Dramatherapy for mentally disordered offenders: changes in levels of anger

The aim of this study was to examine changes in levels of anger associated with a therapeutic theatre project. The population consisted of mentally disordered patients in a maximum security hospital, all of whom had a history of major violence. The subjects were being treated on a ward that specializes in psychotherapeutic interventions. Twelve young adult male patients, defined by structured interview for personality disorder and clinical diagnosis for mental illness, participated in a week-long dramatherapy project. They were evaluated using self-report questionnaires both before and after the week, as well as at three-month follow-up. Levels of anger significantly reduced from before to after the theatre week. This improvement was maintained at three-month follow-up. There was an associated increase in the frequency of attempts to control the expression of anger. It is concluded that a dramatherapy project within a psychotherapeutic environment may be an effective therapeutic modality for reducing anger levels in young mentally disordered offenders. Copyright © 1998 Whurr Publishers Ltd.     

The clinical profile of high-risk mentally disordered offenders

Purpose

High-risk mentally disordered offenders present a diverse array of clinical characteristics. To contain and effectively treat this heterogeneous population requires a full understanding of the group’s clinical profile. This study aimed to identify and validate clusters of clinically coherent profiles within one high-risk mentally disordered population in the UK.

Methods

Latent class analysis (a statistical technique to identify clustering of variance from a set of categorical variables) was applied to 174 cases using clinical diagnostic information to identify the most parsimonious model of best fit. Validity analyses were performed.

Results

Three identified classes were a ‘delinquent’ group (n = 119) characterised by poor educational history, strong criminal careers and high recidivism risk; a ‘primary psychopathy’ group (n = 38) characterised by good educational profiles and homicide offences and an ‘expressive psychopathy’ group (n = 17) presenting the lowest risk and characterised by more special educational needs and sexual offences.

Conclusions

Individuals classed as high-risk mentally disordered offenders can be loosely segregated into three discrete subtypes: ‘delinquent’, ‘psychopathic’ or ‘expressive psychopathic’, respectively. These groups represent different levels of risk to society and reflect differing treatment needs.     

Nonprofessionals in the rehabilitation of mentally disordered sex offenders

Eighty-six sex offenders were exposed to a 6-month voluntary program of either group encounters (experimental group) or hobbies and games (control group) led by nonprofessionals. Pre- and posttests included a personality test, an introspective report, and a behavior rating scale. Written ward records were assessed as were the results of a postexperimental prisoner evaluation of the experience. Significant changes were evidenced by encounter subjects in improved feelings of approval of the prison-hospital experience, lessened hostility, and better attendance at the meetings. Encounter subjects were improved in the predicted direction on 55 of the 74 treatment dimensions. Community volunteers were judged moderately successful as lay therapists.     

The optimum size of a high-security unit for mentally disordered offenders

‘Special’ hospitals in England (i.e. maximum-security hospitals for mentally disordered offenders, including psychopaths) are thought to be too big. On the other hand, there is concern that there is a size below which maximum security containment could become financially inefficient, inhumane or even dangerous. Is there an optimum solution? In this paper we consider the optimum size of a place for the treatment, and eventually rehabilitation to the community, of mentally disordered offenders held in maximum security. We cannot answer the question of size without taking into account principles of rehabilitation, quality of care, cost-effectiveness, the probable length of stay of the prisoner patient, the architecture of secure units and the psychology of dangerous people. We conclude that the notion of an optimum absolute size for such a place, in terms of either people or bricks and mortar, is a nonsense. However, we do produce an arabesque formula, based neither on numbers nor on acres, but on the nearness to, and the population density of, the community which has attempted to segregate the inmates.     

Measuring victim empathy among mentally disordered offenders: Validating VERA-2

There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population.     

Commentary: substance abuse and criminality in the mentally disordered defendant

This commentary discusses the main findings of the research study by Friedman et al. entitled, "Gender Differences in Criminality: Bipolar Disorder with Co-occurring Substance Abuse." Moreover, it shows that the role of substance use should be determined in studies that assess outcomes among co-occurring disorders, such as bipolar disorder and criminal behavior. High rates of substance-related problems were recorded in the study by Friedman et al. Fifty-six percent of the patients with dual-diagnosis, rapid-cycling bipolar disorder had been charged with drug- or alcohol-related offenses. Significantly more men (69%) had incurred substance-related charges than had women (38%). Women who abused cocaine were more likely to be charged with a crime than were those who had not. Sixty-five percent of the women in the study who abused cocaine had been previously charged with a crime, compared with 38 percent of the women who did not; but this finding did not hold true for the men. The number of crimes committed by the men who abused cocaine and by those who did not was about the same. This article also provides an overview of the role of substance use in criminal behavior and how substances of abuse can affect bipolar disorder and criminal outcomes.     

Explanations of firesetting in mentally disordered offenders: a review of the literature

This paper reviews current explanations of firesetting in adult mentally disordered offenders. In particular, attention is given to contemporary research that has examined developmental and background characteristics, personality and associated traits, motivation for firesetting, neurobiological explanations, psychiatric diagnoses, and frequency of self-injurious behavior, including suicide. The likelihood of recidivism and associated risk factors is also considered. Evaluation of the existing research has highlighted that even though a significant proportion has been conducted with psychiatric populations, little is understood about firesetting by mentally disordered offenders. In addition, little research has been conducted that compares mentally disordered firesetters to both other mentally disordered offenders and non-mentally disordered offenders. Recommendations are made for future research to further develop knowledge of this behavior.     

A systematic review of structured group interventions with mentally disordered offenders

Background Over the last 15 years, rehabilitation of offenders has been rigorously researched, resulting in new knowledge and understanding about factors decreasing recidivism amongst them. Typically, such interventions have been based on cognitive behavioural therapy. However, until recently, little research had been carried out on the rehabilitation of offenders with mental disorder. The authors present the first systematic review of the efficacy of structured group interventions with mentally disordered offenders. Aim To evaluate structured group interventions with mentally disordered offenders through systematic review of the evidence for their efficacy and effectiveness. Methods A standardized search strategy, with complementary methods of data retrieval to ensure a high degree of recall, was employed. Meta‐analysis was not undertaken due to sample heterogeneity and lack of comparable data. Instead, effect sizes were calculated on all papers with sufficient data. Pooled effect sizes were calculated for groups of interventions with a similar focus. Results Twenty studies were retrieved that fitted the inclusion criteria. It was possible to categorize these, predominantly British, studies into four main themes: problem‐solving; anger/aggression management; self‐harm; and other. The mean pooled effect sizes for the first two groups were suggestive of a moderate to high effect, but methodological variation means that these findings should still be treated as preliminary. Discussion and conclusions Calculated effect sizes give optimism for the efficacy of structured group interventions with mentally disordered offenders. It is important now that more rigorous and consistent research methods be applied, even in secure hospital environments. Some suggestions towards achieving this are offered, drawing from the work to date, inclusive of the need for agreement on common outcome measures and development of networks to improve sample sizes. Copyright © 2006 John Wiley & Sons, Ltd.     

Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders.

A retrospective study of the prevalence of child neuropsychiatric disorders was done involving pervasive developmental disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome in young offenders (15-22 years, n = 126) consecutively referred for presentencing forensic psychiatric investigation (FPI) in Stockholm, Sweden. Most offenders were referred for FPI because of serious offenses. Case report sheets were prepared, and retrospective neuropsychiatric DSM IV diagnoses were made by the first two authors. For best-estimated diagnoses, the case report sheets were then submitted to the fifth author, a child neuropsychiatrist with expertise in this area. Fifteen percent of the subjects had a definite diagnosis of ADHD, and another 15 percent had PDD, including 12 percent PDD not otherwise specified (NOS) and 3 percent Asperger syndrome. Autistic disorder was not found in any case. Tourette syndrome occurred in two percent of the cases. The rate of PDD is particularly striking. Neuropsychiatric diagnoses had been determined in the FPI in only a few cases. The contribution of constitutional problems to later criminal development may have been underestimated.