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Contents
- Edited by Arthur Geoffrey Dickens, H. P. R. Finberg, John Fines, Gaston Denis Gilmore, Peter L. Hull
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- Book:
- The Gostwicks of Willington and Other Studies
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- Boydell & Brewer
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- 18 July 2023, pp vii-viii
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Map
- Edited by Arthur Geoffrey Dickens, H. P. R. Finberg, John Fines, Gaston Denis Gilmore, Peter L. Hull
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- Book:
- The Gostwicks of Willington and Other Studies
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- Boydell & Brewer
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- 18 July 2023, pp 147-147
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Frontmatter
- Edited by Arthur Geoffrey Dickens, H. P. R. Finberg, John Fines, Gaston Denis Gilmore, Peter L. Hull
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- Book:
- The Gostwicks of Willington and Other Studies
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- Boydell & Brewer
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- 18 July 2023, pp i-vi
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Index
- Edited by Arthur Geoffrey Dickens, H. P. R. Finberg, John Fines, Gaston Denis Gilmore, Peter L. Hull
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- Book:
- The Gostwicks of Willington and Other Studies
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- Boydell & Brewer
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- 18 July 2023, pp 139-146
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The Gostwicks of Willington and Other Studies
- Edited by Arthur Geoffrey Dickens, H. P. R. Finberg, John Fines, Gaston Denis Gilmore, Peter L. Hull
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- Published by:
- Boydell & Brewer
- Published online:
- 18 July 2023
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Contains 'A note on the foundation of Northill College in 1406', by Peter Hull. (An introduction is followed by a transcription in Latin of the College's foundation grant.) 'The origin of St. Mary's Square, Bedford', by J. Fines. (Transcription in English of a return to the exchequer by John Maygott, incumbent of the united parishes of St. Peter Dunstable and St. Mary, concerning the site and use to which the materials were put after the demolition of the former church c. 1555.)
'The Black Book of Bedford', by G. D. Gilmore. (The Black Book contains the constitutions or byelaws of the borough of Bedford made between 1562 and 1603.)
'Estate and household management in Bedfordshire, c. 1540', by A. G. Dickens. (A transcription of instructions and advice written by Sir John Gostwick of Willington addressed to his son William.)
'The Gostwicks of Willington', by H. P. R. Finberg. (The Gostwicks were typical of many families in the upper-middle stratum of society. They began as yeomen, rose to the gentry under Henry VIII, then suffered varying fortunes. The article includes a chronology of the family’s activities 1524-1804 and a nine-generation pedigree over three centuries from 1490s).
4 - Risk management in secure care
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- By Geoffrey Dickens, Research Manager and Head of Nursing Research, St Andrew's Healthcare, and Professor in Psychiatric Nursing, University of Northampton, Ashimesh Roychowdhury, Associate Medical Director, Clinical Informatics and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Muthusamy Natarajan, Consultant Forensic Psychiatrist, St Andrew's Healthcare
- Edited by Geoffrey L. Dickins, Philip Sugarman, Marco Picchioni
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- Book:
- Handbook of Secure Care
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- 02 January 2018
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- 01 July 2015, pp 48-66
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Summary
Introduction
Risk management is central to clinical practice in secure settings and should be determined by informed risk assessment. In the previous chapter we identified that risk assessment should use the information gathered to anticipate and plan for likely scenarios where the individual's risk might be heightened. The subsequent development of risk management strategies from that process is integral to, and is in many respects the most important result of, that process. Risk management has both shorter- and longer-term objectives. The immediate aim is to manage the patient on a day-to-day basis, ensuring their safety and that of others. This should be supplemented by the implementation of strategies to reduce risk over the longer term, and to ameliorate and minimise the effects of risk behaviour when it occurs. In the previous chapter we identified that structured professional judgement (SPJ) involves a systematic approach to risk assessment (Box 4.1). Further, risk assessment is performed for a specific person, at a particular time and for their own unique circumstances. In this chapter we concentrate on risk management in the secure setting, where a considerable proportion of the available risk management interventions are achieved by the therapeutic application of security measures. We therefore provide an overview of physical, procedural and relational security and discuss how their proportionate use can ensure an appropriate level of security for the individual. We describe approaches to the management of violence and aggression in secure care, the management of suicidal and self-harming behaviour and, briefly, a range of other risk behaviours relevant to the secure setting.
Risk and security
In secure mental health settings the context for the safe delivery of care and therapeutic interventions is, by definition, provided by the clinical security arrangements. Importantly, security and therapy should be viewed as
Box 4.1 Six stages of structured professional judgement
Step 1: Gather information
Step 2: Consider presence and relevance of risk factors – historical, current, contextual, protective
Step 3:Develop a risk formulation – motivators (drivers), (dis)inhibitors, destabilisers
Step 4: Consider risk scenarios, e.g. repeat, escalation, twist
Step 5: Develop risk management strategies
Step 6: Summary of judgement
Source: Hart et al (2003)
1 - The evolution of secure and forensic mental healthcare
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- By Philip Sugarman, Chief Executive Officer, St Andrew's Healthcare, Geoffrey Dickens, Research Manager and Head of Nursing Research, St Andrew's Healthcare, and Professor in Psychiatric Nursing, University of Northampton
- Edited by Geoffrey L. Dickins, Philip Sugarman, Marco Picchioni
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- Handbook of Secure Care
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- 02 January 2018
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- 01 July 2015, pp 1-14
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Summary
Introduction and aims
It is in all likelihood a by-product of human evolution, and of the complexity of the human brain and of society, that there have always been dysfunctional individuals who present overtly with a mental or behavioural disorder. They may cause significant harm and disruption to others, as well as to themselves. The most seriously affected depend on the concerted efforts of those around them to provide a safe and supportive environment, or risk neglect, rejection, homelessness and even persecution. Perhaps there always will be such problems in our communities, and thus a continuing need for secure mental health services, at least until science and society have advanced greatly from their present position.
Mentally disordered offenders and others presenting serious challenging behaviour are more often successfully categorised and labelled by local juridical and medical practice, and subject to other processes of social stigmatisation, than they are helped towards recovery. In many instances temporary or indefinite containment is achieved, which may serve to protect the public, but alone this acts as a poor substitute for well-being and social recovery. Those with knowledge of social exclusion and those who work closely with this group will grasp both the immense long-term cost of this failure to society, in terms of morbidity and mortality, crime, social dependency and family breakdown, and the strategic value of early and late intervention. Governments, however, need to be persuaded that the investment involved will reap longer-term benefits (Sugarman, 2012).
It is important to appreciate how the very human need for secure containment of disturbed individuals transcends boundaries of time and place, of gender, age and developmental stage, and of diagnostic and criminal justice status. Very similar challenges of care, control and rehabilitation are seen in different cultures and in different groups. While the international psychiatric community is moving on with active information-sharing on areas such as service models (Maj, 2008), a fundamental debate is just beginning about how societies around the world can best catalyse effective mental health service development (Sugarman & Kakabadse, 2011). We believe that local diversification in provision accelerates improvement in secure and forensic care, focused on service user need rather than organisational goals, with hospitals centred on the care and recovery of the most challenging and needy individuals, and on the promotion of excellence through teaching and research.
13 - Firesetting in secure settings: theory, treatment and management
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- By Theresa Gannon, Director of the Centre of Research and Education in Forensic Psychology and Professor of Forensic Psychology, University of Kent, Nichola Tyler, Postgraduate Researcher, University of Kent, Geoffrey Dickens, Research Manager and Head of Nursing Research, St Andrew's Healthcare, and Professor in Psychiatric Nursing, University of Northampton
- Edited by Geoffrey L. Dickins, Philip Sugarman, Marco Picchioni
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- Book:
- Handbook of Secure Care
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- 02 January 2018
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- 01 July 2015, pp 193-210
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Summary
Introduction
Background and aims
Firesetting confers substantial costs on society. In 2010/2011 there were 36 000 deliberately set fires in Great Britain resulting in 72 fatalities and 1700 non-fatal casualties. Around one in five deliberate fires occur in nondwelling buildings, including hospitals (Department for Communities and Local Government, 2011). While serious fires in psychiatric hospitals are reasonably rare, incidents in UK secure mental health units in recent years, at Stockton Hall in North Yorkshire in 2010 (BBC News, 2010) and Camlet Lodge in London in 2008 (James, 2008), have demonstrated that fire can seriously disrupt service provision and endanger life. Additionally, the total number of incidents in psychiatric hospitals attended by the fire and rescue service is disproportionately greater per bed than in general medical hospitals (Grice, 2012). Around 10% of people admitted to forensic psychiatric services have committed arson (Coid et al, 2001) and many more may have a history of problematic firesetting behaviour (Geller et al, 1992). It is important therefore that staff who work in these services hold sufficient practical and theoretical knowledge to contribute to the prevention of firesetting and to the assessment, treatment and management of firesetters in secure care.
This chapter briefly reviews the epidemiology of firesetting, its relationship with mental disorder and the prevalence of firesetting among particular patient groups who may be resident in secure care. We then describe established theories of firesetting, including motivational typologies, single-factor theories and previous attempts at multifactor theories. We then present a newly developed multi-trajectory theory of adult firesetting (M-TTAF; Gannon et al, 2012a). This theory is important because it proposes different motivational drivers and prominent risk factors for firesetting across various groups, many of whom may be characterised by particular psychopathological features common in secure settings. The implication is that different groups will hold different risk factors and require varying therapeutic approaches. Some psychological treatment interventions delivered in secure settings are then examined. Finally, we discuss aspects of practical risk assessment and management of firesetters in the secure environment.
3 - Clinical risk assessment in secure care
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- By Ashimesh Roychowdhury, Associate Medical Director, Clinical Informatics and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Muthusamy Natarajan, Consultant Forensic Psychiatrist, St Andrew's Healthcare, Laura O'Shea, Research Assistant, St Andrew's Healthcare, Geoffrey Dickens, Research Manager and Head of Nursing Research, St Andrew's Healthcare, and Professor in Psychiatric Nursing, University of Northampton
- Edited by Geoffrey L. Dickins, Philip Sugarman, Marco Picchioni
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- Book:
- Handbook of Secure Care
- Published online:
- 02 January 2018
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- 01 July 2015, pp 27-47
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Summary
Introduction
Overview
This is the first of two linked chapters examining the closely related concepts of risk assessment and risk management in secure mental healthcare.
In this chapter, we consider the nature of risk in the context of secure mental healthcare, particularly the risk of physical violence but also that of suicide. We provide an overview of the epidemiology of violence and suicide risk in people with mental disorder. Next, we explain how risk assessment has developed over recent decades. We describe unstructured, actuarial and structured professional judgement methods of violence risk assessment, and discuss two of the main tools used in secure clinical practice. Finally, we review the evidence on risk assessment in relation to specialist or minority populations in secure care including women, those diagnosed with intellectual disability, autism spectrum disorder, Black and minority ethnic groups, adolescents and those in neuropsychiatry services. In Chapter 4 we discuss methods of risk management in the secure setting.
The importance of risk assessment
The assessment of risk should be a part of every clinical encounter. Public policy, such as the Department of Health's publication Improving Health, Supporting Justice (the ‘Bradley report’; Department of Health, 2009), dictates that mental health services play a key role in public protection. Despite the fact that there is a duty of care to the patient to provide treatment in the least restrictive environment (Mental Health Act 1983), clinicians are also required to ensure the safety of the ward environment for staff and other patients, and the safety of the wider public. Certain adverse outcomes among mental health service users, including homicide or suicide, result in a mandatory inquiry. Significant third-party risk is one of the few situations in medical practice where doctor–patient confidentiality can be breached both in the UK and the USA (Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976); General Medical Council, 2009).
15 - Nursing in secure mental healthcare settings
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- By Geoffrey Dickens, Research Manager and Head of Nursing Research, St Andrew's Healthcare, and Professor in Psychiatric Nursing, University of Northampton
- Edited by Geoffrey L. Dickins, Philip Sugarman, Marco Picchioni
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- Book:
- Handbook of Secure Care
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- 02 January 2018
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- 01 July 2015, pp 231-251
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Summary
Introduction
This chapter appraises the evidence for nursing in secure mental health environments as a specialty branch of mental health nursing. It opens with a brief history of nursing in secure and forensic mental health settings in England, describes the claims made for specialist status and identifies the main definitions and theories of mental health nursing in secure care. The worldwide empirical research evidence about the distinguishing features of the role is reviewed. It is concluded that nursing in secure care requires specialist skills and knowledge related to security, risk, therapeutic activity and clinical specialism. However, nurses working in secure services share many key mental health nursing attributes with those working in mainstream mental health services. Shared characteristics include teamwork, communication and professional development. Core values of both include a recovery and equality focus and commitment to evidencebased practice. Nurses should utilise the best evidence from all settings to support their practice, adapting where necessary to meet the clinical and security needs of the diverse groups for whom they provide care.
A brief history of nursing in secure mental healthcare
In England, nursing in conditions of security is rooted in the development of asylums for the criminally insane (Dale et al, 2001), the first at Broadmoor (opened 1863) and the second at Rampton (1914). Also in 1914, a state institution for people with intellectual disability (then known as mental retardation) of ‘dangerous or violent propensities’ (Mental Deficiency Act 1913) was opened at Moss Side on Merseyside (McGrath, 1966). However, there were no nurses, only ‘attendants’, at Broadmoor until the introduction in 1938 of a nursing examination (Hamilton, 1980). A nursing school was opened at Rampton hospital in 1950 (Nottinghamshire Healthcare NHS Trust, 2007). Until the Mental Health Act 1959 designated all three institutions as ‘special hospitals’ responsible to the Ministry for Health they had been an arm of the criminal justice system responsible to the Home Office. Despite the new healthcare alignment of the hospitals, nurses were solely represented in employment negotiations by the Prison Officers Association until the mid-1990s (Murphy, 1997). Nurses were also considered to be civil servants, until 1979 subject to the Official Secrets Act, resulting in a climate of secrecy about nursing activity in the special hospitals during this period (Kirby, 2000).
A Service Evaluation of a 1-Year Dialectical Behaviour Therapy Programme for Women with Borderline Personality Disorder in a Low Secure Unit
- Emily Fox, Kirsten Krawczyk, Jessica Staniford, Geoffrey L. Dickens
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 43 / Issue 6 / November 2015
- Published online by Cambridge University Press:
- 13 February 2014, pp. 676-691
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- November 2015
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Background: Previous studies about the effectiveness of Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder have had promising results. However, no previous studies have examined its effectiveness when delivered in low secure inpatient services for women. Aims: To evaluate clinical outcomes during and after a 1-year period of admission within a low secure unit for women offering a Dialectical Behaviour Therapy programme. Method: A naturalistic, within subjects study of clinical data collected as part of routine practice was conducted. Participants were18 consecutively admitted women who met the diagnostic criteria for Borderline Personality Disorder and had completed at least 1 year of treatment. Measures covered: risk behaviours; self-reported symptoms of Borderline Personality Disorder, and current mood and symptom experience; staff reports of clinical problems, needs and social functioning. Scores were compared between admission and at 6 months and 1 year. Results: There was a statistically significant improvement on all 13 measures over the year's treatment. Most improvement was demonstrated between admission and 6 months. Conclusions: Engagement in1-year's treatment was associated with significant reduction in risk behaviours and both staff-rated and self-rated outcome measures. Some significant questions remain about which elements of the programme are most effective but the results are encouraging.