Pub Date : 2018-11-01DOI: 10.1093/MED/9780198723196.003.0003
D. Bhugra, A. Ventriglio, K. Bhui
Mental state assessment or examination lies at the core of assessing patients and reaching a diagnosis that can be followed by appropriate and suitable management strategies. It is important that clinicians take enough time to carry out the assessment, which may require several sessions. This is especially true for patients whose cultures may differ from those of the clinician. It is important that assessments are not rushed and that gradual therapeutic alliance is developed so that patients and their carers have confidence in the clinician. Clinicians should take time to understand the cultural context of the individual and the significance of culture in the genesis, perpetuation, and prognosis of illness symptoms. Health professionals need to be aware of cultural idioms of distress and emotional and clinical needs. Even when both the clinician and the patient come from the same culture, a thorough and proper assessment is necessary.
{"title":"Mental state assessment: Basic principles","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0003","url":null,"abstract":"Mental state assessment or examination lies at the core of assessing patients and reaching a diagnosis that can be followed by appropriate and suitable management strategies. It is important that clinicians take enough time to carry out the assessment, which may require several sessions. This is especially true for patients whose cultures may differ from those of the clinician. It is important that assessments are not rushed and that gradual therapeutic alliance is developed so that patients and their carers have confidence in the clinician. Clinicians should take time to understand the cultural context of the individual and the significance of culture in the genesis, perpetuation, and prognosis of illness symptoms. Health professionals need to be aware of cultural idioms of distress and emotional and clinical needs. Even when both the clinician and the patient come from the same culture, a thorough and proper assessment is necessary.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74190305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/med/9780198723196.003.0005
D. Bhugra, A. Ventriglio, K. Bhui
Assessment tools can support clinical assessments but cannot replace them. They can be used for a number of purposes. They are standardized tools but may require some adjustments if they are being used in cultures other than those in which they were developed. If they have been translated into other languages, it is essential that translation be carried out with proper conceptual equivalence rather than simple literal translation. The experiences of migration and acculturation need to be assessed carefully. Furthermore, for the first time DSM-5 includes concepts of cultural formulation; the key features include cultural identity of individuals, cultural explanations of their illnesses, cultural factors related to their environment and levels of functioning, various cultural elements of relationship between the clinician and the individual, and overall cultural assessment. At the heart of cultural formulation lie the principles of cultural sensitivity.
{"title":"Assessment tools and cultural formulation","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/med/9780198723196.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198723196.003.0005","url":null,"abstract":"Assessment tools can support clinical assessments but cannot replace them. They can be used for a number of purposes. They are standardized tools but may require some adjustments if they are being used in cultures other than those in which they were developed. If they have been translated into other languages, it is essential that translation be carried out with proper conceptual equivalence rather than simple literal translation. The experiences of migration and acculturation need to be assessed carefully. Furthermore, for the first time DSM-5 includes concepts of cultural formulation; the key features include cultural identity of individuals, cultural explanations of their illnesses, cultural factors related to their environment and levels of functioning, various cultural elements of relationship between the clinician and the individual, and overall cultural assessment. At the heart of cultural formulation lie the principles of cultural sensitivity.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77657257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791874.003.0007
M. Burns, C. Campbell, J. Craissati
The complex process by which the current Offender Personality Disorder pathway came into existence and the importance of joint operations, both co-commissioning and co-delivery, are explored in this chapter. The importance of providing system leadership and the difficulty inherent in holding together a complex network of service provision in two parallel systems while maintaining effective service delivery is explored. A brief overview of the evolution of commissioning in both health and justice settings is given, as well as a description of ‘co-commissioning’ and the tensions and benefits evident in this unique approach. The importance of collaboration and working towards identified outcomes from a set of agreed strategic principles is emphasized, along with the importance of relationships and the impact the approach has on workforce and environments across the pathway.
{"title":"The Offender Personality Disorder pathway: Modelling collaborative commissioning in the NHS and criminal justice system","authors":"M. Burns, C. Campbell, J. Craissati","doi":"10.1093/MED/9780198791874.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0007","url":null,"abstract":"The complex process by which the current Offender Personality Disorder pathway came into existence and the importance of joint operations, both co-commissioning and co-delivery, are explored in this chapter. The importance of providing system leadership and the difficulty inherent in holding together a complex network of service provision in two parallel systems while maintaining effective service delivery is explored. A brief overview of the evolution of commissioning in both health and justice settings is given, as well as a description of ‘co-commissioning’ and the tensions and benefits evident in this unique approach. The importance of collaboration and working towards identified outcomes from a set of agreed strategic principles is emphasized, along with the importance of relationships and the impact the approach has on workforce and environments across the pathway.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78182768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198723196.003.0008
D. Bhugra, A. Ventriglio, K. Bhui
Specific psychotherapies bring specific challenges with them. Engagement with cognitive behaviour therapy and its success depends upon how the individual’s cognitions are affected by cultures and how amenable these are for therapy. Similarly, family therapy carries with it different roles of different members across cultures, and not everyone’s role will be the same. Minority therapists may face potential difficulties while looking after patients from majority cultures. General principles of psychotherapy across cultures will apply but they may carry different meanings for each individual. It is essential that therapists are flexible enough to ensure the best patient engagement, and additional modifications may be required. Each of these therapies can be reductive, reconstructive, or supportive, and a mixture of more than one approach can be utilized. Assessment must explore very carefully needs and indications for therapy. In many cultures these words have very different meanings with personal and social expectations.
{"title":"Psychotherapy: Specific psychotherapies","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0008","url":null,"abstract":"Specific psychotherapies bring specific challenges with them. Engagement with cognitive behaviour therapy and its success depends upon how the individual’s cognitions are affected by cultures and how amenable these are for therapy. Similarly, family therapy carries with it different roles of different members across cultures, and not everyone’s role will be the same. Minority therapists may face potential difficulties while looking after patients from majority cultures. General principles of psychotherapy across cultures will apply but they may carry different meanings for each individual. It is essential that therapists are flexible enough to ensure the best patient engagement, and additional modifications may be required. Each of these therapies can be reductive, reconstructive, or supportive, and a mixture of more than one approach can be utilized. Assessment must explore very carefully needs and indications for therapy. In many cultures these words have very different meanings with personal and social expectations.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80718320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/med/9780198723196.003.0002
D. Bhugra, A. Ventriglio, K. Bhui
When individuals experience distress, they try to make sense of this and, in the first instance, may seek help from personal, folk, or social sectors. If these interventions do not work, they will contact the professional sector. It is likely that the healthcare system will direct their help-seeking behaviour. In addition, the explanatory models they have will direct them into help-seeking accordingly. Once therapeutic interaction has started, the explanatory models of the individuals, their families, carers, and those of the clinician will affect therapeutic engagement. Race, gender, social status, education, and economic status will all affect explanatory models and where individuals seek help. If different from that of the patient, the culture of the clinician will affect therapeutic alliance. Working with interpreters requires training if the primary language of the patient differs from that of the healthcare professional.
{"title":"Therapeutic encounters","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/med/9780198723196.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780198723196.003.0002","url":null,"abstract":"When individuals experience distress, they try to make sense of this and, in the first instance, may seek help from personal, folk, or social sectors. If these interventions do not work, they will contact the professional sector. It is likely that the healthcare system will direct their help-seeking behaviour. In addition, the explanatory models they have will direct them into help-seeking accordingly. Once therapeutic interaction has started, the explanatory models of the individuals, their families, carers, and those of the clinician will affect therapeutic engagement. Race, gender, social status, education, and economic status will all affect explanatory models and where individuals seek help. If different from that of the patient, the culture of the clinician will affect therapeutic alliance. Working with interpreters requires training if the primary language of the patient differs from that of the healthcare professional.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84927981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791874.003.0002
Chantal Scaillet, Celia A. Taylor
This chapter on staff selection and training reviews the literature on the qualities and competencies required for working with personality disordered offenders. It also discusses the complexity of working with personality disordered offenders who may have challenging behaviours. It then considers various staffing models and outlines why the direction of multi-agency, partnership working was chosen. It explores the needs of staff at all levels for clinical supervision and reflective practice, and the kinds of dilemmas they are likely to bring for discussion. Finally, the chapter examines the results of various evaluation studies of staff recruitment and training, and suggests possible future developments.
{"title":"Staff selection and training","authors":"Chantal Scaillet, Celia A. Taylor","doi":"10.1093/MED/9780198791874.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0002","url":null,"abstract":"This chapter on staff selection and training reviews the literature on the qualities and competencies required for working with personality disordered offenders. It also discusses the complexity of working with personality disordered offenders who may have challenging behaviours. It then considers various staffing models and outlines why the direction of multi-agency, partnership working was chosen. It explores the needs of staff at all levels for clinical supervision and reflective practice, and the kinds of dilemmas they are likely to bring for discussion. Finally, the chapter examines the results of various evaluation studies of staff recruitment and training, and suggests possible future developments.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75432393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198723196.003.0006
D. Bhugra, A. Ventriglio, K. Bhui
Prescribing medicine is one of many therapeutic strategies that clinicians use in managing mental illness in patients. In different cultures, patients have varying expectations of types of medication. Some cultures prefer injections, whereas others like syrups. Patients from some cultures have faith in small tablets whereas others in big tablets. Colour of tablets also affects compliance. In addition, cultural factors like diet, smoking, and religious rituals also play a role in developing and maintaining therapeutic adherence. Individual pharmacodynamics and pharmacokinetic factors are likely to be strongly influenced by ethnic and racial factors. Environmental and personality factors can play an important role in efficacy of medication. There is no doubt that medication is an important part of the therapeutic interaction. Clinicians must give the right information about medication in terms that patients and their families can understand clearly, especially the meaning of the medication and its purpose and potential side effects.
{"title":"Psychopharmacology and culture","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0006","url":null,"abstract":"Prescribing medicine is one of many therapeutic strategies that clinicians use in managing mental illness in patients. In different cultures, patients have varying expectations of types of medication. Some cultures prefer injections, whereas others like syrups. Patients from some cultures have faith in small tablets whereas others in big tablets. Colour of tablets also affects compliance. In addition, cultural factors like diet, smoking, and religious rituals also play a role in developing and maintaining therapeutic adherence. Individual pharmacodynamics and pharmacokinetic factors are likely to be strongly influenced by ethnic and racial factors. Environmental and personality factors can play an important role in efficacy of medication. There is no doubt that medication is an important part of the therapeutic interaction. Clinicians must give the right information about medication in terms that patients and their families can understand clearly, especially the meaning of the medication and its purpose and potential side effects.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91428063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198723196.003.0004
D. Bhugra, A. Ventriglio, K. Bhui
Mental state assessment or mental state examination is important not only in reaching a diagnosis but also in engaging patients and their families and planning therapeutic interventions. In addition to the basic principles of assessment, specific psychiatric conditions require additional details. Working with children and adolescents, with older individuals, and those with intellectual disabilities brings with it special challenges. It is crucial that clinicians are aware of the cultural context of the individual being assessed and that they take care and spend time to carry out the assessment, which may need to continue over a number of sessions. To achieve optimal results and outcomes, good therapeutic alliance is essential. It is critical that clinicians are aware of the impact of culture on the genesis, perpetuation, and prognosis of symptoms. Clinicians must be even more careful when working with special groups and psychiatric disorders, which are described further in this chapter.
{"title":"Mental state assessment: Specific conditions","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0004","url":null,"abstract":"Mental state assessment or mental state examination is important not only in reaching a diagnosis but also in engaging patients and their families and planning therapeutic interventions. In addition to the basic principles of assessment, specific psychiatric conditions require additional details. Working with children and adolescents, with older individuals, and those with intellectual disabilities brings with it special challenges. It is crucial that clinicians are aware of the cultural context of the individual being assessed and that they take care and spend time to carry out the assessment, which may need to continue over a number of sessions. To achieve optimal results and outcomes, good therapeutic alliance is essential. It is critical that clinicians are aware of the impact of culture on the genesis, perpetuation, and prognosis of symptoms. Clinicians must be even more careful when working with special groups and psychiatric disorders, which are described further in this chapter.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84322840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791874.003.0008
J. Craissati, C. Campbell
This concluding chapter adopts a formulation-based approach to reflect on the tough question of whether the Offender Personality Disorder (OPD) pathway has achieved a real impact in terms of the national strategy’s high-level outcomes. First, the explicit and implicit premises of the former Dangerous and Severe Personality Disorder (DSPD) developments are considered, contrasting them with those underpinning the OPD pathway strategy. It is suggested that while DSPD was predicated on an illness model, the OPD strategy more accurately reflects a public health model, with the associated benefits and disadvantages. Second, the evidence for impact to date is summarized. Third, the high-level strategy outcomes are reworked in line with our theoretical model to achieve a more coherent articulation of the hypothesized mechanism of change within the pathway.
{"title":"Making an impact: Have we got it right yet?","authors":"J. Craissati, C. Campbell","doi":"10.1093/MED/9780198791874.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0008","url":null,"abstract":"This concluding chapter adopts a formulation-based approach to reflect on the tough question of whether the Offender Personality Disorder (OPD) pathway has achieved a real impact in terms of the national strategy’s high-level outcomes. First, the explicit and implicit premises of the former Dangerous and Severe Personality Disorder (DSPD) developments are considered, contrasting them with those underpinning the OPD pathway strategy. It is suggested that while DSPD was predicated on an illness model, the OPD strategy more accurately reflects a public health model, with the associated benefits and disadvantages. Second, the evidence for impact to date is summarized. Third, the high-level strategy outcomes are reworked in line with our theoretical model to achieve a more coherent articulation of the hypothesized mechanism of change within the pathway.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73181357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791874.003.0005
Colin Campbell, Pamela Attwell
The chapter begins by reviewing the existing evidence base for services for personality disordered offenders within secure settings, outlining approaches used both in the UK and internationally. The chapter goes on to describe the implementation of the Offender Personality Disorder (OPD) strategy in secure services, setting out the commissioning context and the focus on social environments, including Psychologically Informed Planned Environments (PIPEs) and Enabling Environments. It reviews the approach chosen by the London Pathways Partnership in terms of service model (residential, day programme, and outreach) and the intensity of the interventions used. The delivery of the services is then described in detail, including the development phase; referrals and assessment; intervention; and pathway progression. The chapter reviews the progress of the services over the first four years, including what worked and what didn’t, and concludes with an outline of evaluations of the services and proposals for future developments.
{"title":"Intervening in secure settings","authors":"Colin Campbell, Pamela Attwell","doi":"10.1093/MED/9780198791874.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0005","url":null,"abstract":"The chapter begins by reviewing the existing evidence base for services for personality disordered offenders within secure settings, outlining approaches used both in the UK and internationally. The chapter goes on to describe the implementation of the Offender Personality Disorder (OPD) strategy in secure services, setting out the commissioning context and the focus on social environments, including Psychologically Informed Planned Environments (PIPEs) and Enabling Environments. It reviews the approach chosen by the London Pathways Partnership in terms of service model (residential, day programme, and outreach) and the intensity of the interventions used. The delivery of the services is then described in detail, including the development phase; referrals and assessment; intervention; and pathway progression. The chapter reviews the progress of the services over the first four years, including what worked and what didn’t, and concludes with an outline of evaluations of the services and proposals for future developments.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81097670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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