Search results

This paper aims to review research of relevance to women with learning disabilities, focusing in particular on literature which is applicable to women with learning disabilities who use forensic services.

Research involving women with learning disabilities over the past 30 years was sought out and reviewed, and literature relating to women living in locked wards (including those without learning disabilities) was focused upon. Related themes such as the BPD diagnosis, self injury, and aggression are explored.

The author found very little research relating to women with learning disabilities who use secure services, particularly which included quotes from the women themselves.

The author recommends that more research in this area is needed, primarily research which includes the voices of women service users themselves.

This paper will be relevant to all staff who work with women in secure services.

This article aims to describe the development of secure services for women with intellectual disability in the UK and to outline what is known about their mental health needs.

The paper is a general review which is based on what is known historically about the subject, findings from the current literature and the author's own personal knowledge of these specialist services.

Secure services for women with intellectual disability have developed out of mainstream forensic and learning disability services.

Although there is a reasonable body of literature on offending in the intellectually disabled population as a whole, little of this is specific to women. Despite this, the evidence there is suggests that women continue to require secure services and that they have significant mental health needs.

The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.

A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.

Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.

The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.

First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.

To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.

The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.

Lifestyle change to improve physical health is a significant challenge in secure psychiatric hospitals for women. In addition to factors that contribute to an obesogenic environments body image, self-care, self-esteem, and motivational problems compound efforts to increase physical activity and to lose weight. The paper aims to discuss these issues.

Two elements of a comprehensive programme to improve physical health and mental wellbeing are discussed. The first describes the development of a unique role of self-care and body image therapists and an evaluation of the effects of treatment. The second describes initiatives to assess the environmental and therapeutic milieu contingencies that impact on physical activity and to increase engagement in exercise through motivational strategies.

Research within the current settings has resulted in a validation of the role of the self-care and body image therapist. Other evaluations have described the environmental contingencies that impact on physical activity along with strategies to increase exercise participation.

While much has to be learnt about how to translate awareness of the value of a healthy lifestyle for women into positive behaviour change the programme described represents part of a comprehensive and long term attempt to evaluate and improve the physical wellbeing of women in secure care.

The purpose of this paper is to explore the perceived needs of junior nurses working with women with learning disabilities in a secure setting who display violence and aggression; and to contribute to this specialised area of research and to identify potential areas for further post registration education.

The study adopted a qualitative design using thematic analysis. Initial questionnaires were distributed and the results analysed in order to form initial themes. These initial themes were then used to carry out a one-off focus group and this was transcribed verbatim and then analysed using Braun and Clarke thematic analysis to develop final themes.

The findings identified a need for staff to be able to access effective immediate support following incidents of violence and aggression and support be offered within a clear structured environment. Staff indicated that peer supervision be made available and that they also receive adequate education relating to gender specific issues and the use of seclusion.

The research had several limitations. These included a small sample size which was also largely self-selected. Bias may have to be acknowledged in respect of completion of questionnaires depending on their view of participation and what they might be contributing to. Despite this the results do raise further questions such as staff decision making around the use of seclusion.

Implications centred around the organisation’s delivery of education to staff in relation to the clinical decision-making skills they require in order to effectively support women with learning disabilities who display violent and/or aggressive behaviour. The study also has implications for potential supervision structures currently offered within these services.

This paper fulfils a need to explore services for women with a learning disability further and how services can be shaped using current perspective and up to date research in line with recent policy, e.g. Corston Report (Home Office, 2007).

This paper seeks to explore the perceptions of both staff and patients to the involvement of the Criminal Justice System (CJS) as a response to physical assaults committed by patients. Even though the ‘zero tolerance’ policy advocates the prosecution of perpetrators of violence, problems can arise when attempting to take legal action against psychiatric patients as the displaying of violent behaviour can be due to their mental illness. Nevertheless, the impact of an assault on victims, including both patient and staff members, can be detrimental. To the best of the author's knowledge these issues have not been investigated in a women's enhanced medium secure service (WEMSS). The conclusions drawn from this research are that the majority of respondents perceived the involvement of the CJS as crucial to maintaining high levels of morale among patients and practitioners, as well as assisting in deterring patients from committing subsequent assaults. However, police reports illustrated reluctance on the part of the Police and the Crown Prosecution Service (CPS) to prosecute inpatients.

The purpose of this paper is to assess the effectiveness of a gender-specific group treatment programme for personality disordered (PD) women in a medium secure psychiatric setting.

In all, 56 consecutive admissions with a primary diagnosis of personality disorder (mostly borderline type) and co-morbidity were assessed according to their participation in, and benefit from, a core set of five manualised group treatments that focused on social and interpersonal deficits, instability of mood and problematic substance use. A single cohort pre-test post-test comparison design was used with evaluation based on global change over an amalgam of self-report group specific outcome measures.

In all, 70 per cent of patients attended three or more core groups, with attendance for each group ranging from 85 to 53 per cent. Between 65 and 77 per cent of patients showed a significant improvement on pre-group psychometrics. Patients who achieved a significant positive change in one group tended to do so in others. In all, 85 per cent of patients who completed two or more groups had overall positive direction of change scores. Those who benefited from treatment engaged more quickly, were more likely to have been admitted from hospital, to have previously engaged in therapy and to score lower on measures of impulsivity and personality pathology.

In a clinically representative study the absence of a control group limits the extent to which observed changes can be attributed to described interventions.

Findings reflect the importance of providing a broad clinical approach to changing cognitive behavioural functioning with PD patients in secure settings. They also highlight the need to improve ways of engaging patients at an earlier stage of hospital stay and of increasing the acceptability and uptake of relevant group treatments. Further evidence-informed service developments are needed to meet these challenges.

The study adds to a small literature on the clinical impact of a gender-specific group treatment programme for PD women in secure settings.

The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.

The extant literature on CBT as applied to women in secure settings is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a women's medium secure service.

Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment.

There is comparatively little work on CBT group treatments for women in secure settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment developments.

The purpose of this paper is to assess the antecedent behaviours and consequences of firesetting for women in a secure psychiatric setting along with treatment engagement factors. To explore predictions made about emotionally expressive subtype firesetters by the multi-trajectory theory of adult firesetting (M-TTAF).

In total, 75 individual firesetting episodes involving 25 female multiple firesetters were assessed using the St Andrew's Fire and Arson Risk Instrument. Assessments were made of treatment readiness, firesetting related self-efficacy, insight and barriers to change.

Findings support the relationship between recidivist firesetting and the psychological features of psychosis, personality disorder and substance misuse. The reported association of firesetting with suicidal thoughts, depression, interpersonal problems, anger/revenge motivation and lack of planning supports the view that behaviour is used to manage distressing life experience and as a “cry for help”. However, in a quarter of incidents there was an intention to harm others and evidence of premeditation in twelve percent. A small but significant minority lacked insight into their behaviour, were not ready for treatment and had low firesetting related self-efficacy. Predictions made by the M-TTAF about likely clinical features and motivators of emotionally expressive firesetters were largely supported.

The study highlights the importance of a detailed and specific risk assessment of firesetting that leads to identification of individual risk factors and an individualised treatment approach. This is of particular importance given the complex problems presented by women in secure settings and by the diversity of the conditions associated with fires set by each individual.

The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards.

Patients and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards.

The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment.

Treatment interventions need to optimise research findings that attest to the influence of the environment on the behaviour of patients with intellectual disabilities.

Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care.