Severe personality disorder,treatment engagement and the Legal Aid,Sentencing and Punishment of Offenders Act 2012: what you need to know

Empirical research has demonstrated a link between legal coercion and treatment engagement following conviction among those with severe personality disorder. Legal coercive pressures were often applied by the Indeterminate Sentence for Public Protection (IPP), until it was replaced by the Extended Determinate Sentence by the Legal Aid, Sentencing and Punishment of Offenders Act 2012. In this paper, it is proposed that use of the new determinate sentence will lessen motivation for treatment engagement. One effect of treatment refusal may be greater reliance by the Secretary of State for Justice on his jurisdiction to transfer prisoners due for release to secure hospital transfers under the Mental Health Act 1983. Not only will this risk posturing undermine the principal aim of the Offender Personality Disorder Implementation Pathway to improve treatment engagement among the target group, it will also have negative implications for medical practitioners working in secure forensic hospitals. To demonstrate what is at stake, the paper briefly recapitulates empirical findings familiar to readers of the journal, before drawing on original unpublished data.     

Judges’ views on evidence of genetic contributions to mental disorders in court

This preliminary analysis assesses how judges view the use of behavioral genetics evidence on genetic influences to mental disorders in court. Twenty-one semi-structured interviews, analyzed using constant comparative analysis, were conducted with California trial court judges. Most judges reported the beneficial effects of this evidence being presented in court, particularly as a mitigating factor for sentencing. Yet some judges viewed it as an aggravating factor and expressed concerns about genetic privacy. Judges described initial reactions to being potentially presented with evidence on genetic influences to mental disorders as apprehension, curiosity, and sympathy. Judges also reported putting significant trust in experts on these issues. Findings suggest some judges are skeptical of this evidence, but largely open to its presentation. Sympathetic reactions may result in mitigating attitudes of some judges. As judges significantly trust experts, some judges could also be overly trusting of genetic evidence and expert opinion on these issues.     

Spirituality and health outcomes among police officers: empirical evidence supporting a paradigm shift

The negative impact of traumatic and other work-related stressors on the health of police officers is well-documented. Spiritual development is also commonly mentioned in the professional literature as an effective means of protecting officers from the ill-effects of policing, reportedly resulting in improved health and wellness outcomes. However, few empirical studies have been conducted to support claims regarding spirituality and police officer health. The present study investigated what types of spiritual practices police officers used, the relationships between spiritual effort and spiritual growth regarding various psychological and stress-related symptomatology, and whether differences in psychological and health outcomes existed between police officers engaging or not engaging in spiritual practice (N = 193). With one exception, the results do not support the notion that enhanced spirituality is associated with lower illness symptoms or perceived stress. Rather, opposing findings were demonstrated involving positive associations between spiritual growth and distress. Spiritual effort, however, was inversely associated with alcohol use, a behavioral-based coping mechanism. Implications of these findings are discussed, and suggestions for reconceptualizing police health and spiritual practices are introduced.     

Screening for mental disorder using the UK national offender assessment system

Probation officers have large caseloads with high levels of psychiatric morbidity but receive minimal training in recognising/managing mental health problems. In the UK, there is no national screening procedure for mental illness among offenders that is considered effective. This study’s aim was to develop a screening system for mental/personality disorders using the Offender Assessment System. Seven screens for mental disorder were developed using items from assessments on 574 prisoners: alcohol misuse, drug dependence, antisocial personality disorder, psychopathy, learning difficulties, psychosis and severe mood disturbance. Internal validation showed that the screens performed well across accuracy estimates. Prevalence of mental disorders identified with the screens in test and validation samples was similar. However, the psychopathy and severe mood disturbance screens may be more effective in screening for true negatives. The screens are an economical method for prioritising mental health needs of the UK prison and probation population using routinely collected data.     

Analysis of some commonly found inhalants using gas chromatography-mass spectrometry (GC MS) – Effect of substrates on the identification of inhalants

Inhalant abuse is a serious and ever-evolving problem for our society. Inhalants are abused more commonly by teenagers and adolescents. Inhalants such as glue, paint thinners, correction fluid, and nail paint remover are easily available in the market which makes them readily abused. Out of various methods of abuse, huffing (placing a piece of cloth soaked with inhalant is placed in the mouth), bagging (placing head in a polythene bag containing inhalant), and ballooning (balloons filled with inhalant are used for inhaling vapors through the mouth) are most common. Inhalant abuse results in multiple target organ dysfunction with neuritis and brain damage due to the dissolution of the myelin sheath. In acute poisoning cases, it might cause death due to asphyxia and sudden sniffing syndrome. In such cases, various articles containing traces of inhalants could be retrieved from the scene of incidence and to detect these traces become an important facet of the investigation. However, it might be difficult due to the rapid evaporation of inhalants and the formation of reaction product species. In the present study, an attempt has been made to study the effect of three substrates (balloon, cloth, polythene) on component profiles of four paint thinners and four nail paint removers. The study suggests that although some components are retained, there is the formation of a large number of reaction product species and these must be taken into consideration before furnishing the opinion. These reaction product species might also be inhalant specific which must be further explored.     

社会工作对青少年网络成瘾问题的干预

青少年网络成瘾给青少年的身体、心理和社会性发展带来了极大威胁。究其原因,主要是青少年身心发展不成熟、网络的极大吸引力以及家庭教育失位、学校教育失力与社会环境的复杂共同作用的结果。因此,社会工作者要通过各种方式做好预防工作,并在正确判断青少年网络成瘾＂真假性＂的基础上,激发青少年治疗网瘾的动机,以有效治疗网络成瘾的青少年,并评估成效,跟进服务。     

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital

Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.     

Characterising the psychiatric comorbidities among adults with ADHD who have a history of offending

The prevalence of attention deficit hyperactivity disorder (ADHD) among adult offenders is significantly higher than in the general population. Adults with ADHD often present with multiple psychiatric comorbidities. This study aims to characterise the comorbidities presented by adults with ADHD who have offended and also to investigate predictors of offending among this population. Seventy-three participants with a diagnosis of adult ADHD were divided into a group with a history of offending behaviour (n = 30) and a group of non-offenders (n = 43). Groups were compared on measures of ADHD symptoms, substance use and DSM-IV Axis I and Axis II disorders using the Millon Clinical Multiaxial Inventory – 3rd Edition. Major depression, cannabis use and childhood hyperactivity-impulsivity symptoms predicted offending. These findings indicate that adults with ADHD who have a history of offending behaviour are more likely to present with complex psychiatric needs.     

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.     

Offenders as victims: post-traumatic stress disorder and substance use disorder among male prisoners

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those who had not, were more likely to nominate heroin as their main drug of concern and to be receiving drug treatment in prison. There was also a trend toward inmates who had experienced a trauma in prison being more likely than inmates who had no prison trauma to have experienced a physical assault. Conclusion: Male prisoners with SUD-PTSD are a high-needs group yet treatment responses are poor. Further research examining treatment options for this comorbidity may improve prisoner well-being and reduce recidivism.