In 2003, 90% of the prison population in England and Wales were categorised as having a mental illness (Birmingham, 2003). The male prison population contained a 1000 prisoners affected by Psychosis and nearly 2000 in need of immediate psychiatric treatment (Birmingham, 2004). Schizophrenia has been associated with an increased risk of criminality (Munkner, Haastrup, Joergensen & Kramp, 2009), high levels of reported aggression and violence during first time episode of psychosis (Harris et al., 2010). Schizotypal psychopathological characteristics can be found on a continuum (Claridge & Brooks, 1984; Eysenck & Eysenck, 1975) whereby they vary in severity due to a continuous phenotype (Van Os et al., 2000) in contrast to the categorical model. Consequently, a sub-clinical category of psychopathological behaviour has been identified, referred to as Schizotypy (Claridge, 1998). Method This thesis explores the reasoning abilities of non-clinical individuals screened for Schizotypal tendencies using the Peters Delusion Inventory (PDI, Peters et al., 2004). A series of specially designed unique crime based reasoning tasks were created to assess the potential differences, biases and errors in crime based reasoning when comparing high and low scoring individuals for Schizotypal tendencies. In addition, participants completed a short interview or audio diary, to record their reflections about completing the task, as well as considering any emotional responses. Results An innovative four-part self-referencing scale (me, family, friend & stranger) demonstrated that individuals typically made quicker decisions about themselves compared to making decisions about other people. However, reaction time data suggested that self-reference was unaffected by Schizotypy when engaged in crime based decision making (p > 0.05). Reaction times proved to be either unaffected by Schizotypy whilst completing crime based reasoning tasks or an insufficient measure of the biases associated with Schizotypy. As an alternative, ‘data gathering’ measures provide a much more sensitive measure which helped to describe and detect the differences in Schizotypy, e.g. a significant main effect of reference level was found using ‘data garthering’ data (p < 0.05) and error score data (p< 0.05). The modality in which the crime based reasoning tasks were presented impacted upon the biases associated with Schizotypy, as opposed to any differences being as a result of dual processing functions placing greater demands on cognitive functional processing. The qualitative data provided a consistent and coherent account of metacognitive experience of reasoning whilst completing the tasks. The qualitative results have allowed a more coherent overview of the relationship and differences in experiences between high and low schizotypal scorers to emerge, based around the themes of emotion, justification and morality, and reasoning strategies (Wilkinson, Jones & Caulfield, 2011). Discussion Each of the studies within this thesis contributes to a better understanding of the biases that impact upon crime based reasoning, as well as confirmation of a ‘jump to conclusions’ bias (Dudley & Over, 2003; Dudley & Over, 1997; Huq, Garety & Hemsley, 1988) occurring in those individuals who scored high for Schizotypal tendencies. Furthermore, high scoring individuals demonstrated a reduction in emotive responses to the reasoning task scenarios and in some cases reported seeking the fewest pieces of information upon which to base their decision (Wilkinson, Jones & Caulfield, 2011). The qualitative methods developed for this research are particularly novel in the field of thinking and reasoning, and proved to be invaluable tools in helping shape the direction of the experimental work as well as providing better insight into the mechanisms involved in crime based decision making.

Section 1: Literature Review Page 1: This literature review considers the existing research on empathy and theory of mind in offenders with intellectual disabilities, beginning with definition of the terms and discussion of the importance of considering empathy in terms of its components. Due to a lack of research specific to this area, the review summarises and brings together findings from the separate fields of empathy and theory of mind in offenders and empathy and theory of mind in people with intellectual disabilities. Existing findings are inconclusive, leaving uncertainty about whether offenders are more or less skilled than non-offenders in these areas and further research is therefore necessary. Section 2: Research Report Page 41: A quantitative comparison is carried out between a group of offenders with intellectual disabilities and a group of non-offenders with intellectual disabilities, on measures of empathy and theory of mind. Offenders performed significantly better than non-offenders on some sub-tasks, with all other comparisons showing no significant differences between groups. It is concluded that the present methodology and philosophy of considering empathy and theory of mind as composite concepts should be utilised in future research to clarify the issue. Section 3: Critical Appraisal Page 80: A critical appraisal of the research process, this section discusses both the personal and professional issues that affected the work and comments further on its methodological limitations and clinical implications.

BACKGROUND: Violent personality disordered offenders detained in secure hospital care present 2 major challenges. The first is the provision of appropriate treatment, as the group is heterogeneous. Here, it has been suggested that a typology based on the degree of anger control may be useful. The second is the assessment of their risk to others. AIMS: 1) To revisit the over-undercontrolled typology by examining the evidence for distinguishing criminological and psychopathological features between violent personality disordered subjects whose index offence was their only violent offence (Single Violent offenders, SV) and those who had more than one conviction for violence (Repeat Violent Offenders, RV). 2) To explore the process of risk assessment in respect of these offenders. METHODS: 1) 51 violent personality disordered offenders detained in medium or high secure care, were divided into SV and RV groups and were compared on variables of interest. 2) The process of assessing their risk was examined using a questionnaire administered to members of the patients' multidisciplinary team. RESULTS: 1) In comparison to the RV group, the SV group were less likely to be convicted of non violent offences. They were less antisocial and psychopathic, and showed greater anger and behavioural control. 2) Although perceived agreement as to the risk of future violent behaviour of their patients was high, actual agreement within the MDT was low. Clinicians rated offence and treatment factors as more influential on their risk judgments than other historical and social factors, and structured risk assessment tools. CONCLUSIONS: There were some distinguishing features between the SV and RV groups but these appeared to be due to the undercontrolled nature of the RV group, rather than the overcontrolled nature of the SV group. Risk assessment, as recommended in the research literature was not being carried out in practice.

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ABSTRACT RAND Europe (2008) highlighted several risk factors for violent crime, including mental illness and high levels of anger (Novaco & Renwick, 1998). Recently anger management interventions for the mentally disordered offender (MDO) population have been critiqued for a lack of acknowledgement of the driving force of other emotions present when angry, including shame (Walker & Bright, 2009a). Lewis (1971) argued that shame is such an unbearable emotion that individuals protect themselves using anger and aggression, giving rise to the shame-rage spiral. Evidence for the existence of a link between shame and anger exists in the general population (e.g. Tangney, Wagner, Fletcher & Gramzow, 1992) but within the forensic population, results are less conclusive (Farmer & Andrews, 2009). Authentic (specific) pride in one's achievements can give rise to high social status via prestige and hubristic (global) pride in oneself raises the self through dominance (Cheng, Tracy & Henrich, 2010). Hubristic pride has been linked to aggression and hostility (Paulhus, Robins, Trzesniewski, K.H., & Tracy, 2009). The current study aimed to explore the relationship between shame and anger; in addition it examined the influence of authentic and hubristic pride upon this relationship in MDOs. Medium and low secure settings were accessed from across London and a total of 51 participants completed the State-Trait Anger Expression Inventory-II (Spielberger, 1999); the Experience of Shame Scale (Andrews, Qian & Valentine, 2002); the Authentic and Hubristic Pride Scale (Tracy & Robins, 2007) as measures of anger, shame and pride respectively. Correlation analyses revealed significant positive associations between levels of trait anger, anger expression and angry reaction (sub-scale of trait anger) with total shame and the shame sub-scales of characterological (personal) and behavioural shame. Hierarchical regression analyses were conducted to establish the extent to which pride predicted levels of trait anger over and above that of shame; total shame explained a significant amount of variance (22.3%) in Trait Anger (F(l, 48)= 15.09, p<.OOI; R2 =.239, adjusted R2 =.223). Authentic and hubristic pride at Step 2 did not contribute a significant increase in variance explained. In the final equation, only total shame significantly made a unique contribution to levels of Trait Anger (t(46)= 3.708, p<.Ol). Results are discussed in relation to the literature and limitations are considered. The clinical implications are explored.

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This is an exploratory study of the experiences of service users in forensic mental health settings, including how service users make sense of these experiences and their link to identity. Current research into forensic mental health services is very limited (Coffey,2006). Research has focussed on describing specific events but has not explored how service users have experienced their environment, relationships, and treatment. The information that has been gathered has focused on medium and high secure settings with very little research having been conducted in low secure setting settings. There was therefore a need for further research to inform clinicians and influence their practice so as to reduce psychological distress and risky behaviour, and to work towards recovery and reintegration into the community. Semi-structured interviews were conducted with six service users from a low secure forensic mental health service to explore experience. These accounts were analysed using Interpretative Phenomenological Analysis (Smith, 1995) to create themes that reflected experiences, understanding of these experiences and identity. Individual cases and group themes have been presented. Service users described a range of experiences such as feeling vulnerable, experiencing life as having been interrupted and valuing positive experiences with other people. Their understanding of these experiences fell into four categories: biological, psychosocial stress, behavioural and experience as being senseless. Participants used a range of ways from each category to make sense of their experience and these were sometimes contradictory. There was also a theme of participants trying to make sense of other people's thinking. Each participant had a combination of ways of understanding that was individual to them. Participants evaluated their character, ability and affiliation to help define their identity. These evaluations had an interpersonal aspect. The findings of the study have been discussed in relation to research from settings with different levels of security. They have also been discussed in relation to social psychological frameworks such as Symbolic Interaction (Blummer, 1938,1969), Social Representation Theory (Moscovici, 1973) and Social Identity Theory (Tajfel and Turner, 1986) to help understand meanings and how identity is shaped by experience. Clinical implications have been discussed. These include increasing opportunities for meaningful activities and relationships, and working with service users to help them to find ways of coping with their internal experiences, to feel empowered and take an active role in their recovery, and to build positive identities.

Objectives Previous research has employed the Transtheoretical Model of Change (TIM) (Prochaska & DiClemente, 1982, 1984) to understand the processes of change. This study investigates whether self esteem, distress, locus of control and social desirability are associated with, and can predict readiness to change in mentally disordered offenders, consistent with processes identified by TIM. Design and Method A cross-sectional design was employed to assess 73 mentally disordered offenders, with a diagnosis of psychosis, who completed self-report measures: Rosenberg's Self Esteem Inventory (RSES), the Outcome Questionnaire (OQ-45), Marlowe-Crowne Social Desirability Index (MCSDI) and Rotter's Locus of Control (RLoC). Readiness to Change was measured by the University of Rhode Island Change Assessment (URICA) (DiClemente and Hughes, 1990). Results All participants were categorised in the precontemplative stage of change. Participants with high readiness to change report higher symptom distress, lower self esteem and lower social desirability than those with low readiness to change. Regression analyses identified that self-esteem was the only significant predictor of readiness to change. All participants were found to have an external locus of control relative to previous research. Conclusions The results identify a potential model for readiness to change that could inform interventions, with a focus on self-esteem, to improve readiness to change.

Qualitative research, undertaken with intellectually disabled (ID) offender participants, is rarely reflected within the research literature. This lack of research evidence, which listens to the voices of ID offenders, serves to portray qualitative enquiry as of limited value with this client group and therefore quantitative methods remain the dominant research method within the field. The first section of this thesis reports a mixed-method review exploring the status of published qualitative studies with ID offender participants. The review employs systematic search techniques to identify relevant studies and then assesses the quality of these papers using a quality framework. It is contended within the conclusions of the review that the status of qualitative research with ID offenders is perceived as low due to the limited number of published studies and the poor quality with which this form of enquiry is generally undertaken. Within the research paper, of this thesis, qualitative enquiry was undertaken with ID offender participants, nurses and clinical psychologist using constructivist grounded theory methods. The aim was to explore the process by which ID offenders are seen and see themselves as ready to engage with psychological therapy. The results highlighted a temporal process within which a number of central elements were interlinked, including 'stability/ predictability', 'development of relationships with staff, and 'reassurance'. The model was discussed in relation to current evidence on readiness and clinical implications were made in terms of care and treatment.

No description available.