Brian Thomas-Peter

Violence, mental disorder and risk assessment: can structured clinical assessments predict the short-term risk of inpatient violence?

This study considered the ability of items on the HCR-20 and VRS, structured clinical risk assessments, to predict inpatient violence within the first 6 months of admission to a secure forensic service. A retrospective file review of information available at time of admission was used to complete the Historical and Clinical scales of the HCR-20 and VRS for a sample of 44 male inpatients. The ability of these risk assessments to predict recorded incidents of violent behaviour, as measured by official incident reports, was then assessed. The predictive validity of individual scale items was also considered. The HC composite and VRS did not predict inpatient violence within the first 6 months of admission. However, the clinical sub-scale of the HCR-20 was predictive of violence, abuse or harassment. When considering repetitiveness there was some indication across the scales that static factors predicted isolated incidents and dynamic factors repetitive violence. A number of individual items within the scales appeared to act as predictive or protective factors for inpatient violence. Despite the poor predictive validity of the scales overall, this study provides some indication of the differential utility of these structured clinical assessments for predicting short-term risk of violence in inpatients. In particular the use of dynamic clinical factors in identifying those likely to engage in imminent repetitive violence.

Changing violent behaviour: Forensic mental health and criminological models compared

Evidence-based interventions designed to reduce the risk of re-offending, particularly violent re-offending, are commonly offered in correctional systems around the world. The interventions are often based upon the application of several principles of service delivery that have become widely known as the ‘what works’ approach to offender rehabilitation. The applicability of these principles to forensic psychiatric services has yet to be determined. The aims are to examine the possible application of the ‘what works’ approach and its implications for forensic mental health practice. The method used was a review of relevant research from both the general offender and forensic psychiatry literature. The principles underlying the ‘what works’ approach are likely to have utility in service delivery in forensic psychiatry, particularly when a treatment target is a reduction in risk of harm to others. The individualized models of patient care practiced in forensic psychiatry are also likely to have utility in improving treatment outcomes in correctional settings. The conclusion is that an increased interchange of ideas and interventions between the two areas of practice is likely to be of mutual benefit. This is an area that requires significant development.

Professional and ethical challenges of forensic clinical psychology

This paper describes the ethical and professional challenges encountered by two experienced forensic clinical psychologists in the course of their daily work. Five examples are chosen from a typical working week which illustrate and explain a particular professional dilemma and the forensic or organisational context The paper concludes that professional guidance from the British and Australian Psychological Societies and the legal framework and organisation of services to very damaged mentally abnormal offenders are inadequate and often unsupportive of psychological intervention, It also suggests that preparation to deal with these typical problems should be addressed in continued professional training.

AN INVESTIGATION OF THE FACTOR STRUCTURE OF THE NOVACO ANGER SCALE

The Novaco Anger Scale is the only scale published that allows for the measurement of anger with relation to Novacos (1976) widely used model of anger management. This paper is the first to present a statistical analysis of the factor structure of this scale. From a sample of healthcare employees and outpatients with problems with anger control, a factor solution was identified. It is suggested that the items loading on this scale contribute to valid assessment of anger. The implications for the use of the NAS are considered.

High‐risk inferences in assessing high risk: outstanding concerns in the clinical use of the PCL‐R

The PCL‐R has been heralded as the ‘unparalleled’ (Salekin et al, 1996) risk assessment tool for assessing risk of violent and non‐violent recidivism. In the UK, the PCL‐R looks likely to become an industry standard assessment in psychological evaluation of individuals thought to have a dangerous and severe personality disorder. However, current knowledge about the PCL‐R is unsatisfactory, and a number of issues need to be addressed before clinicians can be confident in the use of this measure. This paper highlights these issues from the perspective of the practising clinician. Questions are raised about the theoretical, methodological and treatment implications of the use of the PCL‐R. Future research needs are established in this context of caution over the use of the measure in routine clinical and academic assessment.

An investigation of the personality characteristics of mentally disordered offenders detained under the Mental Health Act

Abstract Although the debate over the use of the legal classification of psychopathic disorder has been prolific, little research has been conducted in examining how the term is being used in current practice. This study used a retrospective case-note analysis to investigate the characteristics of patients who had been detained under the Mental Health Act 1983 at a regional secure unit (RSU) since 1987. The sample included all individual inpatients referred to, and assessed by, the clinical psychology department, for whom data from the Millon Clinical Multiaxial Inventory were also available. No differences were found between offenders detained under ‘psychopathic disorder’ and those legally classified as ‘mentally ill’ with respect to admission details and offending characteristics. Those people detained under ‘psychopathic disorder’ demonstrated the presence of more antisocial features. The results from a cluster analysis of the MCMI personality scales supported Blackburns (1975) typology. The cluster ...

Debasement and faking bad on the Millon Clinical Multi-axial Inventory III: An examination of characteristics, circumstances and motives of forensic patients

Purpose. This article constitutes the first effort to consider debasement employing the Millon Clinical Multi-axial Inventory III (MCMI-III) in a forensic clinical population and incorporating the recommendations of Van Denburg and Choca (1997). It considers the proposition (Rogers, 1990a) that the pathogenic and criminological models of malingering can be rejected in favour of the adaptional model. Methods. A total of 142 MCMI-III profiles were collected over a 17-month period by a forensic psychology service. Of these, 47 had Debasement scale scores greater than 74. From the remaining 75, a group of 47 were randomly selected for comparative purposes. Of the total sample there were 75 males and 19 females, 68 were out-patients and 26 were in-patients, the latter having been detained under the Mental Health Act 1983, applicable to England and Wales. The two groups were compared on personality variables, offending history, presenting problems and referral circumstances. Results. There is tentative support for Rogers (1990a) in that situational variables appear to have a significant impact on debasement as would be predicted by the adaptional model of malingering. However, this was insufficient evidence to reject the pathogenic and criminological models of malingering. Conclusions. It is suggested that a longitudinal study examining the impact of different stages of the mental health or criminal justice system on debasement, and other validity scales, would illuminate the adaptional model further. Factors that influence the inclination to exaggerate psychopathology and which could be manipulated experimentally are also noted. Some speculation about the possible combined use of Debasement and Histrionic, Narcissistic and Compulsive scales in distinguishing between malingerers is offered. Language: en

Preventing sexual contact between professionals and patients in forensic environments

This paper considers the issue of sexual contact between staff and patients in psychiatric and, especially, forensic environments. Such relationships have been the subject of research in generic settings where a substantial minority of mental health professionals have been found to be involved. The effect of these relationships is substantial on both the individual patient and the organization. However, the issue of unethical intimacy is neglected by professions and organizations despite the harm done to patients they purport to care for. Characteristics of patients and staff who become involved in this type of activity are discussed and the particular features of forensic environments are raised in relation to understanding the violation of intimate boundaries. Recent studies call into question the assumption that such abuse is the preserve of male staff. Some suggestions are made for preventing this problem in psychiatric facilities.

Legal Responsibilities of Forensic Psychologists

This paper discusses the legal, ethical and professional issues encountered in forensic psychology. Psychological theory and research potentially have much to contribute to legal questions. The paper presents examples of psychologys contributions in the areas of risk assessment, the reliability of childrens evidence and the assessment of sexual interest. Furthermore, it is suggested that psychological understanding of personality disorder should inform legal processes to a greater degree than at present. The paper therefore both describes and challenges the current relationship between psychology and the law.