Alice L. Bennett

Investigating changes in anger and aggression in offenders with high levels of psychopathic traits attending the Chromis violence reduction programme

BACKGROUND Chromis was accredited by the Correction Services Accreditation Panel in 2005 as an intervention designed to reduce violence in offenders whose level or combination of psychopathic traits disrupts their ability to engage in treatment and change. It runs as part of the regime in the dangerous and severe personality disorder unit in HM Prison Frankland (Westgate). A multiple case study investigation into changes over time in participants is currently underway, part of which is reported here. AIMS This paper reports on information relating to changes in anger and aggression in Chromis completers. METHODS Change in psychometrics and observed incidents of verbal and physical aggression are considered for five case study participants who have completed Chromis and progressed from Westgate to a different location. RESULTS Findings suggest that cases experienced a reduction in self-reported anger, and expected incidents of physical aggression but had higher than expected levels of verbal aggression after leaving Westgate. CONCLUSIONS These findings offer cautious optimism for the effectiveness of Chromis, although methodological limitations must also be considered. Findings may be seen as positive indicators of Chromis, or at least the approach to working with these offenders across Westgate, in reducing violence. IMPLICATIONS FOR PRACTICE Findings support the continued delivery and evaluation of Chromis. There may be benefit in exploring ways to further understand and address verbal aggression in participants.

The Westgate Service and Related Referral, Assessment, and Treatment Processes:

The formerly named “Dangerous and Severe Personality Disorder” (DSPD) units are no longer standalone services within the criminal justice system in England and Wales. These sites now provide personality disorder treatment services in the high-security prison estate as part of the new national Offender Personality Disorder (OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the assessment, treatment, and management of offenders who are likely to have a personality disorder and who present a high risk of re-offending (men and women) and serious harm to others (men). Further PD treatment and progression services are being commissioned in lower security prisons and in the community as part of the new PD Strategy. While the suitability criteria for the two male high-security PD treatment sites are the same, the individual units have their own assessment and treatment methods. This article aims to communicate the referral, assessment, and treatment methods employed within the prison-based Westgate Personality Disorder Treatment Service, HMP Frankland.

Service users’ initial hopes, expectations and experiences of a high security psychologically informed planned environment (PIPE)

Purpose – The purpose of this paper is to explore service-users’ hopes and expectations of a psychologically informed planned environment (PIPE) located in the high-security prison estate. Design/methodology/approach – A semi-structured interview was used to explore the hopes and expectations of five male Category A PIPE prisoners. Interviews were transcribed verbatim and thematic analysis was used to analyse the data. Findings – Analysis resulted in two overall themes: “Progression” and “Being Part of a Community”. Relevant sub-themes were considered to portray processes within these two wider themes. Practical implications – In applying these findings to practice, this study provides evidence that places value on the current referral process which ascertains prisoners’ motivations to attend the PIPE. Originality/value – This is the first known study that explores service-users’ hopes and expectations of the pilot PIPE service. The PIPEs are included within the recently introduced Offender Personality Di...

The Chromis Experience An Interpretative Phenomenological Analysis of Participants’ Experiences of the Chromis Programme

This study examined male prisoners’ experiences of participating in the Chromis programme, which aims to address violent behaviour in offenders with high levels of psychopathic traits. Four men who had completed Chromis and moved to new locations were purposefully sampled. This provided the opportunity for men to discuss their experiences after participating in the full programme and away from any influences of the treatment environment. Interview schedules were designed using interpretative phenomenological analysis (IPA). Interview transcripts were analysed independently by two researchers using IPA who then compared and contrasted findings to develop superordinate themes across the group. Four superordinate themes resulted. These were “It’s me and what I want that matters,” Reaping the rewards, “It’s treatment itself that makes things hard,” and Make or break external influences. Across the board, participants benefited at some level from Chromis. Participants’ experiences highlighted useful information that can inform practice with individuals with high levels of psychopathy. The clinical implications are discussed.

Co-morbidity of personality disorder and clinical syndrome in high-risk incarcerated offenders

Purpose In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service. Design/methodology/approach The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015. Findings Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ2 analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample. Practical implications In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders. Originality/value The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.

What is the pattern of self-harm and prison rule-breaking behaviour in personality disordered offenders in a high secure prison?

Purpose The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders (PDs) within a high security prison. Design/methodology/approach A comparative quantitative case study design supported the understanding of the frequency and pattern of SH and PRB behaviour across two stages of a PD treatment programme for 74 male prisoners. Data obtained from the prison’s records were analysed using dependent t-tests, χ2 test of independence and time-frequency analyses. Findings Inferential statistics showed that the frequency of SH and PRB behaviour statistically increased across two phases of the PD treatment programme; however, the method of SH or type of PRB behaviour engaged in did not change. Mapping the frequencies of incidents using a time-frequency analysis shows the patterns of both behaviours to be erratic, peaking in the latter phase of treatment, yet the frequency of incidents tended to decline over time. Originality/value This is the first study to explore SH and PRB behaviours in men across two phases of a PD treatment programme. This study highlights the need for continued psychological support alongside the PD treatment programme with a focus on supporting men in treatment to effectively manage their SH and PRB behaviour.

Implementing evidence-based psychological substance misuse interventions in a high secure prison based personality disorder treatment service

Purpose – The purpose of this paper is to describe the need for substance misuse treatment with high risk, personality disordered prisoners and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options. Design/methodology/approach – In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and “InsideOut” interventions are presented. These interventions adopt a risk reduction and health intervention approach, respectively. This includes explanations of how they came to be implemented within a prison-based personality disorder treatment service and potential ways to evaluate these services. Findings – Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery. Practical implications – The high levels of co-morbidity between personality disorder and substance misuse disorders in the high-security prison estate highlights the need for substance-related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered. Social implications – The initial development of evidence-based psychological interventions for this service resulted from the dangerous and severe personality disorder pilot and subsequent introduction of the offender personality disorder pathway. Further developments have occurred alongside the revised National Drug Strategy introduced by the UK Government in 2010. This strategy directed a progression within drug and alcohol treatment services promoting that mutual aid be provided alongside the delivery of treatment interventions in order to maximise the probability of service-users maintaining abstinence from substance use. Originality/value – This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

Personality factors related to treatment discontinuation in a high secure personality disorder treatment service

Purpose – The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) associated with treatment discontinuation in a sample of adult male prisoners. Design/methodology/approach – Data from 92 male offenders in a high secure prison personality disorder treatment unit was analysed. PCL-R and personality disorder diagnoses were predicted as being related to increased treatment dropout. Findings – Having a diagnosis of narcissistic personality disorder was related to treatment dropout, but PCL-R total scores were not. There was a trend for a diagnosis of antisocial personality disorder being associated with remaining in treatment. Research limitations/implications – The current study highlights that narcissistic personality disorder can be associated with treatment dropout, warranting further exploration as to why this is the case. Practical implications – Managing responsivity issues for those presenting with a personality disorder diagnosis could be effective in maximising treatment engagement from this specific offender group. Originality/value – Although treatment dropout has been explored previously, this is the first study to explore treatment dropout at a specialised unit designed specifically to provide treatment for this client group.