HM Prison and Probation Service

Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.

BACKGROUND: Self-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm. METHODS: Records of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed. FINDINGS: 139,195 self-harm incidents were recorded in 26,510 individual prisoners between 2004 and 2009; 5-6% of male prisoners and 20-24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17,307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11-0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than half the deaths occurred within a month of self-harm. Risk factors for suicide after self-harm in male prisoners were older age and a previous self-harm incident of high or moderate lethality; in female inmates, a history of more than five self-harm incidents within a year was associated with subsequent suicide. INTERPRETATION: The burden of self-harm in prisoners is substantial, particularly in women. Self-harm in prison is associated with subsequent suicide in this setting. Prevention and treatment of self-harm in prisoners is an essential component of suicide prevention in prisons. FUNDING: Wellcome Trust, National Institute for Health Research, National Offender Management Service, and Department of Health.

INTRODUCTION: Aluminium and zinc phosphides are highly effective insecticides and rodenticides and are used widely to protect grain in stores and during its transportation. Acute poisoning with these compounds may be direct due to ingestion of the salts or indirect from accidental inhalation of phosphine generated during their approved use. MECHANISMS OF TOXICITY: Both forms of poisoning are mediated by phosphine which has been thought to be toxic because it inhibits cytochrome c oxidase. While phosphine does inhibit cytochrome C oxidase in vitro, the inhibition is much less in vivo. It has been shown recently in nematodes that phosphine rapidly perturbs mitochondrial morphology, inhibits oxidative respiration by 70%, and causes a severe drop in mitochondrial membrane potential. This failure of cellular respiration is likely to be due to a mechanism other than inhibition of cytochrome C oxidase. In addition, phosphine and hydrogen peroxide can interact to form the highly reactive hydroxyl radical and phosphine also inhibits catalase and peroxidase; both mechanisms result in hydroxyl radical associated damage such as lipid peroxidation. The major lethal consequence of phosphide ingestion, profound circulatory collapse, is secondary to factors including direct effects on cardiac myocytes, fluid loss, and adrenal gland damage. In addition, phosphine and phosphides have corrosive actions. CLINICAL FEATURES: There is usually only a short interval between ingestion of phosphides and the appearance of systemic toxicity. Phosphine-induced impairment of myocardial contractility and fluid loss leads to circulatory failure, and critically, pulmonary edema supervenes, though whether this is a cardiogenic or non-cardiogenic is not always clear. Metabolic acidosis, or mixed metabolic acidosis and respiratory alkalosis, and acute renal failure are frequent. Other features include disseminated intravascular coagulation, hepatic necrosis and renal failure. There is conflicting evidence on the occurrence of magnesium disturbances. MANAGEMENT: There is no antidote to phosphine or metal phosphide poisoning and many patients die despite intensive care. Supportive measures are all that can be offered and should be implemented as required.

A survey of clinical views suggests that the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder is unclear. To investigate this issue, we evaluated Psychopathy Checklist-Revised ratings (PCL-R; Hare, 1991) using structural equation modeling. One model, referred to as the measurement model, included PCL-R ratings related to antisocial behavior as primary symptoms of psychopathy; a second, referred to as the causal model, included the same PCL-R ratings as secondary symptoms or consequences. Compared to the measurement models, the causal model included more PCL-R items, was more parsimonious, and had equal or superior fit indices. These findings suggest that antisocial behavior is best viewed as a secondary symptom or consequence of psychopathy, In addition, the findings have important implications for future research and clinical-forensic practice, especially concerning the assessment of risk for criminality and violence.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the management of rheumatological disorders, and as analgesics and antipyretics. Hepatotoxicity is an uncommon, but potentially lethal complication, which usually occurs within 12 weeks of starting therapy. It can occur with all NSAIDs, but appears to be more common with diclofenac and particularly sulindac. Female patients aged >50 years, with autoimmune disease, and those on other potentially hepatotoxic drugs, appear to be particularly susceptible. Liver function test abnormalities generally settle within 4-6 weeks of stopping the causative drug. However, some patients may develop acute liver failure and successful orthotopic liver transplantation may be undertaken in such patients. Recent in vitro animal studies have shown that the mechanism of diclofenac toxicity relates both to impairment of ATP synthesis by mitochondria, and to production of active metabolites, particularly n,5-dihydroxydiclofenac, which causes direct cytotoxicity. Mitochondrial permeability transition (MPT) has also been shown to be important in diclofenac-induced liver injury, resulting in generation of reactive oxygen species, mitochondrial swelling and oxidation of NADP and protein thiols. Physicians and hepatologists must be vigilant to the hepatotoxic potential of any NSAID, as increased awareness, surveillance and reporting of these events will lead to a better understanding of the risk factors and the pathophysiology of NSAID-related hepatotoxicity.

This article considers factors that support or assist desistance from sexual offending in those who have previously offended. Current risk assessment tools for sexual offending focus almost exclusively on assessing factors that raise the risk for offending. The aim of this study was to review the available literature on protective factors supporting desistance from sexual offending. This article discusses the potential value of incorporating protective factors into the assessment process, and examines the literature on this topic to propose a list of eight potential protective domains for sexual offending. The inclusion of notions of desistance and strengths may provide additional guidance to the assessment and treatment of those who sexually offend. Further research investigations are recommended to consolidate the preliminary conclusions from this study regarding the nature and influence of protective factors in enabling individuals to desist from further offending.

Attitudes supportive of sexual offending figure prominently in theories of sexual offending, as well as in contemporary assessment and treatment practices with sex offenders. Based on 46 samples (n = 13,782), this meta-analysis found that attitudes supportive of sexual offending had a small, yet reasonably consistent, relationship with sexual recidivism (Cohen's d = .22). To the extent that differences were observed, attitudes predicted recidivism better for child molesters than for rapists. There was no difference in the predictive accuracy of attitudes assessed at pretreatment or at posttreatment. The current study indicates that attitudes supportive of sexual offending is a psychologically meaningful risk factor for sex offenders. However, given that many different constructs have been designated as sex offender attitudes, further research and theory is needed to understand how these various constructs contribute to recidivism.

A sample of 505 Internet sex offenders and 526 contact sex offenders were compared on a range of psychological measures relating to offense-supportive beliefs, empathic concern, interpersonal functioning, and emotional management. Internet offenders could be successfully discriminated from contact offenders on 7 out of 15 measures. Contact offenders were found to have significantly more victim empathy distortions and cognitive distortions than Internet offenders. Internet offenders were found to have significantly higher identification with fictional characters than contact offenders. Further analysis indicated that an increase in scores on scales of fantasy, underassertiveness, and motor impulsivity were predictive of an Internet offense type. An increase in scores of scales of locus of control, perspective taking, empathic concern, overassertiveness, victim empathy distortions, cognitive distortions, and cognitive impulsivity were found to be predictive of a contact offense type. These findings are discussed in the context of the etiology of sexual offending.

The effect of family visits on prisoner well-being and future behavior is an important consideration in the development of prison policy. This review systematically examines current research findings that explore the impact of prison visits from family members on three specific offender outcomes: prisoners' well-being, rule breaking within the prison, and recidivism. The review focuses on visits by family and does not duplicate earlier reviews but rather extends them into current literature, through identification of empirical studies conducted post 1989, published since 1991. Ten studies met the stipulated inclusion criteria. All are case-control and cohort studies. The review of studies used a standardized quality assessment tool. Results show considerable variation in study quality, methods, and findings. However, studies consistently reported positive effects of prisoners receiving visits. Prison visits reduced depressive symptoms in women and adolescent prisoners. There was some evidence of reduction in rule-breaking behavior. One high-quality study suggested that visits reduced recidivism and increased survival in the community. Although there were positive outcomes associated with prison visits, it was not possible to draw strong conclusions for the outcomes of interest due to a lack of research, methodological discrepancies, and variability in outcome measures and results. The discussion considers the implications of the findings for policy, practice, and research.

BACKGROUND AND PURPOSE: In 1999, the Home Office published a public consultation on the need for better management of offenders with severe personality disorders. The Dangerous and Severe Personality Disorder (DSPD) Programme was launched in 2001. Following a stocktake of the DSPD Programme in 2008, the Department of Health and the National Offender Management Service (NOMS) started the next phase of strategic development for the management of offenders with personality disorder. This paper presents the key features of the Coalition Government's strategy for offenders with personality disorders. CONCLUSION: This strategy offers a co-ordinated joint approach by both the National Health Service and the NOMS to the co-commissioning and development of pathway services.

Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately. Genetic testing holds out the tantalizing possibility of being able to do just this, and hence the vital importance of pharmacogenomic studies. These can potentially identify genetic markers for both tolerance of and vulnerability to clozapine. We aim to summarize progress so far, possible clinical applications, limitations to the evidence, and problems in applying these findings to the management of TRS. Pharmacogenomic studies of clozapine response and tolerability have produced conflicting results. These are due, at least in part, to significant differences in the patient groups studied. The use of clinical pharmacogenomic testing - to personalize clozapine treatment and identify patients at high risk of treatment failure or of adverse events - has moved closer over the last 20 years. However, to develop such testing that could be used clinically will require larger, multicenter, prospective studies.

Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) are common neurodevelopmental disorders that often co-occur. They are both stigmatized and misunderstood conditions. This review critically appraises studies examining interventions using psychoeducational approaches in TS and ADHD. Studies examining the impact of providing educational information (or diagnostic label) about TS and ADHD to parents, teachers and peers (child and adult) were identified by searching relevant electronic databases, reference lists and citations, and consulting colleagues. Twenty-two studies were identified, 20 of which involved teachers or peers. The studies indicate that providing educational information increases knowledge, positive attitudes and behaviours towards individuals with TS and ADHD. Provision of a diagnostic label alone appears insufficient. Parental education may improve treatment enrolment and adherence. While the findings are encouraging, there are a number of gaps in the literature. These include the effects of giving information to parents, whether changes are maintained over time, or are generalizable to the population. Studies are needed to investigate the optimal way to present educational information in everyday contexts in order to improve the lives of those with TS and ADHD.

This study examined the applicability of the Ward and Siegert (Psychology, Crime & Law, 8, 319-351, 2002) Pathways Model of Sexual Offending to a sample of Internet offenders. The Pathways Model identifies five etiological pathways, each with primary psychological deficits that interact to create a vulnerability to sexual offending behavior. The applicability of this model was tested on a sample of 72 cases drawn from a community sample in England and Wales, via the analysis of primary and associated psychometric indicators of pathway membership. Sixty per cent of men in the sample were found to display dysfunctional psychological mechanisms (43 cases). Two pathways were found to be particularly prominent: the intimacy deficits pathway and the emotional dysregulation pathway. The implications for future treatment and the appropriateness of current treatment programs for this population are examined in the light of these findings.

When 29 child sex offenders, 30 violent offenders, 30 nonviolent offenders, and 30 community controls were compared, a secure adult attachment style was 4 times less common in the child sex offender group than in any of the other three groups. Ninety-three percent of sex offenders had an insecure adult attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control. With respect to anger management, the child sexual offenders' profile more closely approximated those of nonviolent offenders and community controls than that of violent offenders.

A sample of 526 contact offenders, 459 internet offenders, and 143 mixed contact/internet offenders was compared on a range of self-report psychological measures assessing offense-supportive beliefs, socioaffective functioning, emotional management, and socially desirable responding. A multivariate general linear model found a mixed offender profile that was similar to internet offenders rather than contact offenders. The contact group demonstrated lower victim empathy, a greater level of pro-offending attitudes, an externalized locus of control, more assertiveness, a diminished ability to relate to fictional characters, and greater impulsivity than the internet and mixed offender groups. The mixed offender group demonstrated a higher level of empathic concern than the other two groups. The mixed offender group could also be distinguished from the internet group by increased personal distress and perspective-taking ability. A discriminant function analysis highlighted the key linear factor distinguishing between the groups to be one relating to offense-supportive attitudes and identification with fictional characters. A second factor was related to higher levels of empathic concern and poor self-management. These findings are discussed in the context of the potential pathways between internet and contact sexual offenses.

Abstract The increase in convictions for internet-related sexual offending has led to new challenges for treatment providers. By 2005 nearly one-third of all sexual convictions in England and Wales were for internet-related sexual offending. In late 2006 a treatment programme for internet-related sexual offending (the i-SOTP) was given accreditation for use in the community by the National Probation Service (England and Wales). This paper reports on the clinical impact as assessed following completion of psychometric assessments pre- and post-treatment by a sample of 264 convicted offenders. Findings suggest an improvement in deficits concerning socio-affective functioning and a decrease in pro-offending attitudes. These changes are encouraging and support the view that widescale delivery of the programme should be continued.

A sexual offender is thought to have victim empathy when he has a cognitive and emotional understanding of the experience of the victim of his sexual offense. Most sex offender treatment programs devote significant time to developing victim empathy. The authors examine three meta-analytic studies and some individual studies that suggest victim empathy work is unnecessary, or even harmful. Service user studies, however, report positive reactions to victim empathy work. The authors conclude that the enthusiasm for victim empathy work as a rehabilitative endeavor is disproportionate given the weak evidence base and the lack of a coherent theoretical model of change. However, because the research is inconclusive, it is not possible to conclude that victim empathy work is "correctional quackery." We suggest a research program to clarify whether or not victim empathy intervention for sexual offenders has value.

OBJECTIVES: Theoretical models implicating the orienting reflex as an explanatory mechanism in the eye-movement desensitization and reprocessing (EMDR) treatment protocol are contrasted and tested empirically. We also test whether EMDR effects are due to a distraction effect. DESIGN: A repeated measure design is used in two experiments. The first experiment employed two independent variables, eye condition (moving vs. stationary) and tone (a pseudo-randomized series of low and high intensity tones). In Expt 2, eye condition was replaced by attentional demand conditions (low or high). In both cases, electrodermal responses served as the dependent variable. METHOD: Participants were recruited from the Psychology Department at Cardiff University. In Expt 1, participants were required to either pursue a moving stimulus following auditory challenge or engage in an eyes-stationary task. In Expt 2, the task following auditory challenge required participants to identify specific items from letter strings in low and high attentional demand conditions. RESULTS: Lower levels of electrodermal arousal were identified in tasks eliciting eye movements, compared to no eye movements. This effect was not due to the attentional requirements of the task. CONCLUSIONS: Eye movements following auditory challenge result in an effect of psychophysiological de-arousal. This supports the reassurance reflex model of EMDR proposed by MacCulloch and Feldman (1996).

Abstract This essay explores the efforts of the Police Court Mission in the courts of summary jurisdiction. For 60 years, in an age which accorded ever‐increasing importance to the methods of science, the missionaries held firmly to a religious philosophy, distinctively their own. This paper attempts to explain how it was possible for the missionaries to be absorbed into the probation system, and for their religious ideals to yield, eventually, to the radically different philosophy of the aspiring, “scientific” social work diagnosticians.

Insects are more similar in structure and physiology to mammals than plants or fungi. Consequently, insecticides are often of greater toxicity to mammals than herbicides. This is particularly the case with neurotoxins. However, some insecticides are targeted at structures or hormonal systems specific to insects (insect growth regulators/chitin synthesis inhibitors) so are less harmful but can still be mildly haematotoxic. There are, therefore, issues specific to insecticides, which do not occur with other pesticides - hence the need for a book specifically on insecticide toxicology in mammals. The book starts with general issues relating to the mammalian toxicity of insecticides, including target/non-target specificity, nomenclature and metabolism of insecticides. It then goes on to discuss specific types of insecticides including: organochlorines; anticholinesterases; pyrethrum and synthetic pyrethroids; nicotine and the neonicotinoids; insect growth regulators/ecdysone agonists/chitin synthesis inhibitors; insecticides of natural origin; biological insecticides; and insecticides used in veterinary medicine.