This thesis aimed to explore assessment and treatment issues amongst underresearched groups of sexual offenders. Chapter One sets the context for the thesis. Chapter Two includes a critical appraisal of a widely used risk assessment tool (Risk Matrix 2000), including its validity with groups such as sexual offenders with intellectual disabilities (ID) and internet offenders. Chapter Three details the results of an empirical study which sought to explore the prevalence, characteristics and static risk factors for sexual offenders with ID, with and without a history of non-sexual violence (N=54). The former group were more likely to evidence antisocial features (prior condition failures and previous non-sexual/non-violent offences); whereas the latter group were more likely to have committed a sexual offence against a male victim. Amongst a subgroup (n=32), one quarter committed a further sexual offence over a mean follow-up period of four years. Failure to complete treatment was associated with sexual recidivism. Over one quarter committed a violent offence and other ·1 non-sexual offence. Age at referral was associated with these types of oj recidivism. History of violence was unrelated to all types of recidivism. Chapter Four includes a systematic review of primary research studies that have investigated dynamic risk factors for sexual offenders with ID (N=214). The results suggested that sexual offenders with ID are more likely to hold offence supportive attitudes, and may not utilise sources of social support as effectively as other men with ID. A case study of an internet offender is presented in Chapter Five. Current issues in the assessment and treatment of this group are also critically explored. Chapter Six considers practice implications, thesis limitations and future research directions.

No description available.

Despite the many barriers ex-prisoners face when attempting to 'go straight' many successfully lead law abiding lives. Yet how this is achieved in light of the widespread stigma attached to this cohort has received little empirical attention. Specifically, an area that neglects consideration is the reformed ex-prisoner's experience of self-change and in particular, how they negotiate their stigmatised ex-offender status. To address these issues, this thesis utilises a hermeneutic phenomenological analytic framework. Three empirical investigations were conducted utilising a small sample of reformed exprisoners. In studies I & 2, a sample of ten male reformed ex-prisoners (five in each study) took part in semi-structured interviews. Data were subjected to an Interpretative Phenomenological Analysis (IP A). In study 3, data was collected by means of a dialogical interview consisting of two male reformed ex-prisoners. Here IPA was used in an innovative way as a means of analysing the data. The initial study illustrated that the ex-offender status (ex-offender self) appears to be a binary phenomenon, which has a contradictory influence on the ex-prisoner's sense of self. The second study develops these findings by illuminating the complex tensions underlying this contradiction. The third study utilises a conceptual lens to refine and distil the previous findings, by identifying the experiential structures underlying the contradictory nature of the ex-offender self. Three key patterns were identified which are equally responsible for generating the conflict, namely morality, masculinity and stigma. A synthesis of all three studies, discussing the most salient patterns with reference to relevant theoretical and empirical literature is provided. This thesis concludes by making suggestions for future research and discusses the implications of this empirical work for policy and practice

This thesis considers the experiences of both staff and adult male prisoners involved in group-based sex offender treatment in prison, and explores the potentially diverse needs of different groups of prisoners. In-depth interviews were conducted with ten prisoner participants at a single prison, all of whom had completed the Core Sex Offender Treatment Programme (SOTP) (Mann & Thornton, 1998) and identified with at least one of three specified minority groups (BME, physically disabled, gay or bisexual). These groups were identified on the basis of current knowledge gaps. A second study involved interviews with fourteen members of staff drawn from different establishments, all of whom had experience of delivering Core SOTP. Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009) was selected as an appropriate method of analysis. For prisoners, superordinate themes relating to the therapeutic process, group membership and identity, and group dynamics are reported. For staff, super-ordinate themes relating to power relationships, responding to needs, and managing the group are presented. For each study, data are presented as descriptive, phenomenological accounts alongside substantive verbatim quotes from interviewees. Separate discussion chapters are included for the purposes of engaging in higher order analysis, interpretation, and making relevant links to existing theory. For prisoners, this allows for a more detailed consideration of various narratives of identity, both at an individual and group level. Connections between wider experiences of prison, and diversity issues in the context of treatment are highlighted. For staff, identity is also discussed, but framed in terms of interactions with prisoners, other staff and feelings of professional competence. The exploratory investigation of data from two small samples allows for a rich and detailed analysis of complex and under-researched issues. A consideration of both studies in tandem also makes it possible to engage in a process of triangulation, revealing commonalities and contrasts in the ways in which both groups experienced related phenomena. In conclusion, recommendations for both further research and practice are considered.

A review of existing literature shows that there is a lack of research regarding appropriate adult schemes for vulnerable adults in England and Wales. Little is known about how appropriate adults construct and understand their role. Given this, the present study aimed to explore ‘professional’ appropriate adults’ accounts of working to support adults with mental health needs during their time in police custody. Semi-structured interviews were conducted with nine ‘professional’ appropriate adults attending police custody settings to support adults identified as mentally vulnerable according to the Police and Criminal Evidence Act (1984). A grounded theory method was used to collect and analyse the data. The core concept generated in the analysis was that appropriate adults ‘construct and manage multiple identities’ when working in their role. There were four categories identified as being part of this process: ‘what is PACE?’; ‘in negotiation with the police’; ‘in negotiation with the clients’ and ‘my appropriate adult scheme’. A complex negotiation and dynamic understanding of each category influenced participants’ construction of their identities as an appropriate adult, and how they went about carrying out their work. The findings are discussed, and recommendations for training, policy review and further research are outlined.

Background: High levels of mental health and substance misuse disorders within the criminal justice system (including prisons, courts and police stations) have been reported across the world. In responding to this challenge, some countries have developed liaison and diversion services. These services began in England and Wales in the 1980s, but their coverage and quality have been patchy and they have been less developed in police custody than in the courts. Studies reported in this thesis aim to evaluate one such service operating in police custody. Methods: A multiagency group including the Local Authority, Metropolitan Police and local Mental Health Trust obtained grant funds to introduce a mental health service innovation into two police stations in South London. The service became operational in 2012, and from the outset routine service and follow-up information was collected on consecutive referrals. Data covering an 18-month period were analysed using a statistical software package. Meanwhile, the effect of an open referral system on local prison mental health in-reach team referrals was evaluated using a before-after design. Results: The referred group (n = 1092) presented with very high levels of mental health and substance misuse morbidity, vulnerability, and suicide risk. Most had established mental health problems (66.8%) and histories of drug or alcohol use (60%) and an important number (144/888: 16.2%) presented with suicide ideation. Many (370/516: 71.7%) required onward referral to a range of services, and although existing service linkage was protective, male gender and current drug or alcohol use predicted non-engagement. Conclusions: It is possible for a mental health service to operate effectively in police custody, but such services require enough resources to deal with the high levels of presenting need and clinical risk. Service links appear protective and should be prioritised, but some referred groups require enhanced support to facilitate service engagement.

Research to date suggests that violent individuals with psychosis do not constitute a homogenous group, and subtypes of offender exist. One proposed subtype consists of people with comorbid antisocial personality traits, who constitute a significant proportion of individuals in forensic psychiatric services but have attracted little focussed research. This thesis aimed to characterise this comorbid group by examining the neuropsychological characteristics, emotion processing characteristics and clinical outcomes of male patients recruited from high-secure forensic psychiatric hospital, falling into one of the following diagnostic groups: 1. psychotic disorder (n=15); 2. dissocial personality disorder (DPD; n=17); and 3. comorbid psychosis and DPD (n=26). Clinical groups were compared to each other and to a group of healthy controls (n=30) on measures of neuropsychological functioning, facial affect recognition, sensorimotor gating and appetitive and defensive responding. In addition, the clinical groups were compared on their historical characteristics (offending, psychosocial, psychopathy) and current clinical outcomes, corresponding to clinician rated clinical progress, risk/violence and engagement with the clinical team. The relationship between the characterisation measures and outcomes (progress, risk and engagement) was explored to assess the clinical relevance of such indices. The results supported a distinct subgroup of those with comorbid psychosis and DPD, who were characterised by a poorer sensorimotor gating profile and poorer fearful facial affect recognition than their non-DPD counterparts, with a tendency towards poorer neurocognition. The comorbid group was more similar to the DPD alone group on experimental and historical measures. The clinical groups did not differ from each other, or healthy controls, on appetitive/defensive responding, and the clinical groups did not differ with respect to outcomes. Measures of memory, executive function and facial affect recognition correlated with indices of outcome, suggesting that such characteristics may be promising treatment targets within forensic mental health services.

No description available.

Formal conceptualisation of the construct of insight' in general psychiatry has been a major research enterprise over the past twenty years. Debate about the construct continues, but it is generally accepted to refer to patients' understanding of their mental state. This review is prompted by the observation that the term 'insight' is also used by the forensic psychiatric community but with apparent differences in meaning. A review was undertaken to examine the use of the term in the current literature relating to the risk assessment and management of mentally disordered offenders. Seventeen papers were retrieved that referred to insight, but an important role for the construct in risk assessment was identified. It is argued that the small number of papers reflects the lack of research interest in this area. Within the identified literature, considerable variation in the use of the term insight' was noted. In many, but not all cases, insight' is used to refer to the patient's understanding of their offending behaviour, as well as, as part of, or instead of their mental illness. The models of this identified insight into offending behaviour' construct also varied. The paper concludes that there are serious ethical and public safety issues in the current non-standardised use of the insight construct within forensic psychiatric practice and calls for further empirical inquiry to formalise matters relating to its nature, value and clinical assessment.

Suicide, a global problem, affects individuals from diverse backgrounds. Higher at-risk groups include vulnerable populations, such as offenders and prisoners. Most suicide research focuses on prisoners with little focus on probation populations. The lived experiences of probation clients who have made suicide attempts has not previously been explored. Furthermore, research on experiences of probation staff managing suicidal offenders is limited. Consequently, the current research explored the experiences of probation clients who made near-lethal attempts, as well as the experiences of staff managing these clients, and strategies to prevent suicide. Study 1 explored probation staff experiences of managing suicidal clients through in-depth interviews. Findings indicate that staff felt inadequate in managing these issues, but training and experience facilitated better management techniques. Studies 2a & 2b explored the perspective of individuals serving probation sentences who had made near-lethal attempts. Findings suggest that the suicidal state was experienced in relation to perceived loss of control, which often related to their probation process. Clients felt that non-judgmental listening prevented suicide attempts. However, disclosure was sometimes unlikely due to a fear of being judged or lacking trust in others. Study 3 employed 3-6 month follow-up interviews to explore changes in clients’ perspectives. Findings suggest that following reflection on their attempts, clients’ time perception fluctuated. For example, time leading up to the attempt was perceived as slow whilst the actual attempt was quick and impulsive, and following the attempt time slowed down. This slowness in time prior to the suicide attempt could be an opportunity for interventions. Findings highlight the need for extra support regarding negative coping strategies in order to prevent offending and suicide. Moreover, clients receiving support for their suicidal feelings and maladaptive coping mechanisms did not make further attempts. Study 4 compared the experiences and views of probation clients with staff. Findings demonstrate similar views in terms of when and why suicides occur, and what can be done to prevent suicide. However, poor communication between the two parties was a barrier to suicide management. The unique contribution of this program of research lies in its understanding of suicide from the perspectives of probation clients who have experienced it; providing unique understandings about clients at high risk of suicide, ways of preventing suicide, and what barriers exist for clients who need help.