Results suggest that it is challenging to measure clinical and risk‐related medium‐term clinical outcomes objectively for these patients, particularly in relation to core issues of treatment of mental disorder, and reduction of both problem behaviour and risk to others. However, it is important that practitioners continue to strive to demonstrate the benefits of care and treatment through appropriate outcomes measures.

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The British Journal of Forensic Practice, vol. 12 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 13 March 2019

Kim Liddiard, Sara Louise Morgan, Charlotte Hill and Andrew Simmonds

The purpose of this paper is to explore whether the current forensic mental health inpatient population within a medium secure unit is more or less complex (i.e. clinical…

Abstract

Purpose

The purpose of this paper is to explore whether the current forensic mental health inpatient population within a medium secure unit is more or less complex (i.e. clinical and risk presentations) than former years using the Health of the Nation Outcome Scale (HoNOS) secure. Additionally, the use of the HoNOS secure as a service-wide measure is discussed in terms of its usefulness. Clinical implications and recommendations are offered for the continued use of the HoNOS secure in services more widely.

Design/methodology/approach

A retrospective case review of completed HoNOS secure assessments for 130 patients over three time intervals 2012, 2015 and 2018 was used. A multivariate analysis was performed on the data using SPSS version 25.

Findings

The findings revealed that contrary to clinical opinion, inpatients’ clinical and risk presentations had not changed significantly overtime.

Research limitations/implications

The study shows the benefits of using the HoNOS secure at a service-wide level to explore and understand similarities and differences in inpatient admissions over time. It also highlights the usefulness of the HoNOS secure for considering different ward characteristics and the needs of patients residing in these environments.

Originality/value

Although much research exists surrounding the individual use of the HoNOS secure in relation to outcomes, there is limited research focusing on use of the HoNOS secure at the service level. The paper therefore provides evidence of the utility and value of the HoNOS secure as a service-level outcome measure.

Details

Journal of Forensic Practice, vol. 21 no. 1
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 11 March 2021

Lorraine Higham, Alessandra Girardi and Holly Victoria Edwards

Autism-specific characteristics have been associated with internet criminal activities. Internet and non-internet offenders differ on a series of demographic…

Abstract

Purpose

Autism-specific characteristics have been associated with internet criminal activities. Internet and non-internet offenders differ on a series of demographic, psychological and offending variables. However, the clinical and criminal presentation of individuals with autism spectrum disorder (ASD) in forensic secure care settings has been underexplored. This paper aims to explore the profiles of internet offenders with ASD admitted to a secure psychiatric unit.

Design/methodology/approach

This study provides the results of a service evaluation of individuals with ASD. The demographic, clinical and criminal characteristics of a small sample of internet offenders with ASD admitted to secure care are described and discussed.

Findings

Internet offenders present in secure care with high rates of comorbid disorders, histories of violence and traumatic experiences, mood disorders and difficulties with relationships. Of the 24 internet offenders discussed, 18 of them committed an offence of a sexual nature involving children.

Originality/value

This paper highlights the potential risks for individuals with ASD in using the internet and the possible difficulties associated with detecting this because of rapid advancements in technology.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 12 no. 2
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 1 August 2018

Gareth Hickman, Su Thrift and Chénelle Taylor

The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium and low secure intellectual disability (ID) service. Over the preceding…

Abstract

Purpose

The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium and low secure intellectual disability (ID) service. Over the preceding five years, service users have followed the outlined treatment pathway. The current paper offers case study material to illustrate the care pathway.

Design/methodology/approach

The treatment pathway is described and two case examples are provided, illustrating participation in the pathway. Evaluative data are provided on length of hospitalisation, direction of pathway at discharge and risk reduction as assessed by the HCR-20, SVR-20 and HONOS Secure measures.

Findings

The case examples provided document the assessment and treatment of two male offenders with ID, outlining their treatment pathways, subsequent reductions in assessed risk and their successful community discharge.

Originality/value

A comprehensive treatment pathway is outlined together with the theoretical rationale, with illustrative case examples.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 9 no. 2
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 21 February 2011

Andy Smith, Jackie Bird and Clive Long

Despite widespread work on the process of safeguarding vulnerable adults, there is a relative absence of research in secure psychiatric settings where reliance is placed…

Abstract

Despite widespread work on the process of safeguarding vulnerable adults, there is a relative absence of research in secure psychiatric settings where reliance is placed on external community safeguarding teams. This study analyses safeguarding incidents over a three‐year period in a medium secure psychiatric setting for women. It focuses on incident type, the characteristics of victims and perpetrators and safeguarding processes, including protection strategies. The action implications of the findings are discussed with reference to the unique feature of the patient population and setting and the extant research literature.

Details

The Journal of Adult Protection, vol. 13 no. 1
Type: Research Article
ISSN: 1466-8203

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Article
Publication date: 9 November 2010

Carol Ireland and Neil Gredecki

Abstract

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The British Journal of Forensic Practice, vol. 12 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 4 February 2014

Rachel Edworthy and Najat Khalifa

The purpose of this paper is to present the arguments for sustaining a clinical database, assess its feasibility in a low-secure service, examine the data that can be…

Abstract

Purpose

The purpose of this paper is to present the arguments for sustaining a clinical database, assess its feasibility in a low-secure service, examine the data that can be captured and discuss what this means for practice implications and service development. The paper aims to demonstrate how a clinical database can provide information on three key areas: what patients are like before admission, what is done with them whilst they are in hospital and what happens to them when they are discharged. The paper also aims to examine the practical, legal and ethical implications of building such a database.

Design/methodology/approach

This is conducted in the form of a feasibility study charting the development and implementation of an inpatient clinical database for a low-secure inpatient service.

Findings

The feasibility of creating and maintaining a clinical database in a low-secure service has been assessed and the paper has found that they are an invaluable source of data that all mental health services should strive to develop. They will enable services to track their own outcome measures and tailor their service and interventions according to the needs of service users. However, ethical and legal issues surrounding building clinical databases are complex and require careful consideration.

Research limitations/implications

This is a small-scale study that captured the experience of one service. Ideally this research should be expanded with nationwide clinical database development.

Practical implications

This paper includes implications for the implementation of a clinical database, the resources needed for the running of this and the development of standardised outcome measures for mental health services.

Originality/value

This is potentially an innovative way of developing a clinical database for a low-secure unit and some of the first research into the feasibility of a database for this population. Its practical application is relatively new and potentially innovative in how it is applied.

Details

Journal of Forensic Practice, vol. 16 no. 1
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 10 May 2013

Simeon Sender‐Galloway and Tom Clark

An association between problematic substance use and severe mental illness has been demonstrated in various settings, but not among community forensic psychiatric…

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Abstract

Purpose

An association between problematic substance use and severe mental illness has been demonstrated in various settings, but not among community forensic psychiatric patients. This paper aims to investigate the prevalence and correlates of problematic substance use among the community patients of one regional forensic psychiatric service.

Design/methodology/approach

Historical data on diagnosis, offending and problematic substance use were gathered by reviewing case notes. Current substance use and psychosocial functioning were ascertained from structured interviews with community psychiatric nurses. Outcome measures included HoNOS ratings, the Global Assessment of Functioning, and the Clinical Rating Scale for substance use.

Findings

Of 92 patients, 91.2 per cent had a history of problematic substance use and 31.5 per cent of them were currently using substances problematically, most commonly cannabis and alcohol. Current problematic substance use was associated with a range of negative outcomes, in terms of illness severity, compliance with treatment, and psychosocial functioning.

Research limitations/implications

The results may not be generalizable to services in different areas or those with different models of service provision. Causality should not be assumed from a cross sectional study.

Practical implications

Inpatient psychiatric treatment in secure services appears to be associated with a large reduction in the level of problematic substance use, but a large residual need remains among community patients. Services which provide community care for forensic patients must seek to integrate treatment for problematic substance use with treatment for mental illness.

Originality/value

This is the first description of the substance use related needs among community forensic psychiatric patients.

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Article
Publication date: 13 March 2019

Petra Habets, Inge Jeandarme and Harry G. Kennedy

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of…

Abstract

Purpose

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders.

Design/methodology/approach

The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements.

Findings

Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability.

Practical implications

The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts.

Originality/value

This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.

Details

Journal of Forensic Practice, vol. 21 no. 1
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 5 March 2014

Clive Long, Arleen Rowell, Anita Gayton, Elizabeth Hodgson and Olga Dolley

– The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI).

Abstract

Purpose

The purpose of this paper is to explore the incidence of obesity and its complications in secure psychiatric settings; and to assess changes in body mass index (BMI).

Design/methodology/approach

Electronic patient records were used to determine levels of obesity and weight change over a three-year period. BMI levels were related to status, medication and patient characteristics.

Findings

The incidence of obesity (34 per cent) in the sample (n=351) was higher than in the general population. One-third of patients were on medication for hyperlipidaemia and 10 per cent were diagnosed with type II diabetes. Patients on regular antipsychotic drugs and sodium valproate and who were less active had higher BMIs. Gender differences over a three-year period showed a tendency for women's weight to continue to increase which may be linked to lower levels of engagement in activities of moderate or vigorous intensity.

Originality/value

Previous surveys using secure psychiatric populations have been point in time reviews. The current study tracks changes over a three-year time period and related this to a range of interventions.

Details

Mental Health Review Journal, vol. 19 no. 1
Type: Research Article
ISSN: 1361-9322

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