Barriers to treatment: reasons for non‐attendance in women's secure settings

Abstract

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -The aim of this paper is to investigate reasons for treatment non-attendance for dual diagnosis women in secure psychiatric settings.Design/methodology/approach -A semi structured interview was used to investigate patients' reasons for session non attendance on the day of non participation across four wards. Reasons for non attendance were grouped using the mulifactorial offender readiness model (MORM) categories of affective, volitional, behavioural, cognitive and external. Assignment of responses to categories was undertaken by a two person team and inter rater reliability was assessed.Findings -Patients' rates of attendance varied by ward and level of security (low vs medium); and diagnosis. Systematic enquiry about the reasons for non attendance led to increased session attendance. Reasons for non attendance were cognitive reflecting negative evaluations of treatment and treatment outcomes. Psychological therapies and educational sessions were deemed the most important along with one-to-one clinician appointments.Originality/value -Issues of treatment engagement and the timing of treatment interventions are major issues in the care of secure psychiatric patients, particularly those with a primary diagnosis of personality disorder. Findings highlight the importance of systematic enquiry about reasons for non attendance and suggest potential interventions designed to improve engagement.

Support for the predictive validity of the multifactor offender readiness model (MORM): forensic patients' readiness and engagement with therapeutic groups

“…These outcomes are broadly comparable with those in other published studies (McMurran and Theodosi, ; Sheldon et al, ; Long et al, ). As refusals out‐numbered dropouts, it appears that optimising the initial assessment is a vital clinical task (Quinsey et al, ; Long et al, ). Our results provided some support for the predictive validity of the internal factors of the MORM, as discussed in the succeeding sections.…”

“…In a study of patients in a high security psychiatric hospital, Sheldon et al () also found evidence that reasons for treatment non‐completion were consistent with the MORM, specifically, emotional arousal/dysregulation, therapy‐incongruent goal motivation and negative attitudes towards self‐efficacy, treatment and staff. Long et al () assessed treatment engagement among female patients in secure hospitals and also found that cognitive, affective and volitional characteristics were associated with non‐engagement, but behavioural and identity reasons were less so.…”

Treatment Engagement From the Perspective of the Offender

“…A broad definition of noncompletion/engagement was included to ensure all factors influencing treatment engagement were identified. While nonengagement has been commonly attributed to an individual’s lack of motivation or resistance, it has been argued that other reasons, including problems with the treatment environment or legitimate and rational concerns regarding treatment, have often been ignored (Long et al, 2012). Therefore, by using a broad definition of noncompletion/engagement, the current review aimed to address this critique and increase awareness that for some individual’s reasons for and against engaging in treatment, even for just one session, may be attributed to organisational factors as well as client factors.…”

“…Furthermore, among the external factors identified in this review, exclusion from treatment was noted in several studies as the reason for noncompletion of treatment (Long et al, 2012;Polaschek, 2010;Sheldon et al, 2010;Strauss & Falkin, 2000). While this is clearly an external reason, the reasons why participants engaged in particular behaviours that led to expulsion were not explored and likely reflect internal factors.…”

“…It should be noted that while Strauss and Falkin (2000) conducted two separate interviews, only the latter explored reasons for completion/noncompletion of treatment. Both Long et al (2012) and McGrain (2006) were an exception, and their studies likely produced more comprehensive and accurate data. The studies also varied in whether they collected data on reasons for completion/noncompletion prospectively or retrospectively.…”