Lucy McCarthy

Beauty in the eye of the beholder? How high security hospital psychopathically-disordered patients rate their own interpersonal behaviour

As service user involvement, particularly through ‘expert patient’ schemes, increases for service development and implementation in the UK, we investigated the concordance between how patients with personality disorder view their interpersonal functioning and the views of staff who care for them in a high security mental health setting. We compared self and observer ratings of interpersonal functioning for 55 legally-defined psychopathic disorder patients detained in a high security psychiatric hospital using the CIRCLE, an instrument designed to assess interpersonal functioning. We found that male patients underestimated their worst qualities, such as dominance (p < .0005) or coerciveness (p < .0005), and overestimated their best qualities, such as nurturance (p < .0005), a finding not intuitively surprising but which confirms aspects of previous research. This result raises the questions of how such discordance should be interpreted, whether self or observer ratings should be considered more valid, and whether such findings have a bearing on both future risk assessment and the individuals eventual movement from high secure care.

The impact of treatment on hostile-dominance in forensic psychiatric inpatients: relationships between change in hostile-dominance and recidivism following release from custody

This study explored the impact of psychiatric and psychological treatment on hostile-dominance in 51 offenders with personality disorder in a secure psychiatric unit. Hostile-dominance was assessed at intake and repeated at six monthly intervals. In 28 of the participants with reassessment of hostile-dominance, who were subsequently discharged into the community, the association between reoffending (Grave and Any) and change in hostile-dominance (measured by subtracting the final hostile-dominance score from the initial score), psychopathic traits, Antisocial Personality Disorder (ASPD) and treatment completion/non-completion was examined. Results revealed that patients who completed treatment evidenced a reduction in hostile-dominance, whereas patients who did not complete treatment worsened. Logistic regression analyses showed that reduced hostile-dominance, psychopathy and ASPD predicted reoffending (Any). Treatment completion and Psychopathy Checklist Factor 1 scores predicted Grave reoffending. Findings are supportive of the potential for the level of hostile-dominance to be reduced through completion of appropriate treatment; such changes are important to reductions in reoffending.

Patients with a history of arson admitted to medium security: Characteristics on admission and follow-up postdischarge

Patients who set fires are a perennial cause of concern with psychiatric services although perhaps rather neglected in the clinical research literature. The current study considered the characteristics on admission of 129 patients, 93 men and 36 women, with a known history of arson who had been admitted to a medium secure psychiatric hospital. The distinguishing characteristics of the sample were high numbers of patients with extensive criminal histories, most probably due to high levels of prison transfer and a higher occurrence of mental illness than psychopathic disorder. Aside from return to prison, most patients were discharged either to another psychiatric hospital or directly to the community. There was a high rate of re-conviction after discharge, mainly for minor offences, with about one in 10 of discharged patients committing arson. It was established, however, that not all incidents of arson led to a prosecution. It is concluded that there are weaknesses in the areas of both risk assessment and evidence-based treatment for arsonists.

Mentally disordered parricide and stranger killers admitted to high-security care. 2: Course after release

When deciding to transfer a patient from high-security care, the most important determinant will often be the likelihood of further violence. Despite this, there are surprisingly few data to inform the clinician on the risks posed by particular groups. We compared the outcome of a group of mentally disordered offenders convicted of either parricide (n = 53) or the killing of a stranger (n = 71) after their release from high-security care (mean duration of follow-up = 6 years). All the patients were released still subject to restriction orders under the Mental Health Act 1983. None of the sample committed a further homicide during the follow-up and their history of further violence was also low. These data add further evidence to the widely held view that transfer from high-security care may be unduly restrictive.

The Characteristics and Course After Discharge of Mentally Disordered Homicide and Non-Homicide Offenders

The aim of this article was to compare the characteristics and outcome of homicide and non-homicide mentally disordered patients all of whom had been hospitalised. Seventy-four patients with a homicide conviction were compared with 521 convicted of a non-homicide offense. The former group were older, were more likely to be diagnosed with schizophrenia but less likely to have suffered from childhood adversity, and had less criminality. They also had fewer convictions during the follow-up. Little distinguished these two groups with both suffering from multiple disadvantages suggesting the need for ongoing care and support.

P-683 - Development and validation of a scale to evaluate treatment progress in secure mental health settings

Introduction Forensic Mental Health provision in secure healthcare is complex. The availability of a short and quantifiable, yet comprehensive instrument for summarising patient progress encompassing multi-professional clinical input would facilitate clinical decision-making. Objectives To develop and validate a Progress Rating Scale (PRS) for use in secure healthcare to assess patient course in treatment. Aims PRS items will reflect multi-professional clinical input. Measurement will be valid and reliable. Method Scale items Development was undertaken at the Personality Disorder Service, Arnold Lodge Regional Secure Unit. Thematic analysis of 5 randomly selected archived treatment reviews resulted in a preliminary list of items. This scale was then piloted and refined via independent rating of further anonymised reports. Validation and further development To assess content validity, 3 independent raters applied the scale on archived treatment reviews of 12 randomly selected patients. Following examination of single-rating intra-class correlations (ICCs), items were revised to achieve greater content validity. Results The domains of the scale were: Engagement, Behaviour, Mental State, Interactions with Peers and Staff, Insight, Supportive relationship, Employment, Leave, Violence/risk, Psychometric score and Final outcome (upon discharge). Initial inter-rater agreement ranged from fair to substantial (ICCs: 0.37–0.82). Following revisions, agreement improved ranging from moderate to substantial (ICCs: 0.63–0.92), the latter applying to most items. Conclusions A scale for evaluating patient progress was developed based on multi-professional clinical input. The scale was refined to improve content validity. Internal consistency and factorial structure are under scrutiny and results will be available at the conference.