July 5 juillet 13:45 – 15:45
Room NCDH–201
Chair: Donna
McDonagh
, Correctional Service
of Canada
In the past decade, descriptive research into the nature of secure psychiatric services, in the UK and elsewhere, for women patients, has consistently revealed a number of relevant clinical factors some of which distinguish this population from its male counterpart and many of which may be important in planning services. In addition, it is well recognized that the security requirements for women offenders (and those with similar clinical needs) are not yet matched by available services and that gender sensitive therapeutic models are, as yet, poorly developed.
This paper reviews the relevant research concerning mentally disordered women offenders and describes the creation of a women only secure ward within a wider group of forensic and secure services in a mental health (National Health Service) Trust. The clinical profile of the patient group, drawn from a series of mixed services, is described with reference to established work concerning detained offender and non-offender women.
A service model will be proposed. The model is designed to
allow for a broad spectrum of women patients requiring secure care to be
effectively and safely treated within a gender sensitive and flexible service,
whilst retaining appropriate linkage with mixed, specialist (including forensic)
and generic psychiatric services.
This paper describes the various psychological interventions used with female patients in a secure psychiatric service, part of a large National Health Service Trust in West London (UK) comprising General and Forensic Services. The female patient population, representing a wide spectrum of diagnosis, offending and behavioural profiles, nevertheless comprises a small proportion of the patients catered for by the Forensic Directorates (In total: 33 women, 169 men). Seventeen of the women are cared for in a dedicated women’s ward, the remainder are distributed amongst five, predominantly male, mixed wards. The use of Individual Psychotherapy, Group Psychotherapy, Cognitive Behaviour Therapy, (CBT), Dialectic Behaviour Therapy (DBT) and psychosocial interventions is discussed, with reference to the advantages and pit-falls of working in this setting and of using several approaches, as opposed to a single psychological model. Issues of staffing, training and resourcing, and evidence of the impact of the work will be presented.
Our 17 bed women’s ward was created in the Local Secure
Directorate (in theory less Secure than Medium Secure Units and more secure than
open wards, in practice most of the patients fulfilled criteria for Medium
Security but were regarded in need of female-only environment due to
vulnerability) as an interim measure (one year) until the completion of a 36 bed
unit, which was to be divided into different areas of treatment and levels of
security to accommodate different rehabilitation stages. This has not happened.
Three years later the business plan for the new unit has been “put on
hold” by the London Regional Office to await the development of a London Wide
strategy for women in need of Secure Services. The factors that have affected the ward environment with regards
to disturbance, violence and therapeutic milieu, (including patients’
diagnosis, interactions, staff training, supervision, Trust’s policies and
political decisions regarding the development of services) are discussed.
We note that adequate services have cost implications that most health
authorities are reluctant to meet, but this has led
to overuse of private facilities (the only ones that have actually moved
ahead to provide these services), which are much more expensive and are draining
the public purse, while they do not provide the integrated inpatient/community
service necessary for this population.
Substance abuse has consistently been related to violence in
male offenders, however, little empirical research has addressed this
relationship in female offenders. This paper will describe the nature and extent
of substance abuse in a sample of 98 female Federal Offenders, convicted of a
violent offence. All women in the sample were convicted of a Schedule 1 offence,
and were referred for a psychological risk assessment. Subjects participated in
a semi-structured interview, and completed a battery of psychological tests.
Tests included the Minnesota Multiphasic Personality Inventory-2, the General
Health Questionnaire, the Interpersonal Behaviour Survey, the Criminal
Sentiments Scale, the State Trait Anger Inventory, the Beck Depression Inventory
and the Shipley Institute of Living Scale. Substance abuse was assessed through
administration of the Alcohol Dependence Scale, Problems Related to Drinking
Scale and the Drug Abuse Screening Test. The MacAndrew Alcoholism Scale of the
MMPI-2 was also scored. Risk of re-offence was assessed using the Level of
Supervision–Revised and the HCR-20 scales. A comprehensive review of files was
also conducted yielding the following information: psycho-social history, prior
criminal history, education, institutional adjustment, prior psychiatric and
psychological assessment and treatment, institutional adjustment and medical
status. Descriptive demographic data will be presented as well as correlational
analysis in which substance abuse severity and degree of violence in the current
(index) and past offences will be analyzed. These data will be related to the
treatment needs of violent female offenders. Directions for future research will
also be explored.
Although acts of sexual abuse are mostly committed by males,
the phenomenon of sexual abuse by women has been taken into consideration by
researchers and clinicians these last few years. Indeed, recent research tends
to demonstrate that the number of reported sex offences committed by females is
increasing. Firstly, we will present a critical review of clinical and empirical
literature on female sex offenders. This review will discuss the prevalence, the
clinical characteristics (Axe I and Axe II symptoms) and criminological
characteristics (type of abuse, sex and age of the
victim) of these women in order to observe constants in the description
of the profile proposed in the literature, and to compare between female sex
offending and male sex offending process. The methodological limits which are
specific to this literature (the definition of abuse, selection sample, clinical
heterogeneity and research design) will also be discussed. Secondly, we will
address preliminary empirical data collected in a female sample who are
incarcerated in a francophone Belgian prison. A group of female (N=15) convicted
for sexual offences will be compared to a group of female (N=15) convicted for
non-sexual offences. These two groups will be matched in terms of age,
socio-economical status and length of detention. Perspectives for future
research will be proposed.
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