Mental Health Interventions for Offenders

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What is the prevalence of psychiatric problems in young offenders (Templin et al, 2002)
60% males and 70% females
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What is one way that mental health problems arise in offenders?
Substance abuse
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Farrington et al (2012)
Found substance abuse to be a predictor of homicide
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Dixon (2004)
Found 84% of offenders to have substance abuse. The prison environement can cause and encourage mental health problems such as depression
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What is the prison environment not do?
Right setting to help minimize or prevent mental health problems and so the need for intervention is key
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What is mental health also associated with?
Recidivism so important to try and prevent this
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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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According to the NICE conduct report, what was linked?
CD is linked with social isolation, drug use, poor education and offending
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Domalanta et al (2003)
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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Depression is highly prevalent in the offending population- what are the figures?
major depression in males around 10.2%, females 14.1% based on systematic review (Fazel et al. 2016) with even high % with less severe depression
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In order to help those offenders with CD and depression what has been implemented?
cognitive behavioural therapy (CBT) (Beck, 1970
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What is CBT?
a talking therapy which works by tackling distorted cognition by breaking down problems positively into smaller parts, giving pps coping skills
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Lipsey et al (2007)
Proved CBT to be effective with offenders without MH, particularly at reducing recidivism
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What does CBT for depression share?
A 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 were pps randomly assigned to?
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 follow up study what was found?
There 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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What does a RCT allow?
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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Double blind is preferred however when is this not appropriate?
The therapist must know which therapy to give
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This study also had an appropriate control group, instead of what?
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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Why is a control group important?
it can affect effect sizes- another therapy is a more stringent test as you are less likely to find an affect of the experimental group (more of a level playing field) so therefore when an effect is found although it is smaller, it is more meaningful
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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?
CBT to have a medium effect size on mental health issues including anxiety and in particular depression
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This is a systematic review of RCT, which is good as it shows what?
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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How many studies were used?
37
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What does this review suggest?
CBT to be effective at reducing depression, therefore it can be concluded that CBT is in fact effective for offenders
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However, what was found in a follow up?
the effects were not sustained, emphasizing the need for more research for interventions which work in the long term
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What do offenders often go through?
Traumatic events as children such as abuse, which may lead to PTSD
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What is PTSD?
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 does this suggest?
it seems this childhood trauma may be a risk factor for criminal activity, and a lot of people in prison may have PTSD so is definitely a need to implement an intervention for offenders
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What is one therapy for PTSD?
Cognitive Processing Therapy
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What is this 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)
Did 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)
CPT for adolescent male offenders
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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 did PTSD symptoms assess?
via self-report and interviews prior, and then self-report throughout and then again at end
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What did this find?
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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However the method used to assess was?
Self report, which is highly unreliable, pps may not give truthful answers, these are criminals and often lie- can they be trusted?
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What sort of sample was this?
Only males so the sample is not generlisable to femals.
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Why?
They may react differently to treatment. 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 involved?
a rapport-building and education phase, a reexperiencing phase and resolution phase
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What are the specific techniques?
relaxation training, role playing, modelling and narrative storytelling
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The control group was what?
A waiting list
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What was found?
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 was the follow up?
Indicated the symptom remained reduced
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What was the sample relatively small to?
conclusively say the results were positive, as well as this there was a high attrition rate-almost half of the pps didn’t complete the treatment
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What does this mean?
there is an attrition bias and results are not reliable especially as they didn’t analyse using intention to treat
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Assessors were not blind to the condition of each pps, what 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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What is bad about the control?
Waiting list, unethical and not a stringent test- bigger effect sizes but less meaningful
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What is a common problem with looking at MH interventions?
Lack of longitudinal data
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The main aim of treating offenders with MH is to do what?
prevent recidivism and behaviours such as substance abuse which often facilitates criminal activity
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Morgan et al (2012)
conducted a meat-analysis on interventions for mental health issues in offenders and recidivism and found reductions in psychological and criminal recidivism
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These findings were based off?
individual studies looking at either interventions or recidivism separately
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Therefore?
longitudinal studies for intervention research to fully comprehend its success and the effects it has on the offenders
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Other cards in this set

Card 2

Front

What is one way that mental health problems arise in offenders?

Back

Substance abuse

Card 3

Front

Farrington et al (2012)

Back

Preview of the front of card 3

Card 4

Front

Dixon (2004)

Back

Preview of the front of card 4

Card 5

Front

What is the prison environment not do?

Back

Preview of the front of card 5
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