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1 – 10 of over 1000Alice Bennett and Darren Johnson
In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical…
Abstract
Purpose
In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service.
Design/methodology/approach
The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015.
Findings
Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ2 analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample.
Practical implications
In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders.
Originality/value
The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.
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Zoe Mawby, Andrew Newman and Megan Wilkinson-Tough
The offender personality disorder (OPD) pathway faces the difficult task of identifying individuals who are eligible for their service from the entire probation caseload. The…
Abstract
Purpose
The offender personality disorder (OPD) pathway faces the difficult task of identifying individuals who are eligible for their service from the entire probation caseload. The offender assessment system personality disorder (OASys PD) screen is a national screening tool used by the pathway to help with this task. This paper aims to describe an evaluation of the effectiveness of this plus an additional screening tool currently used to identify eligible individuals for the OPD service in the South of England. Recommendations for improvements were made as necessary.
Design/methodology/approach
A mixed methods design used a quantitative analysis of data on the effectiveness of the OASys PD for correctly identifying individuals and a thematic analysis of a focus-group conducted with clinicians within the service.
Findings
The analysis revealed a positive predictive value of the OASys PD screen of 72% and a negative predictive value of 91%. Key themes from the focus-group revealed what worked well about the screening process, what was difficult and what needed to be improved.
Practical implications
The OASys PD performed better than the clinicians had expected. It was recommended that the service continued to use the combination of the screening tool and the interviews with minor adjustments.
Originality/value
This is the first research study of its kind on the effectiveness of the OASys Personality Disorder Screening tool. Using such a tool with some caution (the addition of consultation) creates a useful and effective process for tackling the very difficult task of identifying people for the community component of the Offender Personality Disorder Service. This research provides some evidence for the validity of such a process that is currently used throughout the National Probation Service in England and Wales.
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Gary Lamph, Peggy Mulongo, Paul Boland, Tamar Jeynes, Colin King, Rachel-Rose Burrell, Catherine Harris and Sarah Shorrock
The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained…
Abstract
Purpose
The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.
Design/methodology/approach
A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.
Findings
Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.
Originality/value
The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.
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Stephanie Hunter, Eleanor Craig and Jake Shaw
Within the current offender personality disorder (OPD) pathway in the UK, black, Asian and minority ethnic (BAME) populations are underrepresented. Fewer BAME offenders are…
Abstract
Purpose
Within the current offender personality disorder (OPD) pathway in the UK, black, Asian and minority ethnic (BAME) populations are underrepresented. Fewer BAME offenders are engaging with services despite being proportionately identified for inclusion and referred on to the pathway. The paper aims to discuss this issue.
Design/methodology/approach
This qualitative study explored the experiences of 11 BAME men engaged in a prison-based OPD service for young offenders to identify the highlights and challenges of engagement within the service and to what extent they experienced a sense of inclusion/belonging.
Findings
Thematic analysis was used to identify three overarching themes and sub-themes. Why am I going to be an Outcast? describes the barriers to engagement encountered by the participants; and Give it a Try and Nothing but Respect describe the process of overcoming these barriers. Barriers revolved around the experiences of judgement, alienation and hopelessness. These were overcome through peer encouragement, developing relationships with staff and freedom to regulate levels of engagement.
Practical implications
Practice and policy implications are considered to support similar services in addressing the barriers to engagement faced by BAME individuals. Areas for future research are also recommended.
Originality/value
Currently, no research has directly explored the under-representation of young BAME offenders with emerging personality disorder in the OPD pathway. The findings provided an insight into some of the difficulties these young BAME offenders faced when accessing this service, alongside aspects which maintained their engagement.
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Claire de Motte, Di Bailey, Melanie Hunter and Alice L. Bennett
The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders…
Abstract
Purpose
The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders (PDs) within a high security prison.
Design/methodology/approach
A comparative quantitative case study design supported the understanding of the frequency and pattern of SH and PRB behaviour across two stages of a PD treatment programme for 74 male prisoners. Data obtained from the prison’s records were analysed using dependent t-tests, χ2 test of independence and time-frequency analyses.
Findings
Inferential statistics showed that the frequency of SH and PRB behaviour statistically increased across two phases of the PD treatment programme; however, the method of SH or type of PRB behaviour engaged in did not change. Mapping the frequencies of incidents using a time-frequency analysis shows the patterns of both behaviours to be erratic, peaking in the latter phase of treatment, yet the frequency of incidents tended to decline over time.
Originality/value
This is the first study to explore SH and PRB behaviours in men across two phases of a PD treatment programme. This study highlights the need for continued psychological support alongside the PD treatment programme with a focus on supporting men in treatment to effectively manage their SH and PRB behaviour.
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The purpose of this paper is to explore service-users’ hopes and expectations of a psychologically informed planned environment (PIPE) located in the high-security prison estate…
Abstract
Purpose
The purpose of this paper is to explore service-users’ hopes and expectations of a psychologically informed planned environment (PIPE) located in the high-security prison estate.
Design/methodology/approach
A semi-structured interview was used to explore the hopes and expectations of five male Category A PIPE prisoners. Interviews were transcribed verbatim and thematic analysis was used to analyse the data.
Findings
Analysis resulted in two overall themes: “Progression” and “Being Part of a Community”. Relevant sub-themes were considered to portray processes within these two wider themes.
Practical implications
In applying these findings to practice, this study provides evidence that places value on the current referral process which ascertains prisoners’ motivations to attend the PIPE.
Originality/value
This is the first known study that explores service-users’ hopes and expectations of the pilot PIPE service. The PIPEs are included within the recently introduced Offender Personality Disorder Pathway.
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This paper aims to provide a description of a trauma sensitive intervention for men who have committed sexual offences. The intervention aims to support men to process and make…
Abstract
Purpose
This paper aims to provide a description of a trauma sensitive intervention for men who have committed sexual offences. The intervention aims to support men to process and make sense of their own experience of trauma before inviting them to acknowledge their role in causing harm to others. The intervention draws on compassion focussed therapy (CFT) as the overarching therapeutic modality.
Design/methodology/approach
As part of a service evaluation changes in routine repeat measures completed by service users were analysed prior to joining the intervention and after 12 months of intervention. Service users were encouraged to provide regular feedback relating to their experience of the intervention at regular intervals. This feedback was collated and patterns were identified collaboratively to understand the context for assessed change in the measures.
Findings
Prior to the intervention men reported high levels of shame and limited experiences of guilt (as compassion for others). Early findings indicate that men experience less shame and increased experiences of guilt after 12 months. An increase in insight into risk was also evident. Service user feedback pointed towards a more engaging therapeutic style and highlighted the importance of both a collaborative and trauma sensitive approach.
Originality/value
This is the first evaluative description of forensic CFT for sexual offending. Findings offer insight into potential future directions for forensic interventions with this population.
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This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’…
Abstract
This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’, ‘personality disorder and intellectual disabilities’, ‘learning disabilities’ and related terms. Methods of defining offending population, personality disorder and learning disabilities vary greatly, and few studies focus specifically on personality disorder, learning disability and offending. The definition of learning disability often encompasses both borderline learning disability and low average intelligence. Personality disorder, especially anti‐social personality disorder, is prevalent in offenders with learning disabilities, but less than in the general population, and is associated with higher levels of security and poorer outcomes. The study concludes that there is a continuum of offenders with borderline and mild learning disabilities, reflected in learning disability forensic services.
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Rajan Nathan, Laura Cramond, Andrew Brown, Bernadette McEllin and Richard Whittington
The profile of personality disorder in forensic clinical practice has been raised by key developments over the last decade, although services remain in the large part piecemeal…
Abstract
Purpose
The profile of personality disorder in forensic clinical practice has been raised by key developments over the last decade, although services remain in the large part piecemeal and disconnected. This paper aims to describe the lessons learnt from the development of one specialist service for personality disordered offenders.
Design/methodology/approach
The policy context in which the service was developed, the challenges of working in this area, and data relating to the clinical and risk profile of referred cases are presented.
Findings
Data demonstrate extensive comorbidity and heterogeneity amongst those referred to the service. With reference to the experience gained in the first four years of the service, it is suggested that a systematic and formalised model of “understanding” the psychology of the individual should be the core process of future developments for this group of offenders, and subsequently recommendations are made to enhance the practical utility of such formulations rate.
Research limitations/implications
Conclusions are mostly based on expert opinion and upon one particular service provision, and therefore care should be exercised in generalising the results of this study to existing services. The need for further research in order to enhance knowledge and understanding of this complex group is highlighted.
Practical implications
The heterogeneity and comorbidity within this group of offenders emphasises the need for services to offer a range of assessment methods and interventions to meet individuals' requirements.
Originality/value
The experiences and recommendations in this paper are valuable to professionals working with personality disordered offenders and to the development of more extensive services for such individuals.
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Jon Taylor and Catrin Morrissey
The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with…
Abstract
Purpose
The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.
Design/methodology/approach
The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.
Findings
The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.
Practical implications
Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.
Originality/value
There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.
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