Search results

The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two “open” and one “locked”. It identified elements of recovery that were important to service users. It measured the units’ performance on domains of recovery, attending to differences between staff members’ and service users’ perceptions and between the locked and open units.

A cross-sectional design was used. Staff and service users completed the “Developing Recovery Enhancing Environment Measure (DREEM)”.

Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users’ responses highlighted potential areas for service improvement.

The sample was small but reflected the applied setting. Some service users were not invited to participate because of significant communication or cognitive difficulties and it is recognised that they may have had alternative views that remain unrepresented.

The DREEM provided valuable information about current practice and potential for service development. Both locked and open units can provide recovery-oriented environments. Services should be aware of discrepant views between staff and service users.

To the knowledge, this is the first study to use the DREEM to evaluate the recovery orientation of a locked recovery unit and to compare locked and unlocked units.

The purpose of this paper is to present a training package which was delivered to improve staff members’ knowledge and confidence of autism spectrum disorders (ASD) and intellectual disabilities (ID).

The training was facilitated in a locked rehabilitation unit for adult males, many of whom had diagnoses of ASD and/or ID. With all staff receiving an invite, 25 attended which was the majority of the staff team. This included staff from housekeeping, nursing and catering.

To evaluate the effectiveness of the training, a survey and short assessment was administered before and after training. This revealed an improvement in both perceived knowledge and confidence of ASD and ID, as well as actual knowledge. Follow-up interviews also revealed some evidence of sustained learning and practice changes.

Based on these findings, it is recommended that further face-to-face training is delivered at this locked rehabilitation unit to further improve professional practice.

This paper provides value to other inpatient settings as it highlights to practitioners how face-to-face training can significantly improve staff members knowledge and confidence of developmental disorders.

The purpose of this paper is to outline the work of a service provider, service user and carer group created to develop a strategy for service user and carer co-production.

A reflective narrative account is given of the process through which the group formed and began to develop a working model aimed at shaping a cultural shift towards more co-produced services. The paper has been co-produced and includes the collaborative voices of service users, carers, multi-disciplinary staff, third-sector representatives, managers and colleagues from associated services.

The model developed outlines three stages for services to work through in order to achieve meaningful and sustainable co-produced services. The importance of developing associated policies related to such areas as recruitment, payment, support and training is also outlined. Challenges to co-production are noted along with suggested approaches to overcoming these.

The ethos of co-production is relatively new in the UK and so knowledge of the process and model may help guide others undertaking similar work.

A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID) services, yet these approaches are under-evaluated in forensic settings. This study aims to explore and compare the feasibility of two approaches to co-production in the completion of dynamic risk assessments and management plans in a secure setting.

A convenience sample of adults admitted to a secure specialist forensic ID service (N = 54) completed the short dynamic risk scale (SDRS) and drafted risk management plans under one of two conditions. In the first condition, participants rated the SDRS and risk management plan first, separately from the multidisciplinary team (MDT). In the second condition, participants and MDTs rated the SDRS and risk management plan together.

In total, 35 (65%) participants rated their risk assessments and 25 (47%) completed their risk management plans. Participants who rated their risk assessments separately from the MDT were significantly more likely to complete the SDRS (p = 0.025) and draft their risk management plans (p = 0.003). When rated separately, MDT scorers recorded significantly higher total SDRS scores compared to participants (p = 0.009). A series of Mann-Whitney U tests revealed significant differences between MDT and participant ratings on questions that required greater skills in abstraction and social reasoning, as well as sexual behaviour and self-harm.

Detained participants with an ID will engage in their dynamic risk assessment and management plan processes. The study demonstrates the impact of different co-production methodologies on engagement and highlights areas for future research pertaining to co-production.

Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues.

In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought.

Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support.

People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission.

This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting.

Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative phenomenological analysis (IPA).

Four main themes emerged: identity, power, protection and containment, and confusion. The themes of identity, power and protection and containment represented polarised positions which in turn contributed to the theme of confusion.

There are limitations to this study mainly the heterogeneous nature of the sample. However, good quality control and the similarities with previous findings indicate that this study makes a valuable contribution to the understanding of BPD in a forensic setting. In addition it has implications for further research; exploring sense of self and the differences between a sample from a community and a sample from a forensic setting with a diagnosis of BPD.

For practitioners to acknowledge power dynamics and to be able to formulate and address these with patients with a diagnosis of BPD.

This is the first IPA study to ask women with a diagnosis of BPD in a forensic setting what their experience is. It is a qualitative study due to the need to genuinely explore the topic and to provide a basis for others to conduct further research.

Although intellectual disability (ID) and criminal offending have long been associated, the nature of this link is obfuscated by reliance on historically unrigorous means of assessing ID and fractionating social cognitive skills. The purpose of this paper is to review and report current findings and set an agenda for future research in social perception, social inference and social problem solving in ID violent offenders.

The literature is reviewed on comorbidity of criminal offending and ID, and on social cognitive impairment and ID offending. In an exploratory case-control series comprising six violent offenders with ID and five similarly able controls, emotion recognition and social inference are assessed by the Awareness of Social Inference Test and social problem-solving ability and style by an adapted Social Problem-Solving Inventory.

Violent offenders recognised all emotions except “anxious”. Further, while offenders could interpret and integrate wider contextual cues, absent such cues offenders were less able to use paralinguistic cues (e.g. emotional tone) to infer speakers’ feelings. Offenders in this sample exceeded controls’ social problem-solving scores.

This paper confirms that ID offenders, like neurotypical offenders, display specific deficits in emotion recognition – particularly fear recognition – but suggests that in ID offenders impairments of affect perception are not necessarily accompanied by impaired social problem solving. The implication for therapeutic practice is that ID offenders might be most effectively rehabilitated by targeting simpler, low-level cognitive processes, such as fear perception, rather than adapting treatment strategies from mainstream offenders.

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a needs assessment that enabled us to develop a new service for men with intellectual disability who often had substantial additional mental health needs. Consulting with all stakeholders was essential, and we found the service user and family perspectives particularly helpful. We had to make special arguments for some aspects of the treatment programme. We found that foundation trusts that are able to develop services at financial risk, before contracts are signed, enabled development to take place at a faster pace. Good relationships with community teams have been essential, as has true integration with mainstream forensic services. Maintaining a relationship with commissioners was a particularly challenging aspect, perhaps because the development was provider‐led. Despite these challenges, many people with intellectual disability with very high needs are being supported much nearer to home.

Individuals with intellectual disability (ID) are known to experience increased emotional and behavioural concerns. The study aims to assess whether detained ID patients with a forensic history (IDPF) have increased difficulty managing their impulse control in comparison to detained ID patients without a forensic history (IDP). Using the externalising behaviour problems (EBP) subscale of the EPS, the study aims to compare the differences between the IDFP and IDP groups.

A total of 60 patients with ID detained under the Mental Health Act 1983 (Revised 2007) were assessed using the behaviour rating scale of the EPS. The outcome scores of the EBP were used to examine any observed differences between the scores of forensically involved patients [n = 34] and those without a forensic history [n = 26]. It was hypothesised that patients with a forensic history would display higher scoring on externalised behavioural problems (EBP) than patients without such a history.

Non-parametric testing revealed that there were no significant differences in EBP scoring between the two sample groups. These findings indicate that, for patients in the present study, no differences were detected in the presentation of these two distinct groups. In fact, with the exception of the verbal aggression subscale of the EBP, the other three subscales (physical aggression, non-compliance and hyperactivity) show that actually the IDP group displayed the higher ranked means in these subscales when compared with the forensically involved group.

These results indicate possible increased treatment needs within the IDP group and question whether offending history is necessarily a reliable predictor of ongoing hostility and behavioural concerns within similar inpatient services.

People with an intellectual disability (ID) are more at risk of experiencing adverse childhood events. Moreover, prolonged exposure to ACEs results in enduring changes and impairments in neurological, physiological and psycho-social systems and functioning. In response, van der Kolk et al. (2009) have put forward the concept of developmental trauma disorder (DTD) to reflect the “constellation of enduring symptoms” and complex care needs of this population. The purpose of this paper is to ascertain the level of exposure to adverse childhood events and the prevalence of DTD in an inpatient forensic ID population.

A retrospective file review and consensus approach to diagnosis were used in a sample of adults with an ID detained in a secure forensic service.

Results revealed that 89 admissions (N=123) had been exposed to at least one significant ACE, with 81 being exposed to prolonged ACEs. A total of 58 admissions (47 per cent) met criteria for PTSD and 80 (65 per cent) met the criteria for DTD. Significant gender differences were noted in MHA status, primary psychiatric diagnoses, exposure to ACEs and DTD.

The discussion explores the implications for working with forensic ID populations who report high incidents of childhood trauma and the utility, strengths and weaknesses of the proposed DTD, its relationship to ID diagnoses is explored.

The study outlines the prevalence of DTD and PTSD in ID forensic populations and suggests additional key assessment and treatment needs for this population.