Helen Walker

A randomised controlled trial to explore insight into psychosis; effects of a psycho-education programme on insight in a forensic population

A psycho-education programme for people with psychosis has been delivered across forensic services for years. A multi-site randomised controlled trial was carried out over a three and a half year period, to review the effectiveness of the programme. A range of psychometric instruments were used to measure the following: insight; knowledge of psychosis; general mental health, including depression, quality of life, and social behaviour. Results from (n = 81) indicate a significant improvement in knowledge and empathy. An improvement was also noted in the measures of insight, mental health, and quality of life, although they did not reach significance. In conclusion, psycho-education has a place in forensic clinical practice. It is recommended that psycho-education programmes are used across the forensic network as part of a package of care, to improve the patient experience and reduce the likelihood of re-offending.

‘New to Forensic’; implementing a problem‐based introductory educational programme for forensic practitioners in Scotland

Accessible summary • An introductory education programme entitled ‘New to Forensic’ has been developed for staff working in and across existing range of forensic services. The programme allows staff to learn about the processes and methods of working with people who become part of the forensic service, who are often described as mentally disordered offenders. This is the first forensic education programme of its kind in Scotland. • The process of development and implementation as part of the first programme in the new School of Forensic Mental Health (SoFMH) is described, and includes a summary of the numbers of people involved in the project. • A formal evaluation was undertaken as part of this initiative and early findings are described. Results from questionnaires issued before and after using the programme indicate that people who have completed it feel much more confident in their knowledge of forensic-related issues. Abstract The New to Forensic educational programme has been developed for use across all forensic services in Scotland. It is designed to meet the needs of all staff who are both new to and already working within forensic mental health services. Its objectives are targeted to both clinical and non-clinical staff. The programme follows the patients journey through the mental health and criminal justice systems. It covers mental disorder, legislation, psychiatric defences, assessment and treatment, risk of harm to others, services, attitudes and boundaries, multidisciplinary working, users and carers, community, learning disability, and prison services. It is self-directed and practice based, and uses a problem-based approach. Over a 3-year period, trainers and mentors have been trained to deliver the programme by members of the School of Forensic Mental Health http://www.forensicnetwork.scot.nhs.uk/ and all services have adopted the programme as a core educational initiative. Initial findings from the programme evaluation indicate a significant improvement in learning following engagement in the initiative.The New to Forensic educational programme has been developed for use across all forensic services in Scotland. It is designed to meet the needs of all staff who are both new to and already working within forensic mental health services. Its objectives are targeted to both clinical and non-clinical staff. The programme follows the patients journey through the mental health and criminal justice systems. It covers mental disorder, legislation, psychiatric defences, assessment and treatment, risk of harm to others, services, attitudes and boundaries, multidisciplinary working, users and carers, community, learning disability, and prison services. It is self-directed and practice based, and uses a problem-based approach. Over a 3-year period, trainers and mentors have been trained to deliver the programme by members of the School of Forensic Mental Health http://www.forensicnetwork.scot.nhs.uk/ and all services have adopted the programme as a core educational initiative. Initial findings from the programme evaluation indicate a significant improvement in learning following engagement in the initiative.

Experience Focussed Counselling with Voice Hearers: Towards a Trans-diagnostic Key to Understanding Past and Current Distress—A Thematic Enquiry

As it is increasingly evident that distressing voices can be linked to traumatic events across diagnoses, there is a need for new transdiagnostic interventions for persons with voice hearing related distress. Twenty-five interviews with voice hearers and mental health professionals explored the trans-diagnostic suitability of Experience Focussed Counselling (EFC) compared to Treatment As Usual. An Applied Thematic Analysis was used. Themes identified were: intervention applicability; impact of regular treatment before study; impact of EFC process; process of working with voices; impact of regular treatment during study; views on treatment or approach. The EFC focus was considered helpful across diagnoses. The findings support EFC as a transdiagnostic intervention.

Scotland ' s approach to forensic mental health and learning disabilities – the Forensic Network

Purpose – The Forensic Mental Health Services Managed Care Network is described, including the School of Forensic Mental Health. The purpose of this paper is to outline background, it details successes and challenges, focuses on links to clinical practice for Learning Disabilities (LD) service development, describes education and training, multi-disciplinary and multi-agency working and quality improvement. Findings from a small scale brief educational study undertaken in the high-secure service are included as an example of good practice. Design/methodology/approach – Specific features relating to LD are highlighted. Comparisons are made with other managed clinical and managed care networks. Findings – The Forensic Network has evolved over time. It has played a crucial role in shaping Scotland’s approach to Forensic Mental Health and LD. Central to its success is active involvement of key stakeholders, a multi-agency approach and collaborative working practice. Future plans include formal evaluation of i...

Organisational impact of a forensic education programme.

Purpose – The purpose of this paper is to evaluate the organisational impact of the New to Forensic Mental Health education programme, developed for use across all forensic services in Scotland. To date, 267 have been trained as a trainer or mentor; 502 have completed the programme and 375 are yet to complete. The programme is designed to promote self‐directed learning and is multi‐disciplinary and multi‐agency in approach. It includes case studies and problem‐based learning relating to patients in a variety of settings, from the community to high secure care.Design/methodology/approach – As part of a larger longitudinal study to assess the value of this New to Forensic Mental Health education programme, organisational impact was assessed using semi‐structured interviews with (n=13) senior staff working in forensic services. Participants were purposively selected for interview.Findings – Transcripts were analysed using thematic analysis, which revealed three themes: “Acquiring knowledge: what you learn an...

Experience of collaborative research practice in forensic mental health

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.

Are they worth it? A systematic review of QOL instruments for use with mentally disordered offenders who have a diagnosis of psychosis

Purpose – Reports on quality of life (QOL) measures for forensic patients are severely limited. The present paper aims to consider how to assess chronic patients well‐being and to identify and evaluate the content validity of measures used to assess health‐related QOL in psychosis.Design/methodology/approach – A review was undertaken to gather information on the different QOL measures from relevant databases, exploring their strengths and weaknesses.Findings – Results from the review indicate a broad range of assessment tools are used in practice, although very few have been used in forensic settings. A preference for subjective tools is emerging, in addition to patient rated scales as opposed to clinician rated scales.Originality/value – The application of QOL measures in the forensic population is of particular interest and a relatively new area of study, thus of value to practicing clinicians. It is hoped that the use of appropriate tools will enhance understanding of the treatment and service needs f...