Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2016; 6(4): 410-418
Published online Dec 22, 2016. doi: 10.5498/wjp.v6.i4.410
Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome
Susan Young, Mrigendra Das, Gisli H Gudjonsson
Susan Young, Imperial College London, London W12 0NN, United Kingdom
Susan Young, Mrigendra Das, Broadmoor Hospital, West London Mental Health Trust, Berkshire RG45 7EG, United Kingdom
Susan Young, Gisli H Gudjonsson, Reykjavik University, 1IS-101 Reykjavik, Iceland
Gisli H Gudjonsson, King’s College London, Institute of Psychiatry Psychology and Neuroscience, London SE5 8AF, United Kingdom
Author contributions: All authors contributed equally to this work; Young S and Gudjonsson GH designed the research, analysed the data and drafted the manuscript; Das M contributed to interpretation of the data and drafts of the manuscript; all authors read and approved the final paper.
Institutional review board statement: The study was reviewed and approved by the National Research Ethics Service, NRES Committee London-Harrow (REC number 09/HO710/70, R&D No. YOUSW9001); the study was also reviewed and approved by the National Research Ethics Service, NRES Committee London-Harrow (REC No. 09/H0710/46).
Conflict-of-interest statement: SY has received fees for consultancy, travel and educational talks from Janssen, Eli Lilly, Shire, Novartis, HB Pharma, Flynn Pharma and Shire. She has received research funding from Eli Lilly, Shire and Janssen. She is a consultant at the Cognitive Centre of Canada and co-author of the R&R2 program for mentally disordered offenders. GHG has received fees for consultancy from Eli Lilly and educational talks from Janssen and Shire. MD has no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Susan Young, PhD, DClinPsy, BSc, AFBPS, CSci, Senior Clinical Lecturer in Forensic Clinical Psychology, Imperial College London, Hammersmith Hospital Campus, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom. susan.young1@imperial.ac.uk
Telephone: +44-207-3834161 Fax: +44-207-3834160
Received: June 13, 2016
Peer-review started: June 17, 2016
First decision: July 27, 2016
Revised: October 11, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 22, 2016
Processing time: 189 Days and 20.3 Hours
Abstract
AIM

To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders.

METHODS

Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions.

RESULTS

It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program.

CONCLUSION

The findings suggest that a stable mental state is a key factor that predicts treatment completion.

Keywords: Treatment; Completion; Outcomes; Mentally disordered offenders; Reasoning and Rehabilitation Mental Health Programme; Cognitive skills program

Core tip: This study adds important new information to understanding factors that predict treatment completion of the Reasoning and Rehabilitation Mental Health Programme cognitive skills programme for mentally disordered offenders. Out of 97 male patients, 76 (78.4%) completed the programme. There were two factors that predicted treatment completion, low level of behavioural disturbance on the ward prior to treatment commencing, and most importantly patients currently being on oral typical psychotropic medication, which increased over seven times the likelihood that they would compete the programme. The findings suggest that a stable mental state is a key factor that predicts treatment completion.