Aim: To examine the experiences and attitudes of patients aged 60 and over who are resident in a high-security hospital, and their care staff, using qualitative research methodology, with a view to ...informing a service model for this group. Results: Of the 16 patients aged 60 and over resident in Broadmoor Hospital, 12 were interviewed, along with 21 members of staff. The patients were located on nine different wards, despite the existence of a specialist ward for older patients. The median duration of stay was 17 years. The large number of issues identified from the interviews fell into four broad clusters: quality of life, vulnerability, risk to others, and resources. An overarching theme emerged to do with the uniqueness of these older patients, in their difference both from younger high security peers and from people of similar age elsewhere. Conclusions: Care needs should not be assumed on the basis of age alone but must be individually assessed. Many older serious offenders with mental disorder have extensive experience of relevant services, are articulate, and, together with their care staff, could assist in shaping better services for a probably expanding population.
Suicide in high security hospital patients Jones, Roland M.; Hales, Heidi; Butwell, Martin ...
Social Psychiatry and Psychiatric Epidemiology,
08/2011, Volume:
46, Issue:
8
Journal Article
Peer reviewed
Purpose
People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence ...to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide.
Methods
We extracted data from the Special Hospitals’ Case Register on each person resident at any time between 1 January 1972 and 31 December 2000. Suicide rates were calculated for the whole period. We compared rates to the general population using standardised mortality ratios (SMRs). We used poisson regression to estimate the effects of gender, legal category of detention, offending history and length of admission on the suicide rate.
Results
Of the 5,955 individuals, 218 completed suicide. The suicide rate was nearly 7 times higher among resident men (SMR 662, 95% CI 478–845) and over 40 times higher in resident women (SMR 4,012, 95% CI 2,526–5,498) than in the general population; it was 23 times higher (SMR 2,325, 95% CI 1,901–2,751) and 45 times higher (SMR 4,486, 95% CI 2,727–6,245) among post-discharge men and women, respectively. The suicide rate was significantly higher among women than men inside high security but not after discharge.
Conclusions
The suicide rate among high security hospital patients was significantly higher than in the general population. Women were especially at risk while resident, whereas for men, the risk was higher after discharge.
Abstract Background Contemporary theories and evidence implicate defective emotion regulation in violent behaviour. The two psychiatric illnesses most implicated in violence are schizophrenia and ...antisocial personality disorder (APD). This study examined behavioural and brain abnormalities in violent men with schizophrenia or APD during anticipatory fear. Method Fifty-three men 14 non-violent healthy controls, 13 with schizophrenia and a history of serious violence (VSZ), 13 with schizophrenia without a history of violence (SZ), 13 with APD and a history of serious violence underwent blood-oxygenation-level-dependent fMRI during an experiment involving repeated presentations of ‘safe’ and ‘threat of electric shock’ conditions and provided ratings of shock anticipation and fear. Schizophrenia patients did not have co-morbid APD. Results VSZ participants reported the highest, and APD participants the lowest, level of shock anticipation and fear, with intermediate ratings by SZ and healthy participants. The violent, relative to non-violent, groups showed altered activity modulation in occipital and temporal regions, from early to latter parts of threat periods. Additionally, VSZ patients displayed exaggerated whereas APD patients showed attenuated thalamic-striatal activity during latter threat periods. Conclusions Aberrant activity in occipital and temporal regions when exposed to sustained visual threat cues is associated with a predisposition to violence in both schizophrenia and APD. This common biological deficit, however, appears to arise from dissimilar behavioural mechanisms related to differences in the strength of aversive conditioning and behavioural response to sustained threat cues (enhanced in VSZ; attenuated in APD), also reflected in opposite patterns of alternations in thalamic-striatal activity, in these two disorders.
This article examines the evaluation process and approach undertaken for a recent 3-year Integrated Justice Practice project. Three key approaches underpinned the evaluation framework or program ...logic: participatory evaluation, action research, and continuous reflective practice. The project involved an evaluation of community agencies working in complex settings, within a human service delivery context. The mix of processes encouraged these agencies to own the evaluation through providing clarity and grounded information about what works, how, and what does not work and why, so as to improve both service delivery and community understanding, and to affect policy and funding settings. The discussion is situated within several theories of 'participatory evaluation' - meaning that the views of service receivers and providers were included both in the research and in its design. These perspectives were essential because input from young people about how legal services support them, and from providers about the policies services adopt is rare. The services and their partners reported that the evaluation process had been 'transformative', with each identifying changes in practice. It's also edifying for the evaluators, revealing that cultural competency, trust, respect and safety are critical elements when engaging with young people with unresolved legal issues, including family violence.
Subjective experience of early imprisonment Williams, Hannah Kate; Taylor, Pamela J.; Walker, Julian ...
International journal of law and psychiatry,
05/2013, Volume:
36, Issue:
3-4
Journal Article
Peer reviewed
Some say ‘prison works’, others say that it only harms. Overall, longitudinal studies of prisoners suggest some positive impact on mental state, but post-release recidivism is high. How do men at ...high risk for repeated imprisonment experience it?
To explore prison (gaol) experience among men awaiting trial in custody.
In a prospective longitudinal study, 170 men were interviewed just after reception about their social context and mental state and again three weeks later, when each was asked to describe his current prison experience; 75% had been in prison before. Data were analysed qualitatively and quantitatively.
Each man had views on his imprisonment. Data were saturated after 20 interviews. The core concern was its overall emotional impact, in full negative to positive range, with recognition that this could and did change in either direction, both passively and through active processes. Underpinning themes were along the dimensions of missing people to asylum from the outside world; in-prison bullying to positive staff and/or inmate relationships; boredom to relief in routine; and ‘doing my head in’ to salvation from drug-induced decline. Testing the model in the whole sample confirmed no association between prison impact and pre-prison factors. Negative experience was associated with severe depression within but not before this imprisonment. More positive experience related to good in-prison relationships.
During pre-trial custodial detention, there is a greater range of experience than generally previously reported. The simple expedients of prison staff developing good relationships with prisoners, and facilitating these between prisoners, could be life-saving. Highly positive experiences may be more an indictment on community services than an endorsement of imprisonment.
The problematic issues related to standardized assessment of the nonstandard and to multiple ways of knowing in the visual arts motivated the research and first phase development of eLASTIC: ...electronic learning and assessment tool for interdisciplinary connections. In this article, the author describes the evolution and implications associated with this research centering upon the edifying nature of student-initiated links and connections. Using experiences from a 3-year study in Doha, Qatar, this eLASTIC research promises to inform the development of tools that compel students to learn beyond the curriculum while at the same time offering embedded assessments that yield ample data for demonstrating what art students know and are able to do.
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