The Violence Reduction Programme: An exploration of posttreatment risk reduction in a specialist medium‐secure unit

Abstract

BackgroundThere is limited evidence for treatment programmes for offenders with a diagnosis of personality disorder deemed to be of high risk of violence towards others.AimThis study sought to evaluate change in clinician‐rated risk of violence in males among offenders accepted to a specialist medium‐secure hospital providing treatment based on the Violence Reduction Programme (VRP).MethodA retrospective, records‐based cohort study design was used to explore change in risk of violence in a sample including five VRP cohorts composed of 33 offenders. Violence risk scale (VRS) score was the primary outcome measure. Correlates of treatment dropout were also explored.ResultsTwenty‐seven men completed treatment. Paired pretreatment and posttreatment VRS scores were available for 19 men. Six men disengaged with treatment. There was a significant mean reduction in risk of violence score (d = 1.08). At the individual level, eleven (57%) participants in the VRP showed reliable reduction in risk of violence. No treatment completers with a complete rating pair demonstrated an increased risk of violence. Younger age and referral from prison were significantly associated with treatment dropout.ConclusionVRP‐based treatment appears to be a promising intervention for specialist services for offenders with a personality disorder diagnosis in the United Kingdom. Longer term follow‐up to ascertain whether these apparent treatment gains are accompanied by actual reduction in violent recidivism is now required, and a full scale trial warranted.

Outcome measures in forensic mental health services: A systematic review of instruments and qualitative evidence synthesis

“…Nine instruments had some evidence for their reliability, which focused primarily on interrater, rather than test-retest reliability. Measurement error had limited evidence with studies identified for three instruments [48][49][50]. The quality of evidence for measurement error in the review was consistently low, relying on quantitative methods alone, with no attempt to relate the statistical error to the minimal important clinical change [31].…”

“…Three primary types of hypotheses were identified: prediction of future events, such as violence, self-harm, and victimization; difference between subgroups, based on characteristics such as sex, ward type or behavior; and correlation with other measures. Evidence for responsiveness was identified for seven instruments, with only two demonstrating adequate properties in this respect [48,51]. See Table 2 for an overview of the evidence for the selected instruments and Supplementary Material 5 for a detailed summary.…”

Understanding factors predicting violent recidivism

“…On the other hand, minor institutional misconduct consisted of all the other less serious infractions such as common assault on any other inmate, using indecent, violent, threatening or insulting language or defiance etc (Singapore Statues Online, 2020). Studies had suggested institutional misconduct and violent reoffending to be driven by similar underlying mechanisms (Horgan, Charteris & Ambrose, 2019). Findings had proposed that these underlying behavioral tendencies were likely to show continuity prior to incarceration, through incarceration, and even after release, highlighting the potential of violent tendencies and responses to problems to be consistent regardless of contexts (Lai, 2019).…”