Interventions for mental health problems in offenders

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Templin et al, 2002
High prevalence psychiatric problems in young offenders (60% males and almost 70% of females met diagnostic criteria for psychiatric disorder
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For example?
substance abuse, mental health problems can often cause substance abuse as a form of self-treatment, substance abuse is associated with offending
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Farrington et al (2012)
found substance abuse to be a predictor of homicide and Dixon et al. (2004) found 84% of offenders to have substance abuse
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What else can cause mental health problems?
Prison environment can cause and encourage mental health problems such as depression
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What is conduct disorder?
Repetitive and persistent pattern of behaviour where basic rights of others and age appropriate social norms are violated
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What are behaviours linked to?
Significant impairment in social, academic and occupational functioning
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When does this develop?
In childhood and persists into adolescence and adulthood
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According to the NICE conduct disorder report, what is CD linked to?
Social isolation, drug use, poor education and offending
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Domalanta et al., 2003
between 23% and 87% in youth/juvenile detention facilities in US • Youths with CD are increasingly being diagnosed with depression, making the two co-morbid
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What is depression?
Highly prevalence in the offending population, major depression in males around 10.2%, females14.1% based on systematic review (Fazel et al. 2016) with high % even less severe depression
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In order to help those with offenders with CD and depression, what has been implemented?
CBT (Beck, 1970)
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What is CBT?
talking therapy which works by tackling distorted cognition by breaking down problems positively into smaller parts, giving pps coping skills
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What did lisped et al (2007) prove?
CBT to be effective with offenders without MH particularly at reducing recidivism
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What does CBT for depression share?
number of commonalities with treatments developed for aggressive and conduct-disordered youth so suggests that the depression intervention has the potential to affect a broader range of problematic behaviors
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Rohde et al. (2004)
conducted a course of CBT and CWD-A (coping with depression- adolescents) on youth offenders, control was a life skills intervention
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What did Pps randomly do?
assigned to the group, completed questionnaire and interview before and after treatment to assess depression and CD
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What did this study find?
depression and CD recovery rates post-treatment were greater in the experimental condition compared to the control Group
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What was reduced?
externalizing problems, reduced suicide proneness, increased self-esteem, and increased sharing of feelings with staff
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However, in a follow up study?
were no long term gains- the positive effects were not maintained
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What does this suggest?
CBT to be an effective acute treatment for depression in multi-disordered adolescents, and therefore indicates that MH interventions can in fact help offenders as well as non-offenders
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Why is this study good?
RCT which is good as it allows a causal relationship to be determined between treatment and outcome, all pps were allocated randomly into ex or control group- stops bias and creates level playing field for all pps
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What is preferred?
double blind is normally preferred, in this case this it is not appropriate as in order to give effective treatment, the therapist must know which therapy to give
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What else was bad about this study?
• Self report was also used however, which can be seen as unreliable as some pps may not want themselves to come across in a bad light
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This study had an appropriate control group however?
instead of no treatment as a control, which would be highly unethical and not a stringent test, the control was another intervention- life skills training
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What does this mean?
it is classed as evidence based practice and the results are therefore reliable, means this is good evidence for mental health interventions being successful in offenders.
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Yoon et al (2017)
conducted a systematic review and meta-analysis on RCT of psychological therapies for offenders with mental health problems
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What was found?
Found CBT to have a medium effect size on mental health issues including anxiety and in particular depression
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Why is a systematic review of RCTgood?
It shows the overall effect of the intervention throughout the literature, based high quality, evidence based studies, this makes the results reliable and less prone to bias.
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What does the follow up study show?
In a follow up study, the effects were not sustained, emphasising the need for more research for interventions which work in the long term
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What is trauma?
Often offenders go through traumatic events such as child abuse which may lead to PTSD
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What is PTSD?
PTSD is where the individual gets a delayed response to stressful events, often experiencing flashbacks
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Windom (1989)
found that experiencing abuse before the age of 11 was associated with increased offending
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What is one therapy for PTSD?
Cognitive Processing therapy
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What is the treatment based on?
The idea that negative emotional reactions can interfere with emotional and cognitive processing of the trauma memory, which can lead to traumatic symptomatology
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Cusack et al (2016)
a systematic review and meta-analysis of various psychological treatments for PTSD and found that CPT consistently provided a significant reduction in symptoms for pps, this shows its efficacy in the general population
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Ahrens and Rexford (2002)
Conducted CPT for adolescent male offenders
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What was the random assignment?
either waiting list control (however they did receive the treatment after the experiment finished so wasn’t unethical) or the treatment group
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What does CPT involve?
exercises distinguishing thoughts and feelings, examining thoughts associated with the trauma and writing a narrative describing the trauma, and then challenging their maladaptive thoughts
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What was found?
CPT group showed significant decline in their symptoms, while the control did not
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What does this suggest?
this therapy can be used for offenders with MH problems as well as non-offenders, the intervention was successful
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What is wrong with this study?
the method used to assess PTSD was self-report, which is highly unreliable, pps may not give truthful answers, in addition these are criminals, offenders often lie so can their responses be trusted?
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What else was wrong with it?
Small sample which means the power of the study is low
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Also only what?
• Also only males so the sample is not generalizable to females. They may react differently to treatment.
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Lader et al. (2000)
They are also more likely to receive treatment before incarceration as well as inside a prison (Lader et al. 2000) so the treatments may have different effects.
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Ovaert et al (2003)
developed a treatment called structured group therapy which encapsulates aspects of CBT and cognitive processing therapy (CPT) to treat offenders with PTSD
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What is the therapy composed of?
two weekly sessions for 6 weeks and were highly structured
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What is the specific techniques?
Relaxation training, role playing, modelling and narrative storytelling
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The control group was?
waiting list, pps randomly allocated to each condition • Found that the experimental group had significantly lower PTSD scores post-treatment, it was particularly effective for those offenders involved in gang violence
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What did the follow up study show?
indicated the symptoms remained reduced
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What was the sample?
relatively small to conclusively say the results were positive
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What about the assessors?
not blind to the condition of each pps, this can effect the results by causing bias, they may assess the effectiveness of the treatment in a more positive light and in a way that supports their hypothesis
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Also control was a waiting list which is?
unethical and not a stringent test- bigger effect sizes but less meaningful
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What is a common problem with looking at studies looking into MH intervention?
Lack of longitudinal data
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What is the main aim?
prevent recidivism and behaviours such as substance abuse which often facilitates criminal activity
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These Studies and literature do not what
look at this
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Studies looking into any kind of intervention for offenders with MH should what?
should do a follow up study further assessing the symptoms of the offender as well as if they have reoffended
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What is it important to do?
research this to fully understand the extent to which MH interventions are effective for offenders
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Morgan et al (2012)
conducted a meat-analysis on interventions for mental health issues in offenders and recidivism
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What did they find?
found reductions in psychological and criminal recidivism, these findings were based off individual studies looking at either interventions or recidivism separately
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Therefore what is needed?
Longitudinal studies for intervention research to fully comprehend its success and the effects it has on the offenders
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For example?

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substance abuse, mental health problems can often cause substance abuse as a form of self-treatment, substance abuse is associated with offending

Card 3

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Farrington et al (2012)

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Card 4

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What else can cause mental health problems?

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Card 5

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What is conduct disorder?

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