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Theodorou A, Sinclair H, Ali S, Sukhwal S, Bassett C, Hales H. A systematic review of literature on homicide followed by suicide and mental state of perpetrators. Crim Behav Ment Health 2024; 34:10-53. [PMID: 38245874 DOI: 10.1002/cbm.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Homicide followed by suicide is rare, devastating and perpetrated worldwide. It is commonly assumed that the perpetrator had a mental disorder, raising concomitant questions about prevention. Though events have been reported, there has been no previous systematic review of the mental health of perpetrators. AIMS Our aims were twofold. First, to identify whether there are recognisable subgroups of homicide-suicides in published literature and, secondly, to investigate the relationship between perpetrator mental state and aspects of the incident. METHODS We conducted a systematic review of published literature on studies of homicide followed within 24 h by suicide or serious suicide attempt that included measures of perpetrator mental state. RESULTS Sixty studies were identified, most from North America or Europe. Methodologically, studies were too heterogeneous for meta-analysis. They fell into three main groups: family, mass shooter, and terrorist with an additional small mixed group. There was evidence of mental illness in a minority of perpetrators; its absence in the remainder was only partially evidenced. There was no clear association between any specific mental illness and homicide-suicide type, although depression was most cited. Social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified across all groups. Pre-established ideology was relevant in the mass shooter and terrorism groups. Prior trauma history was notable in the terrorist group. CONCLUSION Research data were necessarily collected post-incident and in most cases without a standardised approach, so findings must be interpreted cautiously. Nevertheless, they suggest at least some preventive role for mental health professionals. Those presenting to services with depression, suicidal ideation, relationship difficulties and actual, or perceived, changes in social position or role would merit detailed, supportive assessment over time.
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Affiliation(s)
- Alexis Theodorou
- Tavistock and Portman NHS Foundation Trust, and West London NHS Trust, Cardiff University, Southall, UK
| | - Helen Sinclair
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | | | - Heidi Hales
- Betsi Cadawaladr University Health Board, All Wales Forensic Adolescent Consultation Service, Bangor University, School of Medicine, Cardiff University, Llandudno, UK
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Bartlett A, Hales H. Detaining children: Are we sure we are doing the right things? Crim Behav Ment Health 2022; 32:149-153. [PMID: 35962768 DOI: 10.1002/cbm.2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Smith JG, Bartlett A, Hales H. Exploration of adverse patterns of placement of young people in secure care: The unwanted child? Crim Behav Ment Health 2022; 32:212-226. [PMID: 35962767 PMCID: PMC9545529 DOI: 10.1002/cbm.2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Emerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes. AIMS This study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics. METHODS Data were derived from the (2016) cross-sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI). RESULTS Overall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long-distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long-distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements. CONCLUSIONS Distant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi-agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.
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Affiliation(s)
- Jared G. Smith
- Population Health Research InstituteSt George’s, University of LondonLondonUK
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Souverein F, Hales H, Anderson P, Argent SE, Bartlett A, Blower A, Delmage E, Enell S, Eske Henriksen A, Koomen K, Oostermeijer S. Mental health, welfare or justice: An introductory global overview of differences between countries in the scale and approach to secure placements of children and young people. Crim Behav Ment Health 2022; 32:238-247. [PMID: 35419900 PMCID: PMC9544918 DOI: 10.1002/cbm.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Estimates suggest that over a million children per year are deprived of their liberty across the world. Little is known about the types, ethos or distribution of secure beds in which they are detained. AIM This study aims to provide quantitative data with background information, to explore similarities and differences across jurisdictions, and to inform critical inquiry into key concepts and practices. METHODS Data was obtained using an opportunistic sample of affluent countries, derived from an emerging academic/practice network of senior professionals. Depending on jurisdiction, data was already in the public domain or specifically requested. Data requests were related to the nature and size of health, welfare and criminal justice elements of secure beds and recent occupancy. Key professionals working in child secure settings, within jurisdictions, provided commentary on local approaches. RESULTS Data was incomplete but allowed for comparisons between 10 jurisdictions. The proportions of the populations of children and young people detained varied by jurisdiction as did their distribution across variations of secure settings. Not all jurisdictions had all three kinds of secure settings. Definitions of secure beds varied depending on the use of relational, procedural or physical security. CONCLUSION Findings are tentative but suggestion solely considering numerical descriptions of children's detention is misleading; our study highlights ways in which comparative studies may be improved. Within reported jurisdictions, the framework of health, welfare and justice was meaningful but this may not hold true with a wider international application of this method. Open interrogation of this data would be enhanced by the inclusion of children's perspectives.
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Affiliation(s)
- Fleur Souverein
- Department of child and adolescent psychiatrieAmsterdam University Medical School, Locatie VUmcAmsterdamThe Netherlands
| | | | | | | | - Annie Bartlett
- Institute of Medical and Biomedical EducationSt. George's UniversityLondonUK
| | | | | | - Sofia Enell
- Department of Social WorkLinnaeus UniversityVäxjöSweden
| | | | | | - Sanne Oostermeijer
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Bartlett A, Smith JG, Warner L, Hales H. Young men and young women in secure care: gender differences in the placement of those with mental health needs. BMC Psychiatry 2021; 21:433. [PMID: 34479529 PMCID: PMC8417994 DOI: 10.1186/s12888-021-03440-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. METHODS The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher's exact tests. RESULTS Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. CONCLUSIONS No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.
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Affiliation(s)
| | - Jared G. Smith
- grid.4464.20000 0001 2161 2573Population Health Research Institute, St George’s, University of London, London, UK
| | - Louise Warner
- grid.451052.70000 0004 0581 2008CNWL NHS Foundation Trust, London, UK
| | - Heidi Hales
- grid.439700.90000 0004 0456 9659Adolescent Forensic Psychiatry, West London NHS Trust, London, UK
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Affiliation(s)
- Melissa Beaumont
- Team Lead & Clinical Nurse Specialist, Health & Wellbeing Team Feltham YOI, Central and North West London NHS Trust, UK
| | - Kate Chalker
- Wye CAMHS Clinical Nurse Specialist Hounslow YOT West London NHS Trust, UK
| | - Layla Clayton
- Assistant Psychologist, Health & Wellbeing Team Feltham YOI, Central and North West London NHS Trust, UK
| | - Emily Curtis
- Youth Justice Liaison and Diversion Hammersmith and Fulham Youth Offending Service, UK
| | - Heidi Hales
- Consultant Psychiatrist, North West London FCAMHS, West London NHS Trust, UK
| | | | - Rhiannon Lewis
- Consultant Clinical Psychologist and Clinical Lead for SECURE STAIRS and the Enhanced Support Unit, HMYOI Feltham, Central and North West London NHS Trust, UK
| | - Gabrielle Pendlebury
- Consultant Adolescent Psychiatrist and Medico-legal Adviser, FCAMHS at The Port, Tavistock and Portman NHS Trust, UK. , @PendlesGabriel
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Bell G, Deshpande M, Hales H, Harding D, Pendlebury G, White O. Multidisciplinary research priorities for the COVID-19 pandemic. Lancet Psychiatry 2020; 7:e37-e38. [PMID: 32563313 PMCID: PMC7302781 DOI: 10.1016/s2215-0366(20)30225-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Duncan Harding
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Oliver White
- Southern Health NHS Foundation Trust, Southampton, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Hales H, Holt C, Delmage E, Lengua C. What next for adolescent forensic mental health research? Crim Behav Ment Health 2019; 29:196-206. [PMID: 31478288 DOI: 10.1002/cbm.2124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public. AIM The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective. METHODS Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England. FINDINGS As in most countries, service development seems first driven by unusual, newsworthy cases. Overall, however, current English provision follows sound primary, secondary, and tertiary prevention principles with parallel tiers of service, including public health initiatives. Primary prevention and more specific treatments are likely to be informed by research findings, but service structure tends to emerge from a wider review base, including criminal justice, social and educational practitioner reviews, and also politics. Thus, services and populations of service users may change in advance of research evidence. Substantial reduction in numbers of young offenders in prison in England, for example, is clearly good in principle, but the intensity of need in the residual group is posing new challenges to which there are, yet, few answers. CONCLUSIONS Although the last 15 years of coordinated service development in England has been broadly theoretically based, it has not been systematically assessed to establish what works best for whom. New problems emerging, such as new drugs of misuse, and new opportunities, such as technology for supporting and monitoring, require model studies. More research focusing on correlates of success is essential.
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Affiliation(s)
- Heidi Hales
- West London NHS Trust, Three Bridges Secure Unit, St Bernard's Hospital, Southall, UK
| | - Clare Holt
- STC Rainsbrook, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Enys Delmage
- Nga Taiohi and Hikitia Secure Adolescent Units, Kenepuru Hospital, Porirua, New Zealand
| | - César Lengua
- North East Commissioning Support Unit, Durham, UK
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Souverein F, Dekkers T, Bulanovaite E, Doreleijers T, Hales H, Kaltiala-Heino R, Oddo A, Popma A, Raschle N, Schmeck K, Zanoli M, van der Pol T. Overview of European forensic youth care: towards an integrative mission for prevention and intervention strategies for juvenile offenders. Child Adolesc Psychiatry Ment Health 2019; 13:6. [PMID: 30651754 PMCID: PMC6332583 DOI: 10.1186/s13034-019-0265-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
All over Europe youth delinquency is decreasing; our understanding of the factors related to juvenile delinquency and the characteristics of effective forensic youth care has increased substantially. However, effective prevention and intervention strategies are not always employed due to financial, demographical and socio-political challenges countries face, while the burden of mental health in juvenile justice populations is high. With this commentary, we highlight the importance of international collaboration to set out a direction to improve forensic youth care, to bundle our strengths and overcome our challenges. It is a continuation of the course that was set out by Doreleijers and Fegert (Child Adolesc Psychiatry Ment Health 5:20, 2011), in their editorial they highlighted the importance of collaboration and presented an overview of the state of the art on forensic youth care in eight European countries (and Russia). With this manuscript, we present an overview of statistics in juvenile justice of all European countries and present an integrated mission statement for forensic youth care, which was formulated in a keynote debate at the 6th biennial congress of the European Association for Forensic Child and Adolescent Psychiatry, Psychology and other involved professions (EFCAP).
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Affiliation(s)
- Fleur Souverein
- 0000000084992262grid.7177.6Department of Child- and Adolescent Psychiatry, Amsterdam University Medical Center (AUmc) Amsterdam, Amsterdam, The Netherlands ,Academic Workplace Forensic for at Risk Youth (AWRJ), Amsterdam, The Netherlands
| | - Tycho Dekkers
- 0000000084992262grid.7177.6Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands ,grid.491096.3Department of Forensic Psychiatry and Complex Behavioral Disorders, De Bascule, Academic Center for Child- and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Elena Bulanovaite
- 0000 0004 0575 8750grid.48349.32Department of Psychiatry, Child and Adolescent Psychiatry Sector, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Theo Doreleijers
- 0000000084992262grid.7177.6Department of Child- and Adolescent Psychiatry, Amsterdam University Medical Center (AUmc) Amsterdam, Amsterdam, The Netherlands
| | - Heidi Hales
- Wells Adolescent Forensic Mental Health Unit, West London Mental Health Trust, London, UK
| | - Riittakerttu Kaltiala-Heino
- 0000 0001 2314 6254grid.5509.9Tampere University Hospital and Vanha Vaasa Hospital, University of Tampere, Tampere, Finland
| | - Aurelio Oddo
- grid.425705.1Ministry of Justice, Prison of Udine, Udine, Italy
| | - Arne Popma
- 0000000084992262grid.7177.6Department of Child- and Adolescent Psychiatry, Amsterdam University Medical Center (AUmc) Amsterdam, Amsterdam, The Netherlands ,grid.491096.3Department of Forensic Psychiatry and Complex Behavioral Disorders, De Bascule, Academic Center for Child- and Adolescent Psychiatry, Amsterdam, The Netherlands ,0000 0001 2312 1970grid.5132.5Department of Criminology, Leiden University, Leiden, The Netherlands
| | - Nora Raschle
- 0000 0004 1937 0642grid.6612.3Department of Child and Adolescent Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- 0000 0004 1937 0642grid.6612.3Department of Child and Adolescent Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | | | - Thimo van der Pol
- 0000000084992262grid.7177.6Department of Child- and Adolescent Psychiatry, Amsterdam University Medical Center (AUmc) Amsterdam, Amsterdam, The Netherlands ,Department of Forensic Youth Psychiatry, LUMC/Curium, Oegstgeest, The Netherlands ,0000 0004 0378 2028grid.491093.6Arkin, Amsterdam, The Netherlands
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Hales H, White O, Deshpande M, Kingsley D. Use of solitary confinement in children and young people. Crim Behav Ment Health 2018; 28:443-446. [PMID: 30402993 DOI: 10.1002/cbm.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Heidi Hales
- Forensic Directorate, West London NHS Trust, London, UK
| | - Oliver White
- Southern Health NHS Foundation Trust, Southampton and Oxford Health NHS Foundation Trust, Bristol, UK
| | - Mayura Deshpande
- Southern Health NHS Foundation Trust, Southampton, National Clinical Lead, CAMHS MSU Network, NHSE
| | - David Kingsley
- Priory Group, National Clinical Lead, CAMHS Low Secure Network, NHSE
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Hales H, Dixon A, Newton Z, Bartlett A. Assaults by Mentally Disordered Offenders in Prison: Equity and Equivalence. J Bioeth Inq 2016; 13:317-326. [PMID: 26780106 DOI: 10.1007/s11673-016-9698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 06/11/2015] [Indexed: 06/05/2023]
Abstract
Managing the violent behaviour of mentally disordered offenders (MDO) is challenging in all jurisdictions. We describe the ethical framework and practical management of MDOs in England and Wales in the context of the move to equivalence of healthcare between hospital and prison. We consider the similarities and differences between prison and hospital management of the violent and challenging behaviours of MDOs. We argue that both types of institution can learn from each other and that equivalence of care should extend to equivalence of criminal proceedings in court and prisons for MDOs. We argue that any adjudication process in prison for MDOs is enhanced by the relevant involvement of mental health professionals and the articulation of the ethical principles underpinning health and criminal justice practices.
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Affiliation(s)
- Heidi Hales
- HMYOI Cookham Wood, CNWL NHS Foundation Trust, Sir Evelyn Road, Rochester, UK.
| | - Amy Dixon
- HMP Holloway, 1 Parkhurst Road, London, UK, N7 0NU
| | - Zoe Newton
- HMP Holloway, CNWL NHS Foundation Trust, I Parkhurst Road, London, N7 0NU, UK
| | - Annie Bartlett
- PHSE, St Georges, University of London, Cranmer Terrace, London, SW17 0RE, UK
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Hales H, Somers N, Reeves C, Bartlett A. Characteristics of women in a prison mental health assessment unit in England and Wales (2008-2010). Crim Behav Ment Health 2016; 26:136-152. [PMID: 25808745 DOI: 10.1002/cbm.1953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The high prevalence of mental disorders among women in prison is recognised worldwide. In England and Wales, successive governments and independent reports have argued that the equivalent of community care in prisons is acceptable but that some mental health assessment units (MHAUs), staffed by professional clinicians, should remain. These have not been researched. AIMS This paper aimed to explore patterns of use of a MHAU in a women's prison in England and to test the hypothesis that it was being used only, as intended--to hold women pending transfer to a health service hospital or in a bona fide crisis. METHODS Anonymised data on all women transferred to one MHAU between 1 January 2008 and 31 August 2010 were obtained from the prison files and subjected to descriptive analysis. RESULTS Less than a third of these women were transferred to an outside hospital; this group stayed longest in the unit. An overlapping group of 52% of the women was under a special assessment, care in custody and teamwork protocol because of suicide or serious self-harm risk. Thus, 188 (68%) admissions fulfilled national protocol criteria for MHAU admissions. Two in five women admitted were released or returned to ordinary prison locations. Nevertheless, over 80% of the women were known to external mental health services, and 64 (30%) were so unwell on arrival in prison that they were transferred directly to the MHAU. Over a third of admissions were of women admitted more than once during the 32 months of study, and this was significantly more likely after release from prison directly to the community. CONCLUSIONS Our hypothesis was not sustained, and it seems unlikely that this prison MHAU is unique in being used outside its strict remit. A shift from studying the epidemiology of mental disorder in prisons to the epidemiology of mental health needs could benefit this vulnerable group and the wider community alike.
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Affiliation(s)
- Heidi Hales
- Wells Unit, Three Bridges Secure Unit, St Bernard's Hospital, Uxbridge Road, Middlesex, UB1 3EU, UK
| | - Nadia Somers
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Chrissy Reeves
- CNWL NHS Foundation Trust, 75 Hampstead Road, London, NW1 2PL, UK
| | - Annie Bartlett
- St George's, University of London and CNWL Foundation Trust, Cranmer Terrace, London, SW17 0RE, UK
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Hales H, Edmondson A, Davison S, Maughan B, Taylor PJ. The Impact of Contact With Suicide-Related Behavior in Prison on Young Offenders. Crisis 2015; 36:21-30. [DOI: 10.1027/0227-5910/a000292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Prison suicide rates are high, and suicide-related behaviors (SRBs) higher, but effects of contact with such behaviors in prison have not previously been examined. Aims: To compare the mental state of young men witnessing a peer’s suicide-related behavior in prison with that of men without such experience, and to test for factors associated with morbidity. Method: Forty-six male prisoners (age 16–21 years) reporting contact with another’s suicide-related behavior in prison were interviewed 6 months after the incident, with validated questionnaires, as were 44 without such contact at least 6 months into their imprisonment. Results: Significantly higher levels of psychiatric morbidity and own suicide-related behaviors were found in the witness group, even after controlling for their higher levels of family mental illness and pre-exposure experience of in-prison bullying. Some personal factors were associated with higher morbidity; incident and institutional factors were not. Conclusions: Findings of heightened vulnerabilities among young men exposed to suicide-related behaviors in prison suggest a need for longitudinal study to clarify temporal relationships and inform strategies to prevent or limit development of morbidity and further harm.
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Affiliation(s)
- Heidi Hales
- West London Mental Health NHS Trust, London, UK
| | | | - Sophie Davison
- North Metro Area Mental Health Service, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Barbara Maughan
- Department of Developmental Epidemiology, SGDP, Institute of Psychiatry, Kings College, London, UK
| | - Pamela J. Taylor
- Department of Forensic Psychiatry, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
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Bartlett A, Dholakia N, England R, Hales H, van Horn E, McGeorge T, Moss B, Ovaisi S, Tukmachi E, Patel S. Prison prescribing practice: practitioners' perspectives on why prison is different. Int J Clin Pract 2014; 68:413-7. [PMID: 24674704 DOI: 10.1111/ijcp.12362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The current prison population in England and Wales has multiple, complex healthcare needs, presenting unique challenges to those caring for prisoners. Prison numbers have increased dramatically in the last 10 years. There are now approximately 84,000 prisoners in England and Wales and 120,000 new episodes of imprisonment each year . The authors all contribute to prison healthcare. Below, we discuss a key issue arising from first-hand experience of prisoners' health and social care needs, the prescription of psycho-active drugs by primary and secondary care practitioners. This is a core medical task, but beset with difficulties. These difficulties are not necessarily encountered in other areas of prison healthcare. However, they do illustrate how providing healthcare to prisoners is complex, often lacking a research base and can have pitfalls that are not obvious to the outsider.
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Abstract
Background: Rates of suicide and suicide-related behavior (SRB) are high in prison. Those witnessing such behavior may develop psychological morbidity. Most previous studies have been quantitative. Little has been written about the witnesses’ qualitative experience. Aims: The aim of the study was to explore, through interview and then thematic analysis, the core concerns of those witnessing another’s SRB in prison. Method: We interviewed 70 detained young men about their experience of another’s SRB in prison. Results: Three main themes were identified: their experience of another’s SRB; their thoughts of why the victim died by/attempted suicide; and the physical, emotional, and cognitive effects of another’s SRB on them. Responses to questions about the witnesses’ experience of support from others, unmet needs, and peers’ responses are also described. Two categories within the theme ”thoughts of why the victim died by/attempted suicide” were associated with being in prison, all others could be experienced in the community. Over half of the sample reported negative reactions to witnessing another’s SRB. Conclusion: Most themes were unrelated to prison. Though many reported negative reactions to their experience, suggesting a need for support, many denied that need. The implication of this study is that prison discipline and health-care staff need to consider how to provide needed support and care in an acceptable form to young men in prison.
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Affiliation(s)
| | - Mona Freeman
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Pamela Taylor
- Department of Psychiatry and Neurology, School of Medicine, Cardiff University, UK
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Hales H, Romilly C, Davison S, Taylor PJ. Sexual attitudes, experience and relationships amongst patients in a high security hospital. Crim Behav Ment Health 2006; 16:254-63. [PMID: 17143932 DOI: 10.1002/cbm.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Detention in high security hospitals tends to last several years during patients' early adulthood, yet romantic partnerships and sexuality have been little studied. AIMS To study such relationships among these inpatients. METHOD Patients were engaged in a confidential, purpose-designed semi-structured interview concerning their relationships and their views on those of others. RESULTS Seven (of 10) women and 18 (of 24) men gave interviews. All but one had previously been sexually active. No previous relationship lasted into high security but half (15) reported a new relationship. Most emphasized the importance of caring in respect of sexual activity but sexual intimacy short of intercourse was reported. Most (17) could describe 'safe sex' practices, but few (5) had ever followed them. At least half had experienced seriously abusive sexual relationships in childhood. CONCLUSIONS Patients appeared able to talk reliably about their romantic and sexual relationships, their interest in which did not cease on incarceration. Findings suggest that it is important for staff to have accurate information on these to ensure safety and adequate support.
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Affiliation(s)
- Heidi Hales
- The Tavistock and Portman NHS Trust, London, UK.
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Abstract
Prison suicide rates are increasing. The impact of witnessing a suicide or how many people do so is unknown. The aim of this study was to find how many young people detained in a Young Offenders' Institution (YOI) have had contact with another's suicide attempt and to test for association between this and own self-harming behaviour. A questionnaire, developed for the project, was distributed within a YOI. 74% (355/480) responded. One hundred and fifty-one (43%) of the young men reported that they knew someone who had attempted suicide, 48 of them knowing someone who had thereby died. The contact with a non-fatal suicide attempted by others was associated with own self-harm (OR 1.73, CI 1.39-21.4, p<0.01); contact with completed suicide had no such association. The most important factor that increased the chance of knowing a suicide attempter was actual length of time spent in prison up to the time of the study; 95 (63%) of the young men with such contact had it in prison. No other significant vulnerability factors were identified. It seems likely that imprisonment is a specific vulnerability factor for self-harm, one explanation being that it increases the risk of exposure to a contact with suicidal behaviour by others. Further work is called for to test relationships between such exposure and own behaviour over time, and to gather first hand accounts from the young men in such circumstances in order to understand the meaning for them of the contact with suicidal behaviour by others. This would inform appropriate intervention strategies, and could save much morbidity, and even mortality.
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Affiliation(s)
- H Hales
- Department of Forensic Mental Health Science, Institute of Psychiatry, KCL DeCrespigny Park, London SE5 8AF, UK.
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Bailey S, Hales H. Children and adolescents. Crim Behav Ment Health 2004; 14:S51-S52. [PMID: 23570126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Bailey S, Hales H. Children and adolescents. Crim Behav Ment Health 2004; 14 Suppl 1:S51-2. [PMID: 16575789 DOI: 10.1002/cbm.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Henderson C, Hales H, Ruggeri M. Cross-cultural differences in the conceptualisation of patients' satisfaction with psychiatric services--content validity of the English version of the Verona Service Satisfaction Scale. Soc Psychiatry Psychiatr Epidemiol 2003; 38:142-8. [PMID: 12616312 DOI: 10.1007/s00127-003-0606-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The VSSS is a multi-dimensional questionnaire developed to address methodological concerns about measurement of satisfaction with services on the part of psychiatric patients. The acceptability, sensitivity, content validity and test-retest reliability of the original version of the VSSS, in Italian, have already been demonstrated [1, 2]. The internal consistency [3] and test-retest reliability [4] of the English translation have been shown to be within acceptable ranges. The content validity of the original 82-item and the 54-item English version has not yet been assessed. AIMS The aims of this study were to assess the content validity of the English translation of the VSSS and to compare it with that of the original version in Italian. METHOD We used data collected as part of the first wave (T1) of the PRiSM Psychosis Study [5] and repeated the methods used to assess the content validity of the original Italian version of the VSSS [1, 2]. Content elements derived from answers to four open questions were rated independently by CH and HH in terms of their equivalence to VSSS items or dimensions. RESULTS were compared to those from the content validity study of the Italian version. Results Inter-rater agreement was very high. The largest proportion of the content elements of the answers were rated as equivalent or related to a questionnaire item or a dimension of the VSSS. The dimension 'Professionals' Skills and Behaviour' appears the most significant contributor to satisfaction, as it was most often related to content elements in answers to all four key questions (39.1 %). The second most frequently mentioned dimension was that of 'Types of Intervention' for three out of four open questions, while 'Access' was second most frequent for the fourth. Of the content elements, 17.2 % did not include items or dimensions covered by the VSSS; the three most frequently mentioned were other patients, food and security. CONCLUSIONS The 82-item English version of the VSSS captures sharply most contents relevant to patients' satisfaction. Consideration of contributors to satisfaction so far neglected may refine the conceptualisation of satisfaction.
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Affiliation(s)
- Claire Henderson
- HSRD, Box P029, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
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Vanel D, Rebibo G, Hales H, Lacombe MJ, Masselot J. Contribution of computed tomography in six sacrococcygeal chordomas. Eur J Radiol 1985; 5:87-90. [PMID: 3996428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Six sacrococcygeal chordomas were studied with CT at the Institut Gustave-Roussy. Only one was examined at the time of the initial diagnosis and CT made a valuable contribution to this. In other cases, CT determined the possibility of initial surgical excision and the field of radiotherapy and helped make a reliable diagnosis of local recurrences. CT seems to be the best examination to use for the early diagnosis of chordomas and recurrences, which will perhaps help improve the prognosis of this serious disease.
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Wright KA, Hales H. Cytochemistry of the pellicle of bloodstream forms of Trypanosoma (Trypanozoon) brucei. J Parasitol 1970; 56:671-83. [PMID: 5459049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Abstract
Bloodstream forms of Trypanosoma (Trypanozoon) brucei were observed in Vitro to possess long filaments arising from both the posterior end and the tip of the flagellum, and also to become attached to various substrates, including themselves. The filaments were examined by negative staining and thin-section techniques and found to have a structure resembling filopodia. However, as their functional significance is still questionable, their designation as filopodia must be considered provisional. The possible functions of these structures, such as mediation of attachment, and release of antigenic material, are discussed.
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Hales H. Birds Singing on Their Nests. Science 1894; 23:92. [PMID: 17736355 DOI: 10.1126/science.ns-23.576.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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