Forensic Mental Health Services
Transcription
Forensic Mental Health Services
10th Anniversary National Conference Research in Forensic Mental Health Services Institute of Psychiatry, 14th March 2013 The FANS Teaching Unit at the Institute of Psychiatry Conferences & Workshops The Forensic and Neurodevelopmental Sciences (FANS) Teaching Unit runs conferences, workshops and seminars for mental health professionals of all disciplines. Our multidisciplinary team of trainers has extensive experience in using, and delivering training in, risk assessment tools; providing expert evidence; working with people with learning disability; and assessing and managing developmental disorders. All our risk management trainers have been trained by the authors of the risk assessment tools we use. We offer training in the following risk assessment tools: • HCR-20 - v3 • Structured Assessment of Protective Factors (SAPROF) • Short-Term Assessment of Risk and Treatability (START) • Risk of Sexual Violence Protocol (RSVP) • Managing Risk of Violence in Adolescence (Structured Assessment of Violence Risk in YouthSAVRY) We also provide Advanced Workshops for Instructors: for experienced practitioners in using risk assessment tools. Other events include: • Courtroom Skills and Report writing for psychiatrists • Improving Skills in working with Mentally Disordered Offenders with Learning Disabilities • Autism Spectrum Disorders (ASD) in Adults: Assessment and Management ….and many other conferences and seminars on Forensic and Neurodevelopmental topics All our events can also be delivered in-house. For further information or to be included in our mailing list please contact Alessandra Scotti on [email protected] 10th Anniversary National Conference Research in Forensic Mental Health Services Institute of Psychiatry, 14th March 2013 Welcome We are delighted to welcome you to the Tenth National Conference of Research in Forensic Mental Health Services. This event has been a long standing collaboration between the Institute of Psychiatry (IoP) and Partnerships in Care (PiC). The primary aim of this event is to encourage services to produce high quality research through collaboration and also to provide a forum for significant research findings to be translated and implemented within services. This conference is one of the largest events of its kind in Europe and we believe that its success in this tenth anniversary year is due to the active participation of the broad range of professional groups working across forensic mental health services. Over the years this conference has been able to attract high calibre key note speakers from the UK and internationally. This year is no exception and we anticipate that the key note speaker presentations will generate much discussion and reflection. Again, we have been impressed by the volume and quantity of papers submitted this year. We are encouraged to have received submissions from healthcare services across different levels of security, prison settings and across the life span. The Scientific Organising Committee has found it very challenging to limit the number of accepted papers. The book of abstracts therefore also includes details of the poster submissions that are on display during the conference. We also hope to provide some inspiration for junior researchers to continue with their endeavours. In 2012 we launched a special award for the best paper presented by a junior researcher at the conference. The worthy winner was Lauren Herlitz. We look forward to announcing a winner at this year’s conference. Finally, we wish to thank our colleagues in the Organising Committee and senior administrators at the Institute of Psychiatry and Partnerships in Care for helping to organise this conference. We hope you enjoy it! Professor Tom Fahy Consultant Psychiatrist & Clinical Director Forensic Services, SLaM NHS Foundation Trust and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Dr Quazi Haque Group Medical Director Partnerships in Care and Honorary Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Scientific Organising Committee Dr Adrian Cree, Regional Clinical Director, Partnerships in Care South East Services Honorary Senior Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL Professor Conor Duggan, Head of Research and Development, Partnerships in Care Professor Tom Fahy, Consultant Psychiatrist & Clinical Director Forensic Services, SLaM NHS Foundation Trust Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL Dr Quazi Haque, Executive Medical Director, Partnerships in Care Honorary Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL Dr Shubulade Smith, Consultant Psychiatrist, SLaM NHS Foundation Trust Senior Lecturer & Teaching Unit Co-Director, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, KCL Administrative Support Alessandra Scotti and Maddy Pickles, Forensic and Neurodevelopmental Teaching Unit, Institute of Psychiatry, KCL Debbie Larkin and Susan Ramwell, Communications Team, Partnerships in Care Programme 09.00 09.30 Registration Introduction 09.35 Keynoteaddress-Howcriminalcareerresearchcanhelpinformspecificinterventions Professor Alex R. Piquero, Ashbel Smith Professor, University of Texas at Dallas, and Key Centre forEthics,Law,JusticeandGovernance,GriffithUniversity,Australia Questions & discussion 10.20 10.35 Professor Tom Fahy, Institute of Psychiatry and Dr Quazi Haque, Partnerships in Care 11.00 Key note address - Violence by military personnel deployed to Iraq and Afghanistan: a new forensic population? Dr Deirdre Macmanus, Institute of Psychiatry, King’s College London Questions & discussion 11.10 Morning break - viewing posters 11.40 Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Research presentations 12.50 Premise in South London Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services Dr Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study of adult schizophrenia patients and attending physicians in forensic and civil psychiatry Key note address - Risk assessment in females; violence, psychopathy and self-injury Professor Nicola Gray, Pastoral Healthcare, Ty Catrin, Cardiff Questions & discussion 13.00 Lunch - viewing posters 13.50 14.15 Key note address - Crime and mental illness: clinical implications of new research Dr Seena Fazel, University of Oxford and Oxford Health NHS Foundation Trust Questions & discussion 14.25 Gareth Hopkin, Critical Time Intervention for Severely Mentally Ill Released Prisoners: Pilot and 14.40 Dr Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/ criminaljusticeinterface:preliminaryfindingsfromacase-linkagestudy Dr Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study Afternoon break - viewing posters 11.55 12.10 12.25 14.55 15.10 15.35 Research presentations Randomised Control Trial 16.15 Key note address - What Works for Sex Offenders? A Review of the Evidence Professor Conor Duggan, Partnerships in Care and University of Nottingham Young Scholar Award 16.25 Close Key Note Biographies Professor Conor Duggan BSc, PhD, MD, FRCPsych, OBE, Partnerships in Care and University of Nottingham Conor Duggan is Emeritus Professor at the University of Nottingham and Head of Research and Development at Partnerships in Care. He was until recently an Honorary Consultant Psychiatrist at Arnold Lodge, Regional Secure Unit in Leicester where he shared responsibility for a 22-bedded in-patient unit that treats men with personality disorder and a history of serious offending. His research interests are treatmentefficacyinpersonalitydisorderedoffenders,theirlong-termcourseandtheneuropsychological basis of psychopathy. He was until recently Editor of The Journal of Forensic Psychiatry and Psychology and chaired a NICE Guidence Committee on Antisocial personality Disorder. He was awarded an OBE for his services to mental health in June 2012. Dr Seena Fazel, University of Oxford and Oxford Health NHS Foundation Trust Seena Fazel is a Wellcome Trust Senior Research Fellow in Clinical Science in the Department of Psychiatry, University of Oxford. He is also an Honorary Consultant Forensic Psychiatrist for Oxford Health NHS Foundation Trust, and works clinically in a local prison. His research interests are primarily in the relationship between mental illness and crime, and the mental health and suicide risk of prisoners. Professor Nicola Gray, Pastoral Healthcare, Ty Catrin, Cardiff Professor Nicola Gray received her PhD from the Institute of Psychiatry for her work on the neuropsychology of schizophrenia. She completed her MSc in Clinical Psychology before taking up a joint position at Caswell Clinic (the medium secure unit for South Wales) and Cardiff University where she was awarded a Personal Chair. She is now Head of Psychology for Pastoral Healthcare and has helped set up a new Personality Disorder service in Cardiff (Ty Catrin). She is a honorary professor at Swansea University and the Director of the Welsh Applied Risk Research Network (WARRN). Professor Gray’s research interests are in risk assessment and management, Personality Disorder, sexual offending and neuropsychology. She regularly trains professionals on Structured Professional Judgment for the assessment of future risk and management (e.g., HCR-20, RoSP) and other risk assessment schemes. She has published widely in the areas of risk assessment, psychopathy, implicit cognitions and schizophrenia. Dr Deirdre Macmanus, Institute of Psychiatry, KCL Dr MacManus is a clinical lecturer in forensic psychiatry and currently acting as consultant psychiatrist for the London Trauma Service for Veterans. She trained in Medicine in Edinburgh and came to the Maudsley for higher specialist training in forensic psychiatry. In recent years she has been funded by the Medical Research Council to carry out her PhD research into the risk factors for violence among UK military personnel deployed to Iraq and Afghanistan. 6 Key Note Biographies Professor Alex R. Piquero, Ashbel Smith Professor, University of Texas at Dallas, and Key Centre forEthics,Law,Justice,andGovernance,GriffithUniversity,Australia Alex R. Piquero is Ashbel Smith Professor in the Program in Criminology in the School of Economic, Political, and Policy Sciences at the University of Texas at Dallas, Adjunct Professor Key Centre for Ethics,Law,Justice,andGovernance,GriffithUniversity,FacultyAffiliate,CenterforViolenceandInjury Prevention George Warren Brown School of Social Work Washington University in St. Louis, and CoEditor of the Journal of Quantitative Criminology. Prior to arriving at UT-Dallas, he was on the faculties of Florida State University, University of Maryland, John Jay College of Criminal Justice/City University of New York, University of Florida, Northeastern University, and Temple University. He has published over 240 peer-reviewed articles in the areas of criminal careers, crime prevention, criminological theory, and quantitative research methods, and has collaborated on several books including Key Issues in Criminal Careers Research: New Analyses from the Cambridge Study in Delinquent Development (Cambridge University Press, co-authored with David P. Farrington and Alfred Blumstein) and Handbook of Quantitative Criminology (Springer, co-edited by David Weisburd). His work has been cited over 10,000 times and he has been ranked as the #1 criminologist in the world since 1996 in terms of scholarly publications in elite criminology/ criminal justice journals. In addition to his membership on over a dozen editorial boards of journals in criminology and sociology, he has also served as Executive Counselor with the American Society of Criminology, Member of the National Academy of Sciences Panel Evaluating the National Institute of Justice, Member of the Racial Democracy, Crime and Justice Network at Ohio State University, and Member of the MacArthur Foundation’s Research Network on Adolescent Development & Juvenile Justice. Professor Piquero has given congressional testimony on evidence-based crime prevention practices in the area of early-family/parent training programs, and has provided counsel and support to several local, state, national, and international criminal justice agencies. Professor Piquero is past recipient of the American Society of Criminology’s Young Scholar and E-Mail Mentor of the Year Awards, Fellow of both the American Society of Criminology and the Academy of Criminal Justice Sciences, and has also received numerous teaching awards including the University of Florida’s College of Arts & Sciences Teacher of the Year Award and the University of Maryland’s Top Terp Teaching Award, and was recently awarded the University of Texas at Dallas Diversity Award. 7 Dr Lynne Callaghan Research Manager, University of Plymouth Since completing her research training in psychology Lynne has supported and led a range of research projects and programmes across educational, statutory and third sector organisations in the areas of community, social, and health psychology. Current projects include attrition in cases of adult rape, evaluation of educational and support programmes for victims of domestic abuse and an assessment of the sexual health and social needs of sex workers. Her current role as fundholder and research manager for the Interface Project has brought together her particular interests in inter-agency working and forensic psychology. Speakers’ Biographies Verity Chester Research Assistant, Partnerships in Care Verity obtained her BSc in Forensic Psychology from the University of Leeds in 2009. Since then she has worked as a Research Assistant within the Medical Department at Partnerships in Care Learning Disability Services, where she has contributed to numerous research projects and peer reviewed publications. Verity obtained her MSc in Forensic Psychology from London Metropolitan University in 2012, where her thesis focused on Relational Security within Secure Services. Her research interests include autistic spectrum disorders, fire setting, and health inequalities, particularly as they apply to forensic intellectual disability populations. Friederike Höfer Managing Director, Centre for Forensic Psychiatry Rheinau, University Hospital of Psychiatry Zurich Friederike X. E. Höfer studied medicine at the Charité Medical Centre Berlin, a joint institution of the Free University Berlin and the Humboldt University Berlin. During her studies, Friederike Höfer was a tutor for medical interviewing skills. From 2006 until 2007, she studied abroad at the Faculty of Medicine, Buenos Aires, Argentina for eight months. Friederike Höfer obtained her full registration to practice in 2010. Since 2011 she has been working at the University Hospital of Psychiatry Zurich. In October 2012 Friederike Hofer started working at the Department of Forensic Psychiatry within the same institution. Ms Höfer is currently a specialty registrar in psychiatry. Her MD thesis will be on ‘The impact of legal coercion on the therapeutic alliance’. Gareth Hopkin Research Worker / PhD Student, Institute of Psychiatry Gareth Hopkin is a researcher and PhD student working on the Critical Time Intervention project. Gareth graduated from Cardiff University with a BSc in Applied Psychology in 2012, having completed a year conducting research at Broadmoor Hospital as part of the undergraduate programme. Shortly after graduating, he joined the Health Services and Population Research department of the Institute of Psychiatry as a research worker and has subsequently enrolled as a PhD student. 8 John Morgan Consultant Clinical Forensic Psychologist, Cornwall Partnership Foundation Trust John Morgan is a chartered forensic and clinical consultant psychologist with experience of delivering services to mentally disordered offenders in settings ranging from the community to maximum security. He represents the Trust at the Strategic Management Board for Public Protection Arrangements. His interests are multi-agency approaches to clinical risk management, mental health service delivery and public health impact. John has played a pivotal role in the development and implementation of a range of new service initiatives in Cornwall including the recent Custody Liaison and Diversion Service and is an Interface Project fund holder. Speakers’ Biographies Dr Siân Oram Researcher, King’s College London, Institute of Psychiatry Siân Oram is a post-doctoral researcher at the Section for Women’s Mental Health, Institute of Psychiatry, King’s College London. Her research interests include the associations between mental disorder and violence (including domestic violence and human trafficking) and policy and service responses to the health and social needs of people who have experienced violence. She joined the Institute of Psychiatry in 2010 to work on the NIHR-funded “PROVIDE” project, conducting a series of systematic reviews on domestic violence and mental health, and is currently working on research funded by the Department of Health Policy Research Programme to inform the NHS response to human trafficking. Samantha Russell Forensic Mental Health Practitioner, South London and Maudsley NHS Foundation Trust Samantha is a Forensic Psychologist in Training. She obtained her Bachelor Science (Honours) Degree in Psychology in 2003 followed by a Master of Science Degree in Forensic Psychology in 2005. She has been enrolled on the Diploma in Forensic Psychology since 2006, during which time she held positions of employment with HM Prison Service and the Institute of Psychiatry, King’s College London. Samantha has been employed by South London and the Maudsley NHS Trust since 2009 working in a Forensic Personality Disorder Community Service. 9 Dr Lynne Callaghan Research Manager, University of Plymouth John Morgan Consultant Clinical Forensic Psychologist, Corwall Partnership Foundation Trust Exploring inter-agency decisions at the mental health/criminal justice interface: preliminary findings from a case-linkage study Oral Presentations The Interface Project is a case-linkage study examining current practice relating to the management of individuals with enduring moderate to severe mental health needs (EMHN), specifically at those points where they interface with the NHS and criminal justice system (CJS). It is well recognised that interagency working continues to be challenging (Rutherford, 2012) and that despite serious case reviews and subsequent enquiries (e.g. Laming 2009; IPCC 2010), difficulties remain at this interface. This research, therefore, utilises routinely collected NHS and Police data to qualitatively explore inter-agency decision-making and the impact of these decisions on both service users and the agencies delivering these services with a view to enhancing practice. Section 251 support was received from the National Information Governance Board to access the mental health records of 100 mental health service users without consent. 538 service users of a Trust in the South West of England were identified as having interacted with the police in the second quarter of 2011 through an audit covering this period. Examination of mental health service use showed that 277 (51.49%) were regularly on caseload either through sustained long term (n=159) or multiple short-term referrals (n=118) over the time of police contact. Cases for qualitative analysis were proportionately sampled to mirror the prevalence of CJS contact type in the wider sample. All relevant mental health and police records for 12 months following the date of first identified police contact have been processed to provide a unique linked data corpus. Discussion will include preliminary findings of qualitative framework analysis (Smith & Firth, 2011) with regard to type of inter-agency decisions and impact of decisions on both practice and service user outcome, as well as consideration of early implications for policy and practice. S J Lea 1, L Callaghan 2, J Morgan 3, I Grafton 4, M Bolt 4, G Thornicroft 1, A Patel 1, D Rose 1, S Eick 2 * Institute of Psychiatry, KCL Faculty of Health, Education and Society, Plymouth University 3 Forensic Psychology Service, Cornwall Partnership NHS Foundation Trust 4 Devon and Cornwall Constabulary *Authors in descending order of contribution 1 2 10 Verity Chester Research Assistant, Partnerships in Care An Evaluation of Measures of Relational Security used within Secure Services Background Relational security is the knowledge, and therapeutic relationships between staff and patients within secure services, and the way this knowledge, and relationships are used in order to manage security and risk. Until recently, there have been no direct measures of relational security to assist practitioners in this area. However, two measures of relational security have been introduced. The psychometric properties of these measures have not been evaluated. Oral Presentations Aims This study aims to evaluate the psychometric properties of two measures of relational security, namely; internal consistency, construct validity, contrasted groups validity and principal components analysis. In addition, the study will examine the clinical utility of such measures, from the viewpoint of staff working in secure services. Method The Relational Security Explorer (DH, 2010) and the See, Think, Act scale (Tighe & Gudjonsson, 2012) were administered to n = 89 members of staff working within a secure intellectual disability service. Internal consistency of the two tools was examined using Cronbach’s a and CITC coefficients. Construct validity was assessed using Pearson’s r. MANOVA were used to explore differences between groups upon scores on each of the two measures. A questionnaire investigated staff opinion regarding the Relational Security Explorer. Thematic analysis was used to explore this qualitative data. Results CITC and Cronbach’s a indicated that both measures had acceptable internal consistency. MANOVA analyses revealed significant differences on scores on subscales of the Relational Security Explorer and the See, Think, Act scale, as predicted by relevant theory. Conclusions This study provides preliminary data regarding the psychometric properties of two measures of relational security. The measures appear sensitive enough to detect differences between groups on scores of relational security. The study highlights a number of strengths and weaknesses of relational security measures, as reported by staff members. V Chester¹, W Morgan² ¹Research Assistant, Partnerships in Care Learning Disability Services ²Chartered Forensic Psychologist & Principal Lecturer, London Metropolitan University 11 Friederike Höfer Managing Director, Centre for Forensic Psychiatry, Rheinau, University Hospital of Psychiatry, Zurich The impact of legal coercion on the therapeutic alliance: cross-sectional study of adult schizophrenia patients and attending physicians in forensic and civil psychiatry Abstract Objective: The Quality of the therapeutic alliance (TA) was found to play a key role concerning symptom reduction and medication adherence. Legal coercion is suspected to have a negative impact on the TA: We aimed to identify factors that impact on the quality of the TA by examining the doctor-patient relationship in schizophrenic patients in forensic and civil psychiatry. Oral Presentations Methods 114 male inpatients with schizophrenia were examined in 3 settings: 1. Inpatients treated on own initiative (n=40), 2. Inpatients under forced admission (n=36) and 3. Forensic inpatients (n=37). Using the STAR (Scale To Assess Therapeutic Relationship), patient and attending physician were examined. Disease severity was measured by BPRS (Brief Psychiatric Rating Scale). Results The overall correlation between patient and therapist ratings of TA quality was statistically nonsignificant (r = .07, p = .22, onesided). This outcome remained stable when controlling for the severity of symptoms: partial r = .03 (p = .39, one-sided). Patient groups differed in their mean ratings TA quality. This outcome was due to a significantly higher mean rating of the voluntary patients (M = 2.8) compared to the involuntary patients (M = 2.5); forensic patients gave an intermediate rating (M = 2.7). According to the clinicians, the ratings of TA quality were weakly and inversely associated with the patients’ BPRS total scores (r = -.15, p = .06, one-sided). Among the patients, the ratings of TA quality showed medium-sized negative correlations with the BPRS total (r = -.34) and hostility scores (r = -.41, both p < .001, one-sided). Conclusion TA is not as negatively affected by legal detention as expected. It is not involuntary admission but hostility, which has a major impact on TA. This factor should be focused on. The implementation of feed-back-mechanisms reducing the discrepancy between patient’s and doctor`s perception of TA should be considered. Literature Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. (2012): The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord J Psychiatry Cookson A, Daffern M, Foley F. (2012): Relationship between aggression, interpersonal style, and therapeutic alliance during short-term psychiatric hospitalization. Int J Ment Health Nurs. Donnelly V, Lynch A, Mohan D, Kennedy HG. (2011): Working alliance, interpersonal trust and perceived coercion in mental health review hearings. National Forensic Mental Health Service. Int J Ment Health Syst. McGuire-Snieckus R, McCabe R, Catty J, Hansson L, Priebe S. (2007): A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychol Med. Gairing SK, Jäger M, Ketteler D, Rössler W, Theodoridou A.(2011): Evaluation of the German version of the STAR scale. Psychiatr Prax. F X E Höfer1* MD, S Lau1 MD, A Mokros1 PhD, E Habermeyer1 PhD, S K Gairing2 MD MSc 1 Centre for Forensic Psychiatry, Rheinau, University Hospital of Psychiatry, Zurich, 8462 Rheinau, Switzerland 2 Psychiatric University Hospital, Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland *Corresponding author: Friederike X. E. Höfer, MD, [email protected] 12 Gareth Hopkin Research Worker / PhD Student, Institute of Psychiatry, KCL Critical Time Intervention for Severely Mentally Ill Released Prisoners: A Randomised Control Trial Aims Transition between prison and community is characterised by drop out from mental health services. An initiative that aims to improve continuity of care and promote engagement, Critical Time Intervention (CTI), has been found to be feasible and effective in similar client groups and has potential in this transitional period. The research aims to establish whether the CTI is feasible in a group of mentally ill prisoners, whether it is effective in improving engagement with services and whether it is beneficial in terms of cost. Oral Presentations Method CTI is a time limited, comprehensive case management model targeted at the ‘critical time’ of transition from institution to community. It involves providing practical support to address a number of issues (e.g psychiatric treatment, housing, substance abuse, finances) prior to and on release. A pilot randomised control trial (RCT) has been completed and given encouraging results, a large scale, multi site RCT is being conducted with 200 mentally ill prisoners being recruited from prison. The primary outcome is engagement with services at six weeks post discharge and a longer term follow up recording wider variables such as hospital admission and contact with the criminal justice system. Results The pilot study found that a higher proportion of the CTI group were in contact with mental health services (73%) than those in treatment as usual (TAU; 50%) and in other outcomes, registration with a GP (87 v. 38%) and access to medication (80 v. 38%) were significantly higher in the CTI group than in TAU. Conclusions Initial findings suggest that CTI is feasible in this group of clients and that it leads to increased engagement with mental and physical health services. Due to limitations of the pilot study, a larger RCT is being conducted and will allow further analysis with more definitive conclusions. G Hopkin1, C Stevenson2, M Jarrett1, Dr A Forrester3, Professor G Thornicroft1, Professor J Shaw2 1 Health Service and Population Research Department, Institute of Psychiatry, KCL 2 School of Community Based Medicine, University of Manchester, Manchester 3 South London and Maudsley Foundation Trust, London 13 Dr Siân Oram Researcher, King’s College London, Institute of Psychiatry, KCL Intimate partner homicide and mental disorder: a population-based descriptive study Aims (1) To examine the prevalence of current and lifetime mental disorder and contact with mental health services among convicted perpetrators of intimate partner homicide; (2) to investigate the distribution of characteristics associated with intimate partner homicide with and without mental disorder at the time of offence. Oral Presentations Method A consecutive case series of all convicted intimate partner homicide perpetrators in England and Wales (1997-2008). Information on socio-demographic, clinical and offence characteristics was gathered from the Home Office, the Police National Computer, psychiatric court reports and, for psychiatric patients, questionnaires completed by supervising clinicians. Descriptive statistics were calculated for the socio-demographic, behavioural, clinical, service use and offence characteristics of intimate partner homicide perpetrators. Pearson’s chi-squared tests and were used to compare characteristics between perpetrators with and without mental disorder at the time of offence. Results Between 1997 and 2008, 1180 perpetrators were convicted of intimate partner homicide in England and Wales. 19% of perpetrators had mental disorder at the time of offence. 14% of all intimate partner homicide perpetrators, and 30% of intimate partner homicide perpetrators with mental disorder at the time of offence, were in contact with mental health services in the year prior to homicide. Perpetrators with mental disorder at the time of offence were less likely than perpetrators without mental disorder to have previous violence convictions or a history of alcohol abuse. Conclusions A significant minority of intimate partner homicide perpetrators had mental disorder at the time of homicide. Most perpetrators, including those with mental disorders, were not in contact with mental health services in the year prior to offence. Risk-reduction could be achieved through initiatives to encourage individuals with mental health problems to access mental health services; and to develop closer interagency working, including between mental health services, police, social services and domestic violence services. S Oram PhD1β, S Flynn MA 2, J Shaw PhD FRCPsych2, L Appleby MD FRCPsych2, L M Howard PhD MRCPsych1 1 Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry,KCL 2 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Manchester 14 Samantha Russell Forensic Mental Health Practitioner, SLaM NHS Foundation Trust Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London Background High risk offenders residing in approved premises (AP’s) demonstrate elevated rates of violent recidivism, personality disorder (PD) morbidity and mortality. Innovative partnership working to reduce reoffending and increase psychological wellbeing amongst this population is imperative. Whilst there has been a surge of intervention models piloted across the UK, very little is known about the effectiveness of these in AP’s. Oral Presentations Aim To evaluate the effectiveness of a novel partnership intervention - Psychologically Informed Practice (PIP) – in improving staff performance and reducing antisocial behaviour in high risk offenders residing in an AP. Method Two AP’s in South London were indentified and matched on a number of criteria (e.g., bed capacity, staffing-resident ratios, catchment area, offender demographics). One acted as a waiting list control whilst the other received intensive PD training (6 days) followed by supervision and support from a specialist team. A battery of questionnaires measuring knowledge, attitudes, capabilities and burnout were completed at baseline, at the end of training, and at 3 and 6 months post-training. Staff performance (e.g., resident complaints, sickness) and resident antisocial behaviour (e.g., recalls, warnings) during the 6 months prior to training and 6 months post training was also collected and compared. Results Significant improvements were observed following intensive PD training on a number of staff measures and these appeared to be maintained at each of the follow-up periods. Furthermore, there was a reduction in rates of staff sickness, offender recalls, warnings, and complaints over the 6 month post-training period for the AP receiving the intervention. Conclusions Psychologically Informed Practice (PIP) is a novel partnership intervention which appears to demonstrate positive outcomes for both staff and high risk offender residents. These preliminary findings will inform larger, multi-centre, randomised controlled trials evaluating PIP. M Bruce1, S Russell1, R Kerr1, A E Cullen2 1 SLaM NHS Foundation Trust 2 Institute of Psychiatry, KCL 15 Lara Arsuffi Forensic Psychologist, Northamptonshire Healthcare NHS Trust Is contingency reinforcement and harm reduction key? Evaluating and comparing the effectiveness of the Behavioural Treatment of Substance Abuse (BTSA) BTSA is currently used in community and inpatient settings across SLaM as a method for treating substance abuse among forensic clients. Unlike other psychological methods used in SLaM, such as Substance Awareness, BTSA employs a harm reduction approach and contingency reinforcement. NICE guidelines recommend that contingency reinforcement be used in the treatment of substance abuse, though this does not appear to have been routinely adopted by services dealing with the treatment of substance abuse despite a number of promising studies supporting the use of contingency reinforcement, particularly in patients with SMI and co-occurring substance abuse/ dependence problems (Bellack, Bennet & Gearon et al, 2006; McDonell, Srebnik & Angello et al, 2013). Similar findings have been shown for harm reduction methods over an abstinence based approach in those with SMI (Bellack, Bennett & Gearon, 2007). The current study aims to evaluate the efficacy of BTSA amongst a population of male forensic psychiatric patients. Research has focussed on the use of contingency reinforcement and harm reduction in general psychiatric patients with SMI but no Axis II co-morbidity. However, the population in forensic psychiatry is qualitatively different, with greater presentation of co-morbid Axis II diagnosis (particularly Antisocial and Borderline Personality Disorder). Subsequently, findings from general psychiatric studies are not easily generalisable. This study will explore the use of contingency reinforcement and harm reduction in a forensic psychiatric population. It is hoped that if BTSA is effective in reducing substance misuse, this will, in turn, reduce rates of violence as findings consistently support that substance use increases the risk of violence, particularly in those with SMI (Rasanen, Tiihonen, Isohanni, et al, 1998; Steadman, Mulvey, Monahan et al, 1998). This study also aims to compare the efficacy of BTSA within this population to the Substance Awareness programme (SA). SA is a treatment currently employed with forensic psychiatric patients with co-occurring substance abuse problems at another medium secure unit in SLaM. Many of the treatment techniques such as motivational interviewing and relapse prevention work are employed in SA and BTSA. However, SA does not provide contingency reinforcement as recommended by NICE and the National Treatment Agency for Substance Abuse (NTA). Furthermore, the focus of SA is to achieve abstinence rather than a harm reduction approach used in BTSA. Kelly Cocallis Assistant Psychologist, Croydon Health Services, South London and Maudsley Trust Poster Abstracts Initial outcomes of a recovery-oriented treatment programme within a medium secure unit Aims Contemporary mental health services are in an era where recovery approach principles are a primary goal. Recovery-oriented practice has been associated with improvements in outcomes. However to date, no studies have investigated recovery-oriented group interventions in forensic mental health services in the United Kingdom. The present study examined whether participation in a recovery-oriented treatment programme was associated with significant positive change in recovery-oriented outcomes for service users in a medium secure unit. Method A descriptive cohort with repeated measures was employed. Sixty-five service users completed self-report outcome measures to assess hopelessness, global distress, self-esteem, anxiety, depression, locus of control, and motivation, before and after intervention. Results Analyses of pre- and post-treatment scores revealed a significant decrease in service users’ self-reported global distress, and a significant shift from an external toward a more internal locus of control. A significant decrease in self-reported anxiety and depression was found when examining service users whose scores before intervention fell within ‘borderline’ and ‘definite’ ranges. No significant changes were found for hopelessness, motivation and self-esteem. Conclusions This study, which is the first of its kind, has shown promising early results. Research should continue to investigate recovery-oriented group interventions such as that described in the present study, to determine their potential as a treatment option for forensic mental health service users. Confirmation of the effectiveness of recovery-oriented group interventions has the potential to enhance and promote recovery practice in the United Kingdom. K Cocallis, T Green, S Haddad 16 Lydia Evans Forensic Psychologist in Training (Doc.For.Psy), Nottinghamshire Healthcare NHS Trust and University of Nottingham A systematic review of the relationship between self report psychopathy measures and the PCL-R Background and aims Assessment of psychopathy in offender populations has become important for institutions, services and policy makers. Most of the research into Psychopathy in offender samples has utilised the Psychopathy- Checklist Revised (PCL-R, Hare 2003), which has dominated this field of assessment. However there has been recent growth in other measures such as self report measures of psychopathy. There have been a small number of individual studies exploring how self-report measures of psychopathy compare to the PCL-R, but to date there has been no systematic review. As the use of self-report measures in research and practice is increasing, a review will allow further understanding of how well the current measures stand compared to a well validated tool, and inform clinicians of the suitability of self report measures for application in forensic settings. Method A systematic method was used to examine the relationship between self-report measures and the PCL-R in adult male offender populations and the quality of this research was reviewed. Electronic databases were searched and an inclusion and exclusion criteria applied. Studies found to examine relationships between the PCL-R or PCL and self-report psychopathy measures in adult male offenders were included. Experts in the field were also contacted for further relevant studies. Results The results are currently being collated and will be completed by March. This will detail the hits, duplications and irrelevant publications. Of those included, a data extraction exercise will summarise the correlations between the measures and the quality of the included studies will be scrutinised. Conclusions These are pending, and will focus on the implications for assessment and conceptualisations of psychopathy. Vidya Fatania Student, Institute of Psychiatry, KCL The Influence of a Relational Security Programme on Social Climate in a Medium Secure Service for Men with Learning Disability Method A quasi experimental design was adopted to investigate the change in perception of social climate using the Essen Climate Evaluation Schema (EssenCES) (Schalast, Redies, Collins et al 2008) and the frequency of untoward incidents through collection of frequency data using the Trust electronic datix system. Assessment occurred prior to (Time 1) and 14 months following (Time 2) the introduction of a relational security programme. Results Patients’ perception of the extent to which the unit was supportive of their therapeutic needs was significantly reduced at Time 2 compared to Time 1 (β= -0.429, t= -2.93, p=0.006). At Time 1 patients had a more positive perception than staff of the social climate (p=0.016). At Time 2 patients felt safer in the unit from the threat of violence (p=0.03), but conversely felt that the unit was less able to meet their therapeutic needs (p=0.007) than staff perceived the unit to. In addition, the frequency of untoward incidents increased significantly at Time 2 compared to Time 1(U=751, p=0.001, r=.58). Conclusion The introduction of a relational security programme positively increased some aspects of social climate in a forensic intellectual disability setting. A significant increase in incidents inevitably impacted on the perception of safety by staff, however this appears to have impacted less on patients. Despite this, although patients felt safer than staff they also felt that staff were less available to meet their therapeutic needs. This highlights the importance of maintaining a good balance between safety, treatment and support, which is central to the relational security programme. In this study no factors other than the type of ward (treatment or admissions) was controlled for. To determine the true extent of which a relational security programme can improve social climate, further research would need to be conducted. V Fatania, Dr J Henry 17 Poster Abstracts Aim The study aims to investigate the following: • Does the introduction of a relational security programme change the perception of social climate? • Is there a difference between staff and patient perception of social climate? • Does the introduction of a relational security programme have an impact on the number of untoward incidents? Sharonie Fitzhugh Senior Staff Nurse, St Andrews Healthcare An audit of anti-psychotic monitoring in forensic psychiatry in-patients Aims Patients with schizophrenia die 15-20 years earlier representing a unique cardiovascular disease high risk cohort. Patients are exposed to the obesogenic complications of psychotropic medicines that in forensic services are often prescribed multiply and at high doses. Monitoring of side effects is advised in practice guidelines, including the NICE guidelines for schizophrenia 2009. Our aims were to: • establish the performance of a typical forensic in-patient service at identifying those on anti-psychotic medicines and those on high dose or multiple anti-psychotics • establish clinical practice of side-effect monitoring • compare the service’s practice compliance with relevant local and national guidelines. Method Retrospective data collection from electronic notes of male in-patients in medium, low and locked services between September 2012 and January 2013. Audit standards were based on local and national guidelines. Results 59 out of 64 (92.2%) patients were prescribed at least one anti-psychotic, of them 9 (15.3%) were prescribed two. 23 (39.0%) were additionally prescribed a mood stabiliser, and 18 (30.5%) an antidepressant. Mean daily antipsychotic dose in chlorpromazine equivalents was 348.5mg (range 0 to 1060mg). 15 patients (25.4% of those on antipsychotics) were on combined doses that exceeded BNF maxima, up to 200%. 12 of these patients had warning notes on their medication charts, but only 8 had accompanying care plans to manage monitoring. 60 (100%) patients had weight and height data recorded and 54 (91.5%) pulse and blood pressure. 46 (77.9%) patients had blood glucose reacorded and 32 (54.2%) a fasting lipid profile. 44 (74.6%) had an ECG, the QTc interval ranged from 378 to 483ms. No patients had side effects recorded using an objective scale. Conclusions Patients taking antipsychotics should be regularly monitored for side-effects. This is an essential part of good quality physical health care. Clinical audit can identify local short-comings in physical health monitoring. Poster Abstracts S Fitzhugh, Dr M Picchioni Amanda Gilman, MSW Doctoral Candidate and Research Assistant, Social Development Research Group, School of Social Work, University of Washington Patterns of Juvenile Incarceration and Mental Health-Related Consequences in Adulthood Aims Researchers have found numerous negative consequences of incarceration in various domains, including mental health functioning. However, the experience of juvenile incarceration is likely to be more varied than is captured in the often-utilized “incarcerated vs. not” measure. This study examines whether there are different patterns of juvenile incarceration and, if so, whether the long-term mental health consequences vary by these patterns. Methods Data were drawn from the Seattle Social Development Project, an ethnically diverse, gender-balanced longitudinal study of 808 youth oversampled from high risk neighborhoods in Seattle, Washington. Within this sample 13.4% had an official incarceration record during adolescence. Latent class analysis was used to identify different patterns of incarceration experiences using age, duration, offense type and chronicity as indicators. These classes were then used to predict mental health-related consequences in adulthood (depression, generalized anxiety, and post-traumatic stress). Results Four classes were identified: (1) limited incarceration for nonviolent offenses (32% of incarcerated juveniles), (2) limited incarceration for substance-related and violent offenses (19%), (3) moderate exposure for a variety of offense types (27%), and (4) high chronicity incarceration for more violent offenses (21%). Regression analyses revealed that mental-health-related adult consequences vary based on these different patterns of juvenile incarceration. For example, youth in class 2 showed the highest rates of mental health symptoms in adulthood, and although both classes 1 and 2 experienced limited incarceration, they presented different mental health outcomes in adulthood. Conclusions and Implications These results indicate that distinct patterns of incarceration exist among youth who are often analyzed as a homogenous group, and that the long-term mental health consequences of incarceration may vary by these patterns. These findings echo prior research which has found that incarceration can have long-lasting mental health consequences, but also finds that these consequences can be worse for certain youth. A B Gilman, K G Hill, J D Hawkins 18 Dr Neel Halder Consultant Psychiatrist, Alpha Hospitals Ltd Seclusion Reduction within Secure Women’s Services Aims To establish any changes to the number of incidents which led to seclusion over a period of time within a medium secure women’s service. To identify what factors may have helped towards a reduction in the incidence of seclusion episodes. Method By analysing electronic seclusion data, we looked at the number of incidents of seclusion for 12 months prior to November 2011 and for 12 months post November 2011. We chose this time frame as the organisation was engaged in various strategies (detailed below) around November 2011 which specifically highlighted seclusion issues. Results During the 12 months prior to November 2011, there were 75 seclusion episodes across Women’s services (from a total of 16 patients). During 12 months post November 2011 (November 2011 – November 2012) there have been 41 episodes of seclusion. 7 of the 16 were discharged but 2 were admitted during Nov 2011 to Nov 2012 who accounted for seclusion episodes. Discussion Improving staff awareness and knowledge of seclusion through policy, procedure and training with the emphasis of reducing seclusion may contribute towards a reduction in practice. Other variables could include, better monitoring systems, support and involvement of other professionals and even the nature and presentation of specific patients. 52 of the 75 episodes pre November 2011 are from patients who are still at the hospital now. Conclusion Whilst there were already robust monitoring systems and changes in the audit process for seclusion prior to November 2011, during this month there was a focussed drive to do a number of other things including; a further revision of the hospital policy, ensuring that trainers incorporate pertinent aspects of the policy into training more effectively, a greater emphasis on using seclusion as a last resort and all the preventative/ alternative strategies available to staff. Perhaps November’s (2011) efforts were another ‘spoke in the wheel’ (supporting other current systems in place) that contributed to the decrease in seclusion episodes within Women’s services. J Drabble, Dr N Halder PhD Student, St Andrews Healthcare Service user involvement in planning for the prevention and management of aggression and violence: An audit Introduction NICE guidelines state that patients should be involved in planning for the short-term management of their own disturbed/violent behaviour. One measure of audit suggested in NICE guidance is that each patient’s care plan should contain an advance directive describing their preferred management strategies in the event of a violent incident. Aims 1. To determine if patients have been involved in creating their Prevention and Management of Aggression and Violence (PMAV) care plan. 2. To ascertain whether, in the event of an incident, the recorded management plan was followed. Method The sample for this audit is all mental health inpatients in adult mental health care pathways at St Andrew’s Healthcare. A list of all patients involved in incidents recorded on RiO event forms and classified as: abuse/aggression – verbal, abuse/aggression – physical, abuse – sexual, property damage or self harm & suicide will be obtained. Data from individual incident event forms, from this list will be compared with data in the PMAV care plan using an audit tool designed for this purpose. Every incident and perpetrator of that incident in a six month period (July – December 2012) will be included in the audit. Data to be collected in January 2013. Results and Conclusions Based on previous figures we expect to present results from about 1000 incidents perpetrated by approximately 200 patients. The results will describe i) whether documentation suggests that patients were involved in creating their PMAV care plan, and ii) the extent to which any advance directives or preferences in the care plan were enacted during a violent incident. Important areas where care plans are not adhered to will be discussed, and recommendations made. N Hallett; J Huber, G Dickens 19 Poster Abstracts Nutmeg Hallett Stephanie Harris PhD Student, Institute of Psychiatry, KCL Stroop task performance in violent and non-violent patients with schizophrenia Background There is an established link between schizophrenia and violence that may be mediated in part by a variety of co-morbidities such as substance misuse. It remains unclear however what factors specific to schizophrenia may drive this association. Many patients with schizophrenia exhibit a range of cognitive deficits, though the links between these impairments and violence in schizophrenia remain poorly understood. Emerging evidence suggests that greater neurocognitive deficits in these patients may be associated with violence. It has been proposed that reduced response inhibition and cognitive inflexibility may lead to an increased risk of reactive violence. Methods 33 patients with schizophrenia and 38 healthy controls participated in the study. Patients were subdivided on the basis of prior violence histories, into ‘violent’ (n=24) and ‘non-violent’ (n=9) groups. Three of the healthy control participants had been previously violent. Participants completed the 45 second version of the Colour/Word Stroop task which is composed of three subtests: Word reading, Colour naming and Interference. Results The patients were outperformed by controls for both the word reading and colour naming subtests. There was a trend towards better colour naming in the violent patient groups compared to the non-violent group, though this did not reach statistical significance. Violent patients however showed the greatest interference effect, performing worse than both the non-violent patient and healthy control groups, who in turn did not differ significantly. Conclusions Our data suggests that patients with schizophrenia are impaired on the Colour/Word Stroop task. Furthermore, we tentatively suggest that patients with a history of violence may show greater impairments on this task than their non-violent counterparts. This is consistent with previous findings implicating poor cognitive flexibility and inhibition of irrelevant stimuli as a risk factor in violent patients. Our data are limited by relatively small sample sizes, particularly in the non-violent group. S Harris, Dr C Oakley, Dr A Reichenberg, Professor D Murphy, Dr M Picchioni Eve Hepburn Poster Abstracts Forensic Psychologist in Training and Post Graduate Research Student (Doc.For.Psy), Nottinghamshire Healthcare NHS Trust & University of Nottingham Delusional experiences in a Personality Disordered population Objectives A wealth of literature investigating the links between delusions and violence in people with a history of psychosis/schizophrenia exists, however this has not yet been explored in a personality disordered (PD) population and is what this study seeks to explore. Given the symptomalogical overlap between schizophrenia and certain types of PD you might expect there to be a difference in the incidence of delusions by type of PD. On the basis of the theoretical links between delusions and violence it could be hypothesised that delusional experiences might relate to the severity of PD and/or history of violence. Method Forensic clients (n=70-120) receiving treatment for their diagnosed personality disorder in High Secure, Medium Secure or Community Healthcare settings were administered the Peter’s Delusion Inventory (PDI) along with measures capturing drug/alcohol history and impulsivity (UPPS). The IPDE and PCL-R (along with a severity scale used for ‘DSPD’) were used to explore an individual’s type and severity of interpersonal difficulty and a history of violence was extracted from healthcare records. A history of psychosis/ schizophrenia or an IQ below 70 excluded clients from participating. Results Correlational analyses has identified weak (.3-.5), but significant relationships between the presence of delusions and: a number of aspects of personality; how early/severely people used alcohol; the level of violence in their history of convictions and their impulsivity. A factor analysis is providing dimensions of delusions which could tell us more about the nature of delusions in these sub groups. The overall presence of delusions and conviction with which they are held (Means/SD’s), appears to be similar to that found in the general population previously. Conclusions Results may have implications for the risk assessment and management of violence and further our understanding of the role ‘Delusions’ play in the process of decision making. E Hepburn, Dr N Khalifa, R Howard, Professor K Browne 20 Andy Inett Forensic Psychologist, Forensic Learning Disability Service, Kent & Medway NHS Partnership Trust Predictive validity of the START with intellectually disabled offenders Purpose Offenders with intellectual disability (ID) have been largely neglected in past forensic literature on assessment of dynamic risk factors. The present study evaluated the predictive validity of The Short Term Assessment of Risk and Treatability (START), in a sample of males with intellectual disabilities in a low-secure hospital (n=28). Design / Methodology / Approach A prospective analysis was conducted, with START scores as the predictor variables, and the number of recorded aversive incidents as the outcome measure. Findings ROC analysis demonstrated that total START risk scores had a significant high predictive accuracy for incidents of physical aggression to others (AUC = .710, p<.001) and property damage/theft (AUC = .730, p<.001), over a 30 day period, reducing to medium predictive validity over a 90 day period. Medium predictive validity was also identified for incidents of verbal aggression, suicide, self harm, and stalking and intimidation. START strength scores were also predictive of overt aggression (AUC = .716), possible reasons for this are explored. Originality / value This study represents the first attempt to examine the predictive validity of the START with ID offenders, and a step forward in the understanding of dynamic risk factors for violence in this population. The significant predictive relationship with incidents of physical aggression and property damage offers clinicians a preliminary evidence base supporting its use in low secure settings. However, the small sample size limits the generalisability of the findings, and further research is required. Dr Kate Law Consultant Clinical and Forensic Psychologist, Farmfields Hospital, The Priory Group Validating the Development of a New Substance Abuse Assessment Tool Given the high levels of denial associated with using self-report measures to diagnose Substance Dependency Disorders (SDD), this study sought to validate the use of an observational measure to help identify those who may continue to demonstrate problems with substance use. The observational SMPB checklist was conducted by staff alongside the participants completing two psychometric measures of substance abuse, the adult Substance Abuse Subtle Screening Inventory-3 and the Drug Use Disorders Identification Test. The SMPB checklist was conducted for each participant over a seven day period on two occasions approximately fourteen days apart to allow a reliability test-retest to be performed. The SMPB checklist was found to have good test-retest reliability r=0.943; the internal consistency of the checklist items was α=0.89 and an exploratory factor analysis identified a four factor construct for the checklist. A multiple regression reported no significant relationship between the psychometric measures and the checklist scores F (3, 20) = 4.02, P>0.5 however only 12.5% of the sample were documented as not displaying any SMPBs. This provided preliminary support for the need for further examination into the probable relationship between SMPBs displayed in secure settings where access to illicit substances is restricted and an undetected or prolonged preoccupation with these substances. The findings of the current study showed support for the existence of SMPBs in secure settings. The use of a larger sample size may have allowed for statistically significant relationships to be identified between the checklist and the already well established psychometric measures used. K Law, S-M Campbell 21 Poster Abstracts An independent sample observational study was performed to assess the reliability and validity of a Substance Misuse Paralleling Behaviours (SMPB) checklist using a sample of 24 men in private forensic mental health units. Previous research has suggested that individuals who have previously been addicted to using illicit substances may display patterns of behaviours in hospital similar to those associated with the addiction. These behaviours are thought to serve a psychological need which could be responsible for maintaining an addiction. Ilaria Lega, MD, Psychiatrist Researcher, Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy Setting-up a psychiatric case register of the population of the Italian Forensic Hospitals while Forensic Hospital closure is approaching Aims A research project aimed at setting-up a psychiatric case register of the population of the Italian Forensic Hospitals (IFH) was launched in March 2012. The project is coordinated by the Italian National Institute of Health (INIH) and founded by the Italian Ministry of Health. The main objective of the project is to activate a forensic mental health information system, based upon reliable and accurate data. The closure of the six IFH is approaching and the Italian Mental Health Departments are becoming increasingly responsible of the psychiatric care of mentally ill offenders. The assessment of individual clinical characteristics and needs is a necessary step in planning for the aftercare of the 1200 current inpatients. Method The baseline assessment of the patients will include: 1) axis-I psychiatric diagnosis based on the SCID- I RV; 2) personality disorder diagnosis based on the SIDP-IV; 3) clinical severity and psychosocial functioning by means of the 24-item version of the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning scale (GAF), respectively; 4) cognitive evaluation based on Mini Mental State Examination and Raven Standard Progressive Matrices; 5) assessment of needs based on the CANFOR-R; 6) an ad hoc standardized form to record sociodemographic, psychiatric, medical, and forensic data complete the case assessment. The 6 month follow-up evaluation will be based on BPRS, GAF and CANFOR-R. Eighteen clinicians, at least two for each IFP, came to the INIH to attend a 2-day course in the use of SCID-I, BPRS, and GAF. A web based software system was created for cases reporting from the Forensic Hospitals to the central database at INIH. Results and Conclusions As described above the preliminary phase of the project has been completed. The assessment of the inpatient will start in March 2013. I Lega, V Calevro, A Ciraolo, R Liardo, M Pennino, G Rivellini, F Scarpa, D Del Re, I Cascavilla, A Di Cesare, L Leoncini, L Castelletti, M Forghieri, E Centrone, P Cuzzola, T Frigione, C Perrotta, G Ditta, A Fioritti, A Gigantesco, L Magliano, A Picardi, T Di Fiandra Dr Clive Long Poster Abstracts Associate Director of Psychology and Psychological Therapies, St Andrew’s Healthcare Women Fire Setters Admitted to Medium Secure Psychiatric Settings: Characteristics and treatment needs Aims Knowledge and practice in relation to female fire setters is undeveloped. A survey of the characteristics of fire setters admitted to a secure service was undertaken to inform the development of assessment and intervention strategies for this group. Method 90 consecutive admissions to a secure women’s service in the period from 2002-2010 were assessed. Data was collected from mental health (n= 68 beds) and learning disability (n=24 beds). Patients with a conviction of arson and/or fire setting were identified. Each subject was categorised as a first time or multiple fire setter. Basic demographic data was collected along with primary psychiatric diagnosis and forensic history. Fire setting behaviours were analysed along with scores on routinely administered psychometric measures of symptomatology, impulsivity, self efficacy, general functioning and need. Comparisons were made between those convicted of arson and other fire setters; between fire setters in the mental health and learning disability pathways; and between single and multiple firesetters. Results Of 90 consecutive admissions, 49 (54% of women) had a firesetting history. This group was more likely than other admissions to be diagnosed with personality disorder and schizophrenia and to be more impulsive. Characteristics of firesetters are described along with fire setting behaviours. Fire setters did not differ from other women in terms of psychopathology and no differences were found between fire setters and those convicted of arson. They tended to act alone and choose targets within or close to their place of residence. Conclusions Implicit in descriptions of group treatments for fire setters is the assumption that they represent a distinct group of offenders. Current findings indicate the importance of an individualised approach to treatment based on a sophisticated functional analysis which draws on both individual therapy and manualised cognitive behavioural group treatments. 22 Annette McKeown Chartered & Registered Forensic Psychologist, Primrose Programme, Tees Esk and Wear Valleys NHS Foundation Trust Female Domestic Violence Perpetrators in Prison: Characteristics, explanations and potential treatment pathways Aim The aim of this study was to explore the prevalence, characteristics, and explanations of domestic violence experienced and perpetrated by female prisoners. There is a lack of research considering female domestic violence using prison populations and this research sought to inform this area. Method In this study, female prisoners (n = 92) completed measures of psychological and physical aggression (The Revised Conflict Tactics Scales (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996); attachment (Experiences in Close Relationships Revised Revised; Fraley, Waller, & Brennan, 2000) and personality (Personal and Relationships Profile; Straus, Hamby, Boney-McCoy, & Sugarman, 1999) Results Results indicated high levels of psychological aggression and physical assaults both experienced and perpetrated by female offenders both in current and previous relationships. Physical assaults tended to be severe and high levels of mutual violence were reported both in current and previous relationships. Insecure attachments were associated with being victimised as opposed to perpetrating domestic violence in recent relationships. Borderline and anti-social personality dimensions were significantly associated with offenders being perpetrators and victims of domestic violence. Personality dimensions were also found to mediate relationships between attachment anxiety and victimisation in offenders’ most recent relationships. Conclusions This study highlights the prevalence of domestic violence within female prisoners. It indicates particular treatment needs related to domestic violence in female offenders including attachment and personality dimensions. It also begins to consider potential treatment pathways for such offenders. A McKeown, Dr S Cooper Dr C Morrissey Lead Psychologist, National High Secure Learning Disability Service, Rampton Hospital Therapeutic community approaches have not previously been applied in forensic learning disability services. The National High Secure Learning Disability Service introduced a therapeutic community milieu intervention for patients with personality disorder in June 2010. Data was obtained on seclusion hours, incidents, and a range of informant and self report psychometric measures for 13 patients allocated to the therapeutic milieu and 12 patients receiving treatment as usual. The results are encouraging, with TC patients showing improvements in a range of domains relative to controls. C Morrissey, J Taylor, C Bennett Dr Clare Oakley Clinical Research Worker, St Andrew’s Academic Centre, Institute of Psychiatry, KCL Childhood trauma in violent patients with schizophrenia: the VISA Study Aim This component of the VISA study sought to investigate differences in the rates of childhood trauma in violent patients with schizophrenia and their relationship with prior conduct disorder. Method Male patients with schizophrenia were recruited from secure psychiatric units and community mental health teams and healthy men from the local community. Diagnoses of schizophrenia and conduct disorder were established using the SCID and histories of childhood trauma assessed using an amended version of the CECA-Q. Data were analysed using Stata11. Continued on page 24 23 Poster Abstracts 12 month evaluation of a therapeutic community intervention in a high secure LD service (continued from page 23) Results Seventy-six participants were placed into four groups, patients with schizophrenia and a history of violence with and without childhood conduct disorder, non-violent patients with schizophrenia and finally healthy controls. Histories of both physical and sexual abuse were more common in patients with schizophrenia than the healthy control participants. Physical abuse in childhood differed significantly between the four groups, with the highest rates in the violent patients with schizophrenia and conduct disorder. Among the patients, conduct disorder, physical abuse and being in a children’s home were associated with a greater number of incidents of major violence in adulthood. Conclusions This data indicates that childhood trauma, particularly a history of physical abuse, differs among patients with schizophrenia on the basis of prior conduct disorder. It suggests that a history of physical abuse and conduct disorder are both associated with the risk of future major violence in men with schizophrenia. Further work is needed to elucidate the nature of the interactions between these factors in promoting a risk of violence in schizophrenia. Dr C Oakley, S Harris, Professor T Fahy, Professor D Murphy, Dr M Picchioni Laura O’Shea Research Assistant, St Andrew’s Academic Centre All things being equal? Predictive validity of the HCR-20 among heterogeneous groups of secure psychiatric inpatients Aims The HCR-20 (Webster, Douglas, Eaves, & Hart, 1997; Webster, Eaves, Douglas, & Wintrup, 1995) has good predictive validity for inpatient violence and is widely used in secure mental health care (Khiroya, Weaver, & Maden, 2009). However, previous research has utilised relatively small and homogeneous samples and little is known about whether its predictive ability varies between different clinical and demographic groups (O’Shea, Mitchell, Picchioni & Dickens, 2012). We aimed to address these issues by examining the largest and most heterogeneous known dataset of risk assessment and inpatient aggression data relating to secure psychiatric inpatients. Methods Demographic (age, ethnicity, gender), clinical (diagnosis) and risk assessment data (HCR-20) were collated. Data for frequency and severity of incidents of verbal and physical aggression were collated for the 12 months following assessment. Poster Abstracts Results 386 of 640 patients were still present at 12 months follow-up. 261 (67.6%) had demonstrated physical aggression and 290 (75.1%) verbal aggression during the follow-up period. The HCR-20 total, Clinical scale and Risk Management scale were all predictive of both physical and verbal aggression; the Historical scale was not a significant predictor of either type of aggression. The HCR-20 demonstrated superior efficacy for women compared with men, older people (≥39 years) compared with younger people (<39 years), and for those with a personality disorder compared with those with mental retardation, schizophrenia, schizotypal or delusional disorder or co-morbid schizophrenia/ personality disorder for both physical and verbal aggression. Conclusions This study provides further evidence about the predictive validity of the Clinical and Risk Management scales for inpatient aggression. However, it also reveals differences in efficacy between groups. Further development and optimisation of the HCR-20 may be required. An alternative explanation is that interventions to prevent aggression are more effective among some groups. Future research should address these important issues. L O’Shea, Dr F Mason, Dr M Picchioni and Dr G Dickens Jane Padmore Consultant CAMHS Nurse and Doctorate in Healthcare Student, South London and Maudsley NHS Foundation Trust and Kings College London The Mental Health Needs of Young People Involved in Street Gangs Aims To gain a greater understanding of the mental health needs of young people who are involved in street gangs. Method This was an exploratory study looking at the difference between the mental health needs of young people in three categories: • those not involved in a gang nor involved in offending behaviour • those not in a gang but involved in offending behaviour • those involved in a gang 24 Continued on page 25 (continued from page 24) Method The research sampled 11-17 year old children from two schools in one UK inner city borough and one Young Offender Institution. An adapted Eurogang Youth Survey [EYS] and the Strengths and Difficulties Questionnaire [SDQ] (Goodman, 2001) were completed by participants. Three categories of young people were then compared in relation to their mental health needs- gang members, non-gang members who offend and non-gang members who do not offend. Results 507 questionnaires were returned of which 310 (260 community and 50 YOI) were complete and included in the full analysis. The small sample size within the YOI made it inappropriate to analyse alone. The results can be summarised as follows: • Young people who were gang members were significantly more likely than the general population and offenders not in gangs to experience hyperactivity symptoms and conduct problems. • Offenders, both in gangs and not in gangs, had significantly more emotional symptoms and difficulties with pro-social behaviour than the general population, but being in a gang or not did not show a significant difference. • Offenders not in a gang showed significantly more difficulties with peer relations when compared to both the gang members and the general population. Conclusions Gangs have become an increasingly significant, and controversial, phenomena in both the academic and media worlds, and yet the impact of gang involvement, especially on the mental health of the young people involved, remains under explored. Despite policy and media concern about gangs and youth violence, it rarely considers the mental health needs of these young people. Although this research tells us that there is an increase in hyperactivity symptoms and conduct problems in gang members, it does not tell us if this increase is a cause or an outcome of being involved in a gang, or if there is a complex interaction between the two variables. Currently services for young people involved in gangs are commissioned on a short term basis and rarely are they supported by evidence or targeted at mental health needs. This research supports the need for further, more detailed research in this area as well as services targeted for this groups mental health needs. A feasibility study for the R&R2 programme has been funded to explore this further. J Padmore, Professor I Norman and Dr N McCrae Rachel Quinn The Validity of the Short Term Assessment of Risk and Treatability (START) in a UK Medium Secure Forensic Mental Health Service Aims To evaluate the validity of the START within a UK Medium Secure hospital, which holds both male and female mentally disordered offenders (MDOs) (n=83) across a variety of wards (from Intensive Care through to Pre-Discharge). Method The START had recently been implemented within this service and the researchers undertook a file-review to collect all completed START assessments over an 18 month period (n=665), as well as all aversive incidents reports (n=664). In particular, this study evaluated the construct, predictive, discriminative and concurrent validity of START scores (Strength and Vulnerability totals) and the clinician’s risk ratings. A validation analysis comparing the number of aversive incidents pre- and post-START implementation was also conducted. The researchers further assessed the presence of gender differences among START scores and conducted a cost-analysis and staff interviews to gain a perspective on the START’s cost to the service and usability. Results START scores were appropriately significantly correlated with aversive incidents; they were the most predictive of total aversive incidents at 1 month, decreasing to small/medium effects at 6 months. The START could discriminate between male/female MDOs at different stages of their forensic care pathway (with the exception of Rehabilitation and Pre-discharge males) and females were rated as having significantly less strengths and more risks compared to males. The START holds concurrent validity with the HCR-20 total and C-Scale scores, and both scales of the HoNOS Secure and no significant differences were found between the number of incidents pre- and post-START implementation. Moreover, the START was found to be a cost-effective tool although staff viewed the START negatively but agreed it was a useful tool. Conclusion The results suggest that the START can be validated within this population and, after improvements are made to its usability, the START is a viable choice when assessing the short-term risk of MDOs. R Quinn, Dr H Miles, Dr C Kinane 25 Poster Abstracts MSc Student, Assistant Psychologist, Kent Forensic Psychiatry Service Masuma Rahim MSc Student, Institute of Psychiatry, KCL Cognitive skills training for male mentally disordered offenders: the effect of co-morbid antisocial personality disorder Aims Amongst mentally disordered offenders (MDOs) treated in secure forensic settings, co-morbid antisocial personality disorder (ASPD) is common and may complicate treatment outcomes. Whilst cognitive-behavioural programmes such as the Reasoning and Rehabilitation (R&R) programme can lead to improvements in social cognitive skills and antisocial behaviour amongst MDOs, it is unclear whether MDOs with comorbid ASPD benefit equally from treatment. In this exploratory study, we used data from the first randomised trial of R&R in a forensic secure setting and conducted subgroup analyses to compare treatment outcomes amongst MDOs with and without ASPD. Method Forty-four male MDOs were recruited from forensic secure units and randomly allocated to receive R&R. Treatment outcomes, including blame attribution, social problem-solving, criminal thinking, anger expression, and antisocial behaviour were compared amongst those with ASPD [(MDO+ASPD (n=20)] and those without ASPD [MDO-ASPD (n=24). Results Within-group analyses indicated that the MDOs-ASPD showed significant improvements on three subscales of criminogenic thinking during the treatment period whilst the MDOs+ASPD group demonstrated significant improvements in impulsiveness only. Between-group analyses were used to compare scores on social-cognitive measures completed at the end of treatment after adjustment for baseline scores. Relative to the MDO-ASPD group, MDOs+ASPD were more likely to attribute blame for their index offence on external factors; however, after adjusting for the number of sessions attended, the MDO+ASPD group demonstrated better social problem-solving ability than the MDO-ASPD group. Incidents of verbal aggression during the treatment period and the 12-month follow-up period were significantly higher amongst MDOs with ASPD relative to those without ASPD; incidents of physical violence were significantly higher amongst the MDO+ASPD group during the 12-month follow-up period only. Conclusions Although MDOs with ASPD showed improvements in social-cognitive skills during treatment, these findings tentatively suggest that ASPD may diminish the effect of cognitive-skills programmes on antisocial behaviour in this population. M Rahim, A E Cullen, A Y Clarke, K Dean, T Fahy Dr Chantal Scaillet Poster Abstracts Head of Psychology, Cygnet Healthcare Enhancing Psychological mindedness on in-patient settings by facilitating coaching of psychosocial skills to front line staff Aims 1. To improve the quality of care of all The Service Users across wards 2. To enhance psychological mindedness via the facilitation of psychosocial skills 3. To improve staff confidence in delivering psychosocial skills Method Audit of The Service Users treatment Needs Data from across the four wards (n= 43) was collected by an audit of The Service Users’ case notes. The Symptom Check List 90 Revised (SCL-90-R) was completed for all the Service Users to provide more information of their treatment needs. All service users were female who presented with varying Axis I and II diagnosis. Audit of the Staff Skill Confidence Self-Appraisals Data (n = 16) was collected by completing semi-structured interviews with staff. The process included conducting a semi-structured interview. Staff were prompted to provide an appraisal of their confidence level in completing certain psychologically informed interventions. Confidence levels were on a 0-10 scale, where 0 was no confidence at all and 10 was the most confident. The process included a prompt sheet for the student in guiding staff to elect a confidence level. Results Each ward yielded unique Service User treatment needs. A wide range in staff responses (perceived confidence levels and ability level) existed across and within the wards – suggesting a variation in staff’s self-efficacy beliefs. Staff are not making the link (generalising) between generic competency skills and how these may relate to the delivery of psychologicallyinformed practice; thus undermining their confidence. Conclusion Staff across the wards perceived their level of confidence in delivering psychological minded care as low. Concordance between perceived Advanced ability range and perceived high confidence – suggesting that strength of belief in one’s ability leads to higher self-efficacy. Results suggest that staff are not making the link between their existing skills and how these skills may relate to the delivery of psychologicallyinformed practice. An opportunity to make this link more robust and overt would enable staff to raise their own level of confidence, thus impacting positively on overall delivery of psychological-informed care. 26 Mareike Suesse DClin Psych student, St Andrews Healthcare Patient characteristics and secure in-patient ward atmosphere Aims Better in-patient ward atmosphere is associated with greater patient satisfaction and improved patient outcomes. This study aimed to explore relationships between patient characteristics and ward atmosphere in specialist secure in-patient wards. Method Clinical data were gathered from 63 adult participants across 13 medium and low secure wards. We examined information on: gender; risk assessment; psychopathology; risk-related incidents; subjective recovery; session attendance; and leave status. Staff- and patient-rated ward atmosphere (Essen Climate Evaluation Schema) was examined at three longitudinal time-points. Multiple linear regression was used to explore relationships between patient characteristics and atmosphere. Results The main findings were that: • lower-secure and female wards were more cohesive and felt safer • wards containing patients rated lower at risk-assessment were experienced as more cohesive • wards containing more individuals with personality disorders or psychosis felt safer • lower-secure wards, or wards with lower session attendance, felt more therapeutic; subjective recovery was not related to therapeutic hold • ward atmosphere was stable over time • staff tended to rate the atmosphere as more therapeutic; patients as safer. Discussion The nature of the relationship of patient characteristics with ward atmosphere might be more complex than thought. Previous work on the stability of ward atmosphere using this measure despite patient and staff turnover, and despite ongoing active attempts to improve ward atmosphere, was replicated. Staff had overly positive views of the therapeutic climate of the ward compared to patients. The study was limited by its cross-sectional design, and inability to capture causality. Prospective studies are needed to establish determinants of ward atmosphere and effectively monitor improvement attempts. M Suesse, P Snyman, M Picchioni Dr John Tully Outcome measures on four years of admissions to female MSU: a new approach Aims In the last decade, there has been a six-fold increase in the number of women admitted to Medium Secure services. Despite this, very few studies have reported outcome measures using structured tools and there is very little reporting of quality of life assessment. Our study aimed to address these issues by assessing the characteristics and outcomes of 45 consecutive admissions to the female MSU ward of the South London and Maudsley Foundation Trust, since its opening in 2008. Methods Ethical approval was obtained from the trust Ethics Committee. Data on demographics, length of stay, rates of self-harm, HoNOS-Secure and HCR-20 assessments on 45 consecutive admissions between April 2008 and May 2012 were prospectively collected and subsequently analysed. Completed WHO-QoL-BREF surveys, which were offered to all patients prior to discharge, were also analysed. Results Our sample consisted of 45 consecutive admissions. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult abuse and low socioeconomic status. 62.2% percent of the patients had Schizophrenia, 57.8% had multiple diagnoses. The median length of stay was 465.5 days. There were significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 clinical and risk item scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties. Conclusions This is one of a small number of studies to report outcome measures in a female MSU using structured tools and the first of which we are aware to use HCR-20 scores in doing so. It is also the first to attempt to establish quality of life using a validated scale. MSU admission was associated with reduced self-harm, improvements in well-defined clinical outcomes and relatively good quality of life scores. These data suggest an ongoing need for a specialised service for this group of complex patients. Dr J Tully, Dr R B Ribeiro and Dr M Fotiadou 27 Poster Abstracts Specialty Doctor and Researcher in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust Presentations A Piquero, How criminal career research can help inform specific interventions 28 A Piquero, How criminal career research can help inform specific interventions Presentations 29 Presentations A Piquero, How criminal career research can help inform specific interventions 30 A Piquero, How criminal career research can help inform specific interventions Presentations 31 Presentations Alex Piquero, How criminal career research can help inform specific interventions 32 Alex Piquero, How criminal career research can help inform specific interventions Presentations 33 Deirdre Macmanus, Violence by military personnel deployed to Iraq and Afghanistan: a new forensic population? Summary There is growing concern about violent offending among Iraq and Afghanistan conflict veterans and considerable public debate about the proportion of ex-military personnel in the Criminal Justice System. Whilst the psychological impact of these conflicts is well documented, the potential legacy of violent offending has yet to be established. This presentation will review the findings from on-going work which has linked approx. 14,000 UK military personnel with official criminal records. The impact of deployment, combat and post-deployment mental health and behaviour problems, such as Posttraumatic Stress Disorder, alcohol misuse and self-reported aggressive behaviour, on violent offending relative to pre-existing risk factors will be discussed and patterns of offending compared with the general population. (the PDF of the presentation will be available after the conference) Presentations Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London 34 Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London Presentations 35 Samantha Russell, Effectiveness of Psychologically Informed Practice (PIP) in an Approved Premise in South London Presentations Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services 36 Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services Presentations 37 Verity Chester, An Evaluation of Measures of Relational Security used within Secure Services Presentations Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study of adult schizophrenia patients and attending physicians in forensic and civil psychiatry 38 Friederike Höfer, The Impact of legal coercion on the therapeutic alliance: cross-sectional study of adult schizophrenia patients and attending physicians in forensic and civil psychiatry Seena Fazel, Crime and mental illness; clinical implications of new research Summary Presentations Dr Fazel’s presentation will review latest epidemiological research on mental illness and violence, and discuss clinical implications, particularly for risk assessment and the treatment of mentally disordered offenders. A particular focus will be on risk factors for violence, and recent meta-analytic evidence will be presented. (the PDF of the presentation will be available after the conference) 39 Presentations Gareth Hopkin, Critical Time Intervention for Severely Mentally Ill Released Prisoners: Pilot and Randomised Control Trial 40 Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/criminal justice interface: preliminary findings from a case-linkage study Presentations 41 Lynne Callaghan and John Morgan, Exploring inter-agency decisions at the mental health/criminal justice interface: preliminary findings from a case-linkage study Presentations Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study 42 Siân Oram, Intimate partner homicide and mental disorder: a population-based descriptive study Presentations 43 Presentations Conor Duggan, What Works for Sex Offenders? A Review of the Evidence 44 Conor Duggan, What Works for Sex Offenders? A Review of the Evidence Presentations 45 Presentations Conor Duggan, What Works for Sex Offenders? A Review of the Evidence 46 Conor Duggan, What Works for Sex Offenders? A Review of the Evidence Presentations 47 Presentations Conor Duggan, What Works for Sex Offenders? A Review of the Evidence 48 Index The FANS Teaching Unit, Institute of Psychiatry, KCL Welcome Programme Page 2 4 5 Key note speakers biographies Professor Conor Duggan BSc, PhD, MD, FRCPsych, OBE Dr Seena Fazel Professor Nicola Gray Dr Deirdre Macmanus Professor Alex R Piquero 6 6 6 6 7 Speakers’ biographies & oral presentations Dr Lynne Callghan Verity Chester Friederike Höffer Gareth Hopkin John Morgan Dr Siân Oram Samantha Russell 8/10 8/11 8/12 8/13 9/10 9/14 9/15 Poster abstracts Lara Arsuffi Kelly Cocallis Lydia Evans Vidya Fatania Sharonie Fitzhugh Amanda Gilman Dr Neel Halder Nutmeg Hallett Stephanie Harris Eve Hepburn Andy Inett Dr Kate Law Llaria Lega Dr Clive Long Annette McKeown Dr Catrin Morrissey Dr Clare Oakley Laura O’Shea Jane Padmore Rachel Quinn Masuma Rahim Dr Chantal Scaillet Mareike Suesse Dr John Tully 16 16 17 17 18 18 19 19 20 20 21 21 22 22 23 23 23/24 24 24/25 25 26 26 27 27 Presentations Alex Piquero Deirdre Macmanus (PDF of presentation will follow after conference) Samantha Russell Verity Chester Friederike Höfer Seena Fazel (PDF of presentation will follow after conference) Gareth Hopkin Lynne Callaghan and John Morgan Siân Oram Conor Duggan 28-33 34 34-36 36-38 38-39 39 40 41-42 42-43 44-48 About Partnerships in Care Partnerships in Care (PiC) is the largest independent provider of secure and step down facilities across the UK, with 1200 beds across 23 hospitals. We have over 27 years experience in providing specialist care. We provide: Medium Secure, Low Secure, Locked Rehabilitation, Open Rehabilitation and Community Housing to support patients’ safe and positive re-integration into the community Individually-tailored measurable and evidence-based treatment programmes with clearly specified goals and timescales Forensic specialisation with focus on risk reduction, relapse prevention and independent living skills Specialist care pathways for prisoners with mental illness and challenging behaviours Specialist services for vulnerable adults, aged 50 and over Medium Secure Low Secure Risk reduction Safety management Locked Rehab Social integration Open Rehab/ Community Placements Life skills Cognitive skills National care pathways with Partnerships in Care Get in touch Group Medical Director: Dr Quazi Haque - [email protected] Read about us: PiC Quality Account www.partnershipsincare.co.uk Join the IoP/PiC debate: “This House believes that most sex offenders don’t show meaningful benefit from psychological treatments to address risk to others” London, 16th May 2013 [email protected] Partnerships in Care Mental Health Group Mental Illness Personality Disorder Learning Disability Autistic Spectrum Disorder Brain Injury