Offending behaviour is a major societal concern, causing great individual suffering and costs to society. Some individuals, e.g. those with personality disorders, contribute disproportionately to offending within society.
Forensic-psychiatric services are high cost-low turnover services which are highly restrictive to those detained within them. Yet, little is known about effective methods to prevent offending and reduce the risk of reoffending in those who have already offended and about the outcomes of those detained in forensic settings.
What we are doing about...
1. Effectiveness of forensic-psychiatric service provision
This research area has included a broad portfolio of studies, ranging from intervention trials (psychoeducation), evaluation of staff training, audits of prescribing in secure settings, predictors of self-harm in prisoners and studies on factors associated with the use of seclusion and forced medication.
current studies in this theme ...
Treatment engagement in personality disordered (PD) patients
Treatment non-completion in people with PD is high and associated with poor outcome. We have developed a Treatment Readiness Model, including intra-individual and external factors implicated in and a staff-training programme to enhance treatment engagement in people with PD.
Innovative community interventions for high risk sex offenders:
Circles UK is an innovative approach to the reintegration of sex offenders using a circle of carefully selected and trained volunteers. We are currently evaluating the outcomes and effectiveness of this approach and are involved in the adaption and implementation of Circles in other European countries.
Long-stay in forensic-psychiatric settings
A number of patients stay in forensic-psychiatric settings for excessive amounts of time, i.e. more than 10 years in high secure or more than 5 years in medium secure care. A NIHR 3 years study explores how many patients of the current high and medium secure forensic-psychiatric population are long-stayers and describe their characteristics. We will also interview patients, carers and staff about their experience with long-stay and explore whether different services are needed for this population. We are part of a European network on long-stay in forensic-psychiatric care.
Follow up of medium secure patients
Staff within this group are involved in the maintenance of a large database of approximately 800 patients from a medium secure setting which has led to a number of high-quality publications reporting outcomes in these patients.
2. Neurobiology of personality disorders:
We are interested in the translation of neurobiological findings (e.g. from brain imaging studies) into clinically meaningful approaches.
current studies in this theme ...
Neuropsychological deficits in ASPD
This study investigates whether neuropsychological test results predict treatment engagement and outcome.
Oxytocin and social cognition
This study looks at the effect of oxytocin on judgements of trustworthiness and complex social cognition in healthy controls. A further project expands this work using fMRI techniques to describe the modulation of neuronal networks following oxytocin administration.
Transcranial magnetic stimulation (TMS)
This recently started study looks at the effect of TMS on the performance on impulsivity tasks in healthy individuals with a view of later application to clinical samples.
3. Systematic reviews
The group has been involved in completing high quality systematic reviews on the treatment of personality disorders--an area of considerable recent policy development.
reviews undertaken so far...
So far four reviews have been completed and published, two on borderline PD (one regarding psychological and one regarding pharmacological interventions) and two on antisocial PD with further reviews underway.
Current projects include...
- 2013 – 18 European Cooperation in Science and Technology (COST) – ‘Towards an EU research framework on Forensic psychiatric care’, details of funding to be determined, likely to be in region of € 300 000 (Co-Investigator)
- 2013 – 2015 European Commission Daphne programme – ‘Circles 4U’ € 928,132 total University of Nottingham € 43 300) (Birgit Völlm Co-Investigator)
- 2013 – 2015 National Institute of Health Research, Service Delivery and Organisation – ‘Characteristics and needs of long-stay patients in high and medium forensic-psychiatric care: Implications for service organisation’ - £671 542 (Birgit Völlm Principal Investigator)
- 2012 – 2014 Psychoeducation with problem solving (PEPS) therapy for adults with personality disorder: A community-based, randomised controlled trial (Health Technology Assessment, PI Prof Mary McMurran)
- 2010 - 2013 ESRC Case studentship ‘Use of Coercive and Restrictive Measures in In-Patient Forensic Settings: Association with Staff Attitudes and Ward Atmosphere’ - Student fees and stipend (Birgit Völlm Co-Investigator)