(Webster et al., 2006, p. 451).
18.4.8 Mentally Disordered Offenders
Within England and Wales, there are 4,679 mentally disordered offenders currently detained within hospitals (Ministry of Justice, 2017). In line with prison populations these numbers have increased, year on year, since 1999 (Ministry of Justice, 2010a, 2017). There is a common misconception (perhaps fuelled by certain sections of the media) that all mentally disordered people are dangerous individuals who consequently present a risk of harm to the general population. Furthermore, this viewpoint seems to place the cause of this assumed dangerousness at the door of the mental disorder itself. Such a position, however, fails to consider those members of the population who are diagnosed with a mental disorder but are law-abiding citizens and present no risk of harm to the public. At the same time, this stance assumes that the correlates of dangerousness in the non-disordered criminal population are inherently different to those in the disordered criminal population.
To some degree, the direction of research within this field has historically concurred with these assumptions, choosing to focus on clinical or psychopathological factors in their investigations of risk amongst the mentally disordered. Meta-analytical research in this field, however, has found that “the major predictors of recidivism were the same for mentally disordered offenders as for non-disordered offenders…clinical variables showed the smallest effect sizes” (Bonta, Law, & Hanson, 1998, p. 123). On the basis of such conclusions, there is a call for a shift away from clinical or psychopathological variables, to an investigation of the role social psychological and criminological factors play in the relationship between mental disorder and recidivism.
Having said this, there is one type of mental disorder that perhaps has a closer link with offending behaviour than others. Previously psychopathy was legally defined by the Mental Health Act (1983) as “a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned” (p. 2) and hence is, by definition, closely linked with offending behaviour.
Within England and Wales, the Offender Personality Disorder Pathway programme (see Joseph & Benefield, 2012 for more information), which spans the Ministry of Justice and the Department of Health, aims to identify, assess, risk manage, and provide treatment options for males and females who present a high risk of committing serious offences, or harm to themselves or others, as a result of a severe personality disorder (see Chapter 22 for a detailed description of mentally disordered offenders).
18.4.9 Psychopathy Checklist-Revised (PCL-R)
(Hare, 1991)
Designed to guide clinical assessment, the PCL-R provides a framework for diagnosis of psychopathic disorder. As such it is not strictly a risk assessment tool but it has been found to predict violent recidivism among adult (Hart, Hare, & Forth, 1994; Serin, 1991; Serin, Peters, & Barbaree, 1990) and young (Forth, Hart, & Hare, 1990) male offenders. Based on the work of Cleckley (1964), Hare conducted an empirically based assessment of the clinical factors that comprise psychopathy (Hare, 1980). The resultant checklist, and its later revision (Hare, 1991), is now used widely within the forensic and clinical fields and has been described as the “gold standard for the diagnosis of psychopathy worldwide” (Morana, Arboleda-Flόrez, & Câmara, 2005, p. 2).
The 20 items of the PCL-R cover demographic, criminological, social and psychological domains (see Table 18.4), and the presence or absence of these are determined through interview, file and case history review. Each item is scored 0 (not evident in the record of the offender), 1 (some but not complete evidence) or 2 (the characteristic is definitely present). The maximum possible score is hence 40. The cut-off score for a diagnosis of psychopathy has been the subject of debate within forensic psychology and psychiatry circles. Hare (1991) recommends that only those individuals who score at, or above, a score of 30 should be deemed to be psychopathic. This high number was set in order to reduce the number of false positives within the psychopathic group. Rice and Harris (1995), however, reported that the validity of the tool is maximised when the cut-off score of 25 is applied, and furthermore different cut-offs have been used depending on the population under review (Morana, Arboleda-Flόrez, Câmara, 2005).
Table 18.4 Items within the PCL-R (Hare, 1991, 2003)
Superficial charm
Grandiose sense of self-worth
Need for stimulation/easily bored
Pathological lying
Manipulative
Lack of remorse or guilt
No emotional depth
Callous
Parasitic lifestyle
Poor behavioural control
Promiscuous sexual behaviour
Early behaviour problems
Lack of long term planning
Impulsive
Irresponsible
Failure to accept responsibility for own actions
Frequent marital failures
Delinquent as a juvenile
Poor record on probation or other conditional releases
Versatile as a criminal
18.4.10 Summary of Assessing Risk
As has been described within this section, the method of assessing risk in relation to offender recidivism has been, and continues to be, the subject of much debate. Actuarial tools seem to be more reliable in predicting future outcomes than clinical judgement alone, but they are not sensitive to idiosyncratic evidence of risk in the way a clinician would be and also provide little detail about the needs of the assessed offender. In light of this, there has been a move in recent years to develop structured tools that combine actuarial and clinical methods of assessment. These “third generation” assessment tools provide not only judgement as to the risk the individual poses, but also rich needs information that informs subsequent rehabilitative work with the offender. The remaining sections of this chapter will focus on the frameworks of rehabilitative work that is currently untaken with offenders.
18.5 TREATMENT DELIVERY
The number of offending behaviour programmes available to practitioners for use with offenders continues to grow apace. An illustration of this can be seen within the correctional services of England and Wales. Within this jurisdiction, the components of effective practice identified by meta-analytic reviews of programme evaluations have been formalised into a set of programme accreditation principles (see Table 18.5).
Table 18.5 Correctional Services Accreditation Panel Accreditation Criteria
Programmes must be based within a clear model of change.
Programmes should have clear and justified selection criteria for selection of offenders.
Programmes should intervene on a range of dynamic risk factors.
Programmes should use effective methods of change.
Programmes should encompass skills orientated targets
The dosage (sequencing, intensity, and duration) of programmes should be outlined and based within research.
The programme should be designed as to attend to motivation and engagement issues.
There should be clear links between the programme and the management of the offender both within prison and in the community i.e. continuity of programmes and services.
Programme should attend to issues of programme integrity
The programme should be designed as such as to allow for continued evaluation.
PHOTO 18.2 Manualised programmes have now been developed for a wide range of offenders, including violent offenders.
Source: © Maksym Bondarchuk/Shutterstock
The latest information from the England and Wales Correctional Services Accreditation Panel (CSAP), the role of which is to assess programmes and provide accredited status to those that satisfy all criteria, describes 47 programmes that have provisional or full accreditation for use within either the Prison or Probation Services (HM Prison and Probation Service, 2015).
Manualised p
rogrammes have now been developed for a wide range of offenders, including violent offenders, sex offenders, drink impaired drivers, offenders whose crimes are committed to support drug use, psychopathic offenders, female and acquisitive offenders. Additionally there are a number of general offending programmes, developed not to address offence specific treatment needs, but for the needs of recidivistic offenders who have usually been convicted of a variety of offences. These programmes will now be examined in some detail. See Chapter 19 for details of specific programmes for dangerous violent and sexual offenders.
18.6 GENERAL OFFENDING BEHAVIOUR PROGRAMMES
General offending behaviour programmes draw on the theory of cognitive social learning (Bandura, 1977, 2001), which proposes that an individual does not require direct experience of an event in order to learn from it. Instead learning can occur indirectly through the observation of an event happening to some other person. Moreover, this observational learning, or vicarious reinforcement, is thought to explain how people acquire and maintain certain behavioural patterns. Bandura proposed that there are three classes of people from whom the individual may learn: family members, peer groups and figurative models (viewed, for example, through the media). General offending behaviour programmes, therefore, promote the reduction of offending behaviour, through the acquisition of new skills. Using reinforcement strategies, offenders are encouraged to improve their problem-solving skills to enable the selection of alternatives to criminal behaviour. Furthermore general offending behaviour programmes promote the acquisition of self-management and social interaction skills.
The main group-based general offending programmes accredited for use within Prisons and Probation in England and Wales is the Thinking Skills Programme (TSP), which replaced the Enhanced Thinking Skills (ETS) programme, the Reasoning and Rehabilitation (R&R) programme, and the Think First programme. General offending behaviour programmes are also available for male juveniles (JETS Living Skills programme) and for those that have the need to reinforce the earlier learning of a general offending behaviour programme (Cognitive Skills Booster programme).
18.6.1 The R&R Programme
The R&R programme was the first of these programmes to appear on the correctional scene (Ross & Fabiano, 1985). This programme was developed in Canada and has been implemented within at least 17 different countries (Antonowicz, 2005). However, the delivery of the R&R programme within custodial and community settings in England and Wales was discontinued in 2004. Following this, the ETS programme was utilised by the Prison Service as its sole general offending behaviour programme, while the ETS programme and Think First were available to community-based offenders.
18.6.2 The ETS Programme
The ETS programme was developed in the 1990s by the Prison Service of England and Wales to complement the R&R programme (a long programme that, in line with the risk principle, targeted high risk offenders), and to provide an intervention for medium risk offenders. The focus of the ETS programme is on the provision of interpersonal problem solving, social, and moral reasoning skills through interactive programme delivery (Clark, 2000). The programme also heavily promotes the use of “pro-social modelling” whereby the facilitators model positive behaviours and interaction. This curriculum is delivered using a combination of direct tutoring and more interactive learning, with the main focus being on the latter, more “Socratic”, method of provision. Within this, programme deliverers utilise role plays, guided discussion, group exercises, and small group work.
18.6.3 The Think First Programme
The Think First programme (McGuire, 2000) differs from ETS and R&R in that, in addition to the social cognitive components of problem solving, self-management and social skills training, it is also offence-focussed. As such, the programme provides for an analysis of the offender’s own criminal behaviour with the intention of enabling behaviour modification. Through the use of the “5-WH” exercises, programme participants break down their offences and analyse in detail what happened, who was involved, when it happened, where it happened and why it occurred. The repetition of this exercise, focussing on the offender’s series of crimes, allows for the emergence of patterns of behaviour and highlights contributory factors. Avoidance strategies are then developed to prevent the repetition of the problem behaviours.
18.6.4 The Thinking Skills Programme
The Thinking Skills Programme (TSP) has been designed for male and female offenders at medium to high risk of reconviction. TSP aims to reduce reoffending first through the development of thinking skills and, second, through the application of these skills to the management of personal risk factors and the development of protective factors. TSP also aids the offender in setting pro-social goals supportive of relapse prevention. As such, the TSP programme is offence-focussed and requires offenders to explore their patterns of offending to develop awareness of their risk and protective factors in relation to their offending behaviour.
CASE STUDY 18.2 JOHN
John is a 22-year-old man who has just been convicted by his local magistrate’s court of burglary. John has a history of similar criminal behaviour and has also previously breached a community order. John was assessed prior to sentencing as having an OGRS2 score of 64 (medium to high risk of reoffending) and also as being deficient in cognitive skills such as self-control and problem recognition. John’s pre-sentence report, therefore, recommended to the court that John be sentenced to a community penalty with the requirement of attending a general offending behaviour programme. This sentence was passed by the magistrate. John therefore has to report to his offender manager (a probation officer) once a fortnight and attend the Thinking Skills Programme (TSP).
During John’s supervision meetings with his offender manager, John has the opportunity to address those needs, identified by his OASys assessment, which are related to his offending behaviour. His OASys profile has indicated John has offending related needs in the fields of accommodation and employment. In his supervision meetings with his offender manager, John has the opportunity to discuss how his unemployment status results in a lack of money and hence he feels he has no option but to commit burglary in order to live. He is also able to discuss his accommodation problems and to receive advice on how these might be alleviated.
After a period of four weeks from sentence, John is asked to attend the next TSP programme. John is nervous about doing so as he had particularly bad experiences at school and consequently does not have very good literacy skills. Once he starts the programme, however, John quickly realises that the programme is quite different from school: although is it challenging in that it makes him think about how his own thoughts, feelings and behaviours interact with each other, it is more relaxed, and the tutors are less authoritarian than his old school teachers. Despite this, there are clear and strict rules about attendance – if he misses two sessions he will be sent back to court.
Eleven weeks later, John and his programme colleagues have completed the TSP programme. This process has not been easy but there were six group members who got to the end of the programme. John has also arranged some permanent accommodation and has started to apply for jobs. In conversations with his offender manager he states that the TSP programme has made him stop and think about his behaviour and what the consequence might be before acting. John is proud of himself for completing the programme (he has even received a certificate!) and is hopeful that with his new skills he can resist offending again in the future.
The TSP programme is arranged into three modules of learning, each consisting of six sessions: five delivered within a group format and one as an individual session. These modules focus on self-control, problem-solving, and positive relationships. The modules are supplemented with an individual introductory session, bringing the total number of sessions to 19 (15 group and 4 individual). The programme can be delivered either in a fixed group format, whereby the group remains the same throughout the three modules, or in a rolling group format, whereby offenders can start and finish at
any module and hence the group composition alters throughout the programme.
18.7 EVALUATION OF GENERAL OFFENDING BEHAVIOUR PROGRAMMES
General offending behaviour programmes have been subject to a steadily increasing number of evaluations of their effectiveness. A meta-analytic review of the Reasoning and Rehabiliation programme in Canada, the United States, the UK and Sweden concluded that programme attendees were 14% less likely to reoffend than the control group participants (Tong & Farrington, 2006). Evaluations of the Think First programme have also concluded that the programme produces positive changes on psychometrics tests (McGuire & Hatcher, 2001; Steele, 2002a), and in relation to reconviction (Roberts, 2004; Steele, 2002b). Likewise, research utilising a sample of approximately 17,000 prison-based ETS attendees, which compared predicted (by OGRS) and actual reconviction rates, reported a 7.9% reduction in reconviction (Travers, Wakeling, Mann, & Hollin, 2013). When the same sample was compared to a large comparison group of similar prisoners, the researchers found a reduction of reconviction of 6.4% for ETS attendees and 7.5% for ETS completers (Travers, et al., 2013). Indeed a national evaluation of R&R, ETS and Think First in community settings concluded that all three programmes produced significant reductions in reconviction amongst the programme completer group comparative to the controls (Hollin, Palmer, McGuire, Hounsome, Hatcher, & Bilby, 2004; Hollin, Palmer, McGuire, Hounsome, Hatcher, & Bilby, 2008; Palmer, McGuire, Hounsome, Hatcher, Bilby, & Hollin, 2007). A comparison of the three programmes showed that Think First outperformed ETS and R&R in relation to attrition and reconviction rates (Palmer et al., 2007). Given its comparatively recent development and implementation, TSP is yet to establish a comprehensive evidence base; however, pilot studies undertaken with group facilitators and male and female programme participants (Barnett, 2012; Turner, 2008) have influenced the design of the programme. Furthermore, a small-scale psychometric evaluation of TSP in prison settings has reported pre-to-post programme improvements on scales measuring impulsivity, attitudes towards offending, and criminal thinking styles (Gobbett & Sellen, 2014).
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