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We explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single National Health Service (NHS) mental health trust. From clinical records, we extracted data on the length of time of CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014.
A small number of individuals accounted for a disproportionately large proportion of CSO hours in each setting. Adverse incident rates were higher on CSO than when not on CSO. There was considerable variation between different settings in terms of CSO use and the reasons for commencing CSO.
The study describes the prevalence and nature of CSO in secure forensic mental health services and the associated organisational costs. The marked variation in CSO use between settings suggests that mental health services continue to face challenges in balancing risk management with minimising restrictive interventions.
Declaration of interest
A.B. and J.L.I. are both directly employed by the NHS trust in which the study was conducted.
Risk assessment instruments have become a preferred means for predicting
future aggression, claiming to predict long-term aggression risk.
To investigate the predictive value over 12 months and 4 years of two
commonly applied instruments (Historical, Clinical and Risk Management -
20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)).
Participants were adult male psychiatric patients detained in a high
secure hospital. All had a diagnosis of personality disorder. The focus
was on aggression in hospital.
The actuarial risk assessment (VRAG) was generally performing better than
the structured risk assessment (HCR-20), although neither approach
performed particularly well overall. Any value in their predictive
potential appeared focused on the longer time period under study (4
years) and was specific to certain types of aggression.
The value of these instruments for assessing aggression in hospital among
patients with personality disorder in a high secure psychiatric setting
As a topic of academic study, bullying between prisoners has not seen the same volume of research as that dedicated to other populations, such as bullying among children or within the workplace. Indeed, the first studies into prison bullying were published only in 1996 (Connell and Farrington, 1996; Ireland and Archer, 1996), and even now there is a tendency for research into prison aggression to be published which makes no reference to the concept of bullying (Blitz et al., 2008) nor to any UK prison-based research. This is despite the fact that the UK has led this area, coupled with a marked increase in prison bullying research across the last decade (e.g. Ireland and Ireland, 2008), which has included in excess of 50 publications. Bullying among prisoners is a topic of particular interest on a number of grounds: academically, you have the opportunity to explore aggression between sex-segregated groups representing extreme samples of the general population, samples who are residing in unique environments that arguably serve to promote bullying behaviour (Ireland, 2005); and on practice-grounds, there is a need to refine and evaluate prison-based anti-bullying strategies and approaches, accounting for the elevated levels of bullying reported in comparison to other populations, and the absence of theory evident in current strategies (Ireland, 2005).
This chapter first traces the origin and development of bullying among prisoners, with first study having been published in 1996, followed by 27 more between 1999 and 2007. The DIPC SCALED is a multiple-indicator method of assessing bullying behaviour which requires respondents to indicate the frequency at which the perpetration/victimization has occurred. Although conclusions can be reliably drawn in relation to the nature and extent of bullying, further work is required before definite conclusions can be drawn; the chapter presents four areas in this direction. There are a number of clear applications that can be drawn from the acquired knowledge on prison bullying. Some examples of how the research findings/theoretical models can be applied in practice are listed in the chapter. Interventions managing prisoner bullying need to attend to the empirical literature and theory base. Ill-informed intervention approaches beyond the expectations of the existing literature need to be avoided.