E Glorney

Dual diagnosis in the suburbs: prevalence, need, and in-patient service use.

Abstract  Background: Previous research has found comorbid severe mental illness and substance misuse (dual diagnosis) to be highly prevalent and to be associated with serious clinical and social problems, and increased service use in inner-city populations. The present study measures the prevalence of dual diagnosis, patterns of substance misuse, and associated in-patient use in a more demographically representative population in a suburban area of South London Method: We identified representative prevalent cases with psychotic illnesses who had been in contact with services in a geographically defined catchment area in Croydon over the previous 6 months. Cases of alcohol or substance misuse and dependence were identified through standardised interviews with patients and keyworkers, and socio- demographic and in-patient psychiatric service use data were also recorded. Results: Sixty-one of the 124 cases identified were randomly selected for interview, of whom 66% responded (N = 40). The prevalence rates of dual diagnosis (DD) observed were 33% (95% CI 18–47%) for any substance misuse, 20% (95% CI 8–32%) for alcohol misuse only, 5% (95% CI −16 to 26%) for drug misuse only, and 8% (95% CI −0.7 to 16%) for both drug and alcohol misuse. A lifetime history of any illicit drug use was observed in 35% of the sample (95% CI 20–50%). Patients who misuse alcohol and drugs were not found to be more likely to have been admitted to hospital in the previous 2 years, with little difference being observed between DD and psychosis-only patients in the mean number of in-patient admissions in this period (mean difference 0.25, 95% CI for difference −1.5 to 2.0). However, the DD patients were found to have spent on average over twice as long in hospital as other psychotic in-patients over the previous 2 years (mean difference 67.3 days, 95% CI for difference −205.9 to 71.2 days). DD patients were also found to have a greater number of unmet areas of need than the psychosis-only patients, which included accommodation, daytime activity, and social life, as well as substance misuse. Conclusions: The prevalence of substance misuse in patients with severe mental disorders in a suburban area is about as high as that for similar patients in inner-city London. While DD patients are not admitted more often than patients with psychosis alone, they have double the length of in-patient stay, which may be attributable to higher levels of unmet need.

Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

There are financial and humanitarian consequences to unmet need amongst service users of high secure hospital care, not least in terms of length of stay. This article presents two reviews of high secure service user needs. They provide support for the sequencing of interventions to meet service user needs and the utility of a structured framework for their review. Through analyses of these reviews, eight domains of need were identified: Therapeutic Engagement, Risk Reduction, Education, Occupational, Mental Health Recovery, Physical Health Restoration, Cultural and Spiritual Needs, Care Pathway Management. A model is presented, within which logically sequenced, timely and relevant interventions could be framed in order to provide a comprehensive and streamlined pathway through a high secure hospital.

Mental illness, substance abuse, demographics and offending: dual diagnosis in the suburbs

High rates of offending and violence have been found in patients with co-morbid severe mental illness and substance misuse (dual diagnosis), although research has focused upon inner-city populations. This study compares offending and violence rates in patients with dual diagnosis (DD) and patients with psychosis only, drawing on a more demographically representative population. Forty patients with severe mental disorders were interviewed in a geographically defined catchment area in Croydon, Surrey. Cases of alcohol or drug misuse were identified, and measures of lifetime history of offending (including violence) and recent violence were obtained. DD patients were more likely to report a lifetime history of both offending and violence than patients with psychosis only (although gender may play a greater role than substance misuse). Few instances of recent violence were found, and no between-group differences were detected. The medical caserecords of DD patients were significantly more likely to contain a lifetime history of non-substance misuse-related offending, but not violence. However, the extent to which substance misuse contributes to violence and offending independently of contextual variables requires further investigation.

Toward Identification of the Sexual Killer: A Comparison of Sexual Killers Engaging in Post-Mortem Sexual Interference and Non-Homicide Sexual Aggressors

Establishing a model of sexual assault reflecting psychosocial and behavioral characteristics of perpetrators of sexual killing and rape is necessary for development in risk assessment and intervention. Methodological variations in defining sexual killing have amalgamated serial and non-serial offenders and perpetrators with direct and indirect associations between killing and sexual arousal. This study defined sexual killing specifying that killing should be directly linked to sexual arousal, and sampled 48 sexual killers, operationalized to include only those engaging in post-mortem sexual interference, with one or two known female victims (non-serial), from prison service national (England and Wales) databases. These sexual killers were compared with 48 non-homicide, life or indeterminately sentenced sexual aggressors on psychological and crime scene characteristics. Contrary to previous research, fatal outcomes were associated with neither stranger victims nor weapon presence; sexual killing was characterized by severity of violence less so than non-fatal assault. Sexual killers more often reported problems with emotional loneliness, empathic concern, and sexual entitlement than the sexual aggressors. Theoretical and applied implications are discussed.

Development of a Case Formulation Model for Individuals Who Have Viewed, Distributed, and/or Shared Child Sexual Exploitation Material:

Increases in the number of arrests of individuals who download or distribute Child Sexual Exploitation Material (CSEM) have highlighted a need to further understand the offending pathways of this offender group. This article describes the development of an aetiological model specific to CSEM offending. Individuals who had viewed, distributed, and/or shared CSEM (n = 20) were interviewed regarding their life and sexual history, relationships, substance use, offending details, and circumstances leading to their CSEM offending, resulting in seven superordinate themes: Developmental Context, Individual Propensities (risk-related and risk-protective) and Psychological Vulnerabilities, Personal Circumstances, Permission-Giving Thoughts, Internet Environment and Behaviour, Evaluation of Consequences for the Individual, and Desistance. These themes were combined into a case formulation tool specific for CSEM offending behaviour, with the aim of providing systematic guidance for assessment and treatment providers.

Individuals’ experiences of sexual offending therapy in a forensic psychiatric setting

ABSTRACT There is a paucity of research exploring individuals’ experiences of sexual offending therapy, particularly in forensic psychiatric settings. This study qualitatively explored the perspectives of six male medium-secure patients regarding the treatment programme they completed to address their sexual offending behaviour. Thematic analysis of interviews generated two themes: the experience of transition through the programme and the experience of engagement. The importance of gaining service-user feedback and the implications for programme design and delivery are discussed.

Patient Focus Group Responses to Peer Mentoring in a High-Security Hospital

Peer mentoring programs in secure hospitals have attracted limited attention despite reported benefits of similar schemes within other mental health and prison services. High-secure hospital patient perspectives (N = 17) on the concept of peer mentoring and the implications for establishing a peer support scheme were investigated via focus groups. Thematic analysis of discussions generated five themes: how to meet the adjustment and support needs of a peer; differences between mentoring and other relationships; mentoring by peers within a secure setting; expectations of a mentors skills to meet the challenges of mentoring; and ownership of a mentoring scheme. The need to offset risk management against the potential benefits of peer support for a population excluded on the basis of risk is reviewed throughout.