Mental health of offenders on probation

This thesis forms part of the criteria for the qualification of the Doctorate in Forensic Psychology Practice (ForenPsyD). Its overall aim is to examine the prevalence of mental disorders and unmet needs among offenders managed by the Probation Service, because the understanding of this has very important implications for epidemiology, health service planning and future offending. The first chapter of this thesis presents a general introduction to the topic. Chapter two is a single case study, which describes work undertaken in relation to risk assessment and development of a care plan with a client managed by the Probation Service. A number of previously researched risk factors for offending have been identified in this case, these included: high numbers of previous convictions, presence of mental disorders, substance misuse, poor educational and vocational skills, poor cognitive and interpersonal skills, and limited social support. This study also demonstrated the practical utility of the Structured Assessment of Personality Abbreviated Scale (SAPAS; Moran et al., 2003), a brief screening measure for personality disorder case identification. The Structured Assessment of Personality Abbreviated Scale (SAPAS; Moran et al., 2003) is discussed and evaluated in chapter three. Presented evidence suggests that this measure can rapidly identify individuals at high risk of personality disorder with a good level of psychometric properties. Based on the above and developing evidence supporting its validity and reliability with forensic populations the SAPAS has been chosen to screen for case identification in the empirical study. Chapter four presents findings from the literature review on the prevalence of mental disorders in offenders on probation using a systematic approach. A total of 18 studies published between 1993 and 2013 were reviewed, suggesting significant lack of research in this area. The little research that exists demonstrates mixed findings as the prevalence of mental disorders reported varies making a comparison between the papers difficult. Despite the above, where possible weighted average prevalence rates were calculated. The estimated overall prevalence of PD was 19%, any current mental disorder 6%, alcohol misuse 62%, drug abuse 54, anxiety 13% and depression 10%. The findings from previous chapters were considered and informed more in depth, empirical research on the prevalence of mental disorders amongst offenders on probation presented in chapter five. The present study estimated that 61% of the probationers suffer from a current mental disorder according to Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998), and found that a significant proportion experience difficulties with regards to social needs such as financial and housing difficulties, which have been previously identified as significant risk factors for reoffending. Finally, chapter six presents overall findings discusses its implications, explores limitations and provides direction for future research. Several wider implications can be drawn from this thesis, which shows that high numbers of probationers suffer from a variety of Axis I disorders, likely personality disorders, substance misuse and have a number of social needs. Based on these findings, it is possible to conclude that there is a need for the mental health substance misuse and social needs of offenders to be given a higher priority in terms of service delivery, education and research