Does Treatment for Sexual Offending Work?

PURPOSE OF REVIEW: We review and synthesize the literature on the effectiveness of offense-focused treatment for sexual offending. Specifically, we consider whether the extant literature suggests treatment is effective in reducing sexual reoffending and features of effective interventions. We also consider how the design of program evaluations may influence treatment outcomes. RECENT FINDINGS: Recent research suggests that offense-focused psychological treatment for sexual offending shows some level of effectiveness in reducing both sexual and general reoffending. Further, there appear to be key program, individual, and study design features associated with treatment effectiveness. Although recent findings paint an optimistic outlook for offense-focused psychological treatment for sexual offending, further high-quality differential studies are needed to fully understand the range of content, delivery, and individual factors associated with successful treatment outcomes so as to establish what works best for whom.

An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences.

PURPOSE: Epidemiological data on the mental health needs of prisoners are essential for the organisation, planning, and delivery of services for this population as well as for informing policy and practice. Recent reports by the National Audit Office and NICE call for new research to provide an updated picture of the mental health needs of men and women in prison in the UK. This study aimed to measure the prevalence and comorbidity of mental health needs across a representative sample of both men and women across 13 prisons in one UK region. METHOD: Participants completed a standardised battery of psychometric assessments which screened for a range of mental health difficulties including: mental disorders, personality disorder, and substance misuse. RESULTS: 469 participants were included in the final sample (338 males, 131 females). A high number of participants reported having had previous contact with mental health services and/or a pre-existing diagnosis of a mental disorder. High rates of current mental disorder were detected across the range of disorders screened for. Levels of comorbidity were also high, with nearly half of participants screening positive for two or more types of mental disorder. Gender differences were noted in terms of previous contact with mental health services, having a pre-existing diagnosis, prevalence of current mental disorder, and levels of comorbidity; with women reporting higher rates than men. CONCLUSIONS: Rates of pre-existing and current mental illness continue to be high amongst prisoners. Women report significantly higher levels of mental health need compared to men.

An evaluation of a specialist firesetting treatment programme for male and female mentally disordered offenders (the FIP-MO).

Individuals who set deliberate fires are frequently encountered by clinicians working in forensic mental health services. However, little attention has been paid to developing standardised treatment for this behaviour, and few evaluations of treatment have been conducted in forensic mental health services. This study evaluates a new standardised group cognitive behavioural treatment programme for individuals residing in forensic psychiatric hospitals who have engaged in deliberate firesetting (The Firesetting Intervention Programme for Mentally Disordered Offenders; FIP-MO). Sixty-three male and female patients with a history of deliberate firesetting commenced FIP-MO treatment. Patients who met the referral criteria for treatment but who resided at hospitals where FIP-MO treatment was not available were recruited as a treatment as usual comparison group. The treatment group completed a battery of psychometric assessments pre- and post-treatment, with the comparison group completing these at similar time points. Results showed that patients who completed the FIP-MO made significant improvements post-treatment, relative to the comparison group on fire-related measures (e.g., problematic interest and associations with fire) and anger expression. Further, effect size calculations showed that the treatment group made larger pre-post treatment shifts on the majority of outcome measures compared to the comparison group. These findings suggest that FIP-MO treatment is effective for reducing some of the key factors associated with deliberate firesetting.

An evaluation of mandatory polygraph testing for sexual offenders in the United kingdom.

This research examined whether a government-initiated pilot project of mandatory polygraph testing would increase the disclosures made by community-supervised sexual offenders in the United Kingdom. The Offender Managers of 332 pilot polygraph sexual offenders and 303 sexual offenders who were receiving usual community supervision were telephoned quarterly, over a 21-month period, to collect information about numbers of clinically relevant disclosures, the seriousness of disclosures made, and actions taken as a result of disclosures. Perceptions of polygraph usefulness were also collected. Offender Managers in the pilot polygraph group-compared to comparison Offender Managers-reported (a) a higher proportion of offenders making at least one disclosure (i.e., 76.5% vs. 51.2% respectively), and (b) that their offenders made more total disclosures overall (Ms = 2.60 vs. 1.25 respectively). The majority of disclosures made by sexual offenders in the polygraph group were associated with the polygraph session itself. Polygraph Offender Managers reported being more likely to take an action that involved increasing supervision, informing a third party, informing Multi-Agency Public Protection Arrangements (MAPPA), changing supervision focus, or issuing a warning to the offender. However, the relative seriousness of disclosures did not appear to differ across groups. In terms of polygraph test results, one third of offenders (most notably those who were higher in risk) failed their first test with "Deception Indicated." This outcome-received on a first test-was most likely to elicit clinically relevant disclosures. Offender Managers described the polygraph as aiding supervision strategies. This research and its associated caveats are discussed.

Corrigendum: "Wading through the worst that humanity does to each other": New Zealand Crown prosecutors' experiences of working with potentially traumatic material in the criminal justice system.

[This corrects the article DOI: 10.3389/fpsyg.2023.1164696.].

"Wading through the worst that humanity does to each other": New Zealand Crown prosecutors' experiences of working with potentially traumatic material in the criminal justice system.

Introduction: Occupational exposure to trauma and its potential impacts on legal professionals working in the criminal justice system is an area that has historically been neglected and has only gained traction in recent years. Crown prosecutors, as a subset of practising criminal lawyers in New Zealand, are arguably at heightened risk of vicarious trauma (VT) due to their occupationally distinct exposure to potentially traumatic material (PTM). However, no research to date has explored the experiences of this group of working with PTM. Methods: This qualitative study aimed to explore New Zealand Crown prosecutors' experiences of working with PTM. Nineteen Crown prosecutors from four Crown Solicitor firms across New Zealand participated in individual semi-structured interviews. The data was analysed using reflexive thematic analysis. Results: Three themes were developed that described Crown prosecutors' experiences of work-related exposure to trauma: trauma is everywhere, enduring effects of PTM exposure, and coping in the moment. These findings add to the growing body of literature on legal professionals' work-related wellbeing and highlights how they are an at-risk population for VT, which can be significant and enduring. Discussion: Further research is needed to understand the unique etiological pathways for both the consequences of working with PTM and effective ways to reduce this occupational risk for legal professionals working in the criminal law.

Adult Externalizing and Suicidal Behavior in Children Who Set Fires: Analysis of a 40 Year Birth Cohort Study.

OBJECTIVE: Firesetting in children is thought to be an indicator of severe conduct problems in young people. However, no research has examined whether childhood firesetting is also associated with increased risk of externalizing and suicidal behaviors in adulthood. METHOD: Data were obtained from a longitudinal study (n = 1265). Childhood firesetting/conduct problems (7-10 years) were derived from an assessment of antisocial behavior. Externalizing/suicidal behavior was derived from the Composite International Diagnostic Interview and the Self-Report Delinquency Inventory. Generalized estimating equation (GEE) models estimated associations between childhood firesetting and adult substance use disorders, criminal offending, and suicidal ideation, adjusting for childhood conduct problems and other confounding factors. Associations between childhood and adult firesetting (age 18-40 years) were examined using cross-tabulation (χ2). RESULTS: Five percent of children reported firesetting (7-10 years). Childhood firesetting appeared to increase the risk of adult firesetting; however, in most cases adult firesetting was not associated with childhood firesetting (χ2 (1) = 4.15, p = .0417). Childhood firesetting was a risk marker for adult externalizing/suicidal behavior; however, the effect was relatively weak (IRR = 1.51; 95% CI: 1.11-2.05). Children with conduct problems who also engaged in firesetting were found to be at substantially higher risk of later externalizing/suicidal behavior (IRR = 2.84; 95% CI: 1.24-6.49). CONCLUSION: This study found that childhood firesetting is a risk marker for adult externalizing/suicidal behavior, not an independent risk factor. It may be more useful for clinicians to focus on child conduct problems generally, rather than focussing on firesetting behavior.

Reorienting Locus of Control in Individuals Who Have Offended Through Strengths-Based Interventions: Personal Agency and the Good Lives Model.

Having an external locus of control has been associated with a range of well-supported risk correlates of offending behavior. Further, individuals with an internal locus of control orientation are suggested to be more open to engaging in treatment and are also considered more likely to have successful treatment outcomes. In forensic settings, where individuals are subject to external controls and have little personal autonomy, it is important to consider what treatment approaches might be most successful in reorienting individuals' locus of control. The Good Lives Model (GLM) proposes a strengths-based approach to the rehabilitation of individuals who have offended. Within the GLM, an external locus of control is suggested to be associated with a deficit in the primary good of agency. In this article, we will provide a brief overview of the literature on locus of control and its hypothesized role in offending behavior. We will discuss how an external locus of control orientation is related to personal agency and how strengths-based models, such as the GLM, may assist with reorienting locus of control in individuals who have offended through promoting personal agency.

The face validity of an initial sub-typology of people with autism spectrum disorders detained in psychiatric hospitals.

LAY ABSTRACT: Autistic adults who have a history of committing crimes pose challenges for the criminal justice system in terms of disposal and treatment. For this reason, we investigated the validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals. Initially, we ran a focus group with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital to consider a sub-typology of autistic adults who may come into contact with secure psychiatric hospitals. We asked 15 psychiatrists and clinical psychologists to rate 10 clinical vignettes based on our sub-typology with three rounds; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology and percentage of agreement ranged from 96% to 100% for overall subtype classification. The findings suggested that the further validity of the sub-typology should be investigated within a larger study using a clinical sample. These subtypes may help inform treatment and care pathways within hospital.

Measuring the Cognition of Firesetting Individuals Using Explicit and Implicit Measures.

This study examined un-apprehended deliberate firesetters' cognition. Relative to non-firesetters, un-apprehended firesetters reported higher explicitly measured fire interest. However, their reaction times (RTs) on a fire interest implicit LDT were inconsistent with these findings. They did, however, display a pattern of LDT RTs consistent with Dangerous World and Fire is Powerful beliefs.

Pathways to Firesetting for Mentally Disordered Offenders: A Preliminary Examination.

The current study aimed to investigate the specific pathways in the offence process for mentally disordered firesetters. In a previous study, an offence chain model was constructed (i.e., the Firesetting Offence Chain for Mentally Disordered Offenders, FOC-MD) using offence descriptions obtained from 23 mentally disordered firesetters, detailing the sequence of contextual, behavioural, affective, and cognitive factors that precipitate an incidence of firesetting for this population. The current study examines the prevalence of the specific pathways to firesetting for the original 23 mentally disordered firesetters and a further sample of 13 mentally disordered firesetters. Three distinct pathways to firesetting are identified within the FOC-MD: fire interest-childhood mental health, no fire interest-adult mental health, fire interest-adult mental health. In this article, we describe these three pathways in detail using illustrative case studies. The practice implications of these identified pathways are also discussed.

A Practical Guide to Assessing Adult Firesetters' Fire-Specific Treatment Needs Using the Four Factor Fire Scales.

OBJECTIVE: Practitioners working with offenders who have set fires have access to very few measures examining fire-specific treatment needs (e.g., fire interest, fire attitudes). In this article we examine the new Four Factor Fire Scales (Ó Ciardha et al., 2015), which may be used by practitioners to examine fire-specific treatment needs for offenders who have set deliberate fires. We present a standardized scoring procedure when using these scales, as well as an associated scoring template for practitioner use. METHOD: Norm data are based on male and female firesetters (n = 378) and nonfiresetters (n = 187) recruited from 19 prison establishments (including six female establishments, one young offender institution) and 12 secure mixed-gender mental health settings. RESULTS: We present a full overview of all data we have collected to date relating to the Four Factor Fire Scales across prison, mental health, and young offending participants. For each population, we present mean scores as well as associated cutoff scores and reliable change indices to aid practitioners in their interpretation of scores. CONCLUSIONS: The Four Factor Fire Scales provide professionals working in the area with a robust template for administering, scoring, and interpreting the fire-specific factors currently identified as playing a role in deliberate firesetting behavior. Strengths and limitations of the measure are discussed.

Specialist group therapy for psychological factors associated with firesetting: Evidence of a treatment effect from a non-randomized trial with male prisoners.

Despite huge societal costs associated with firesetting, no standardized therapy has been developed to address this hugely damaging behavior. This study reports the evaluation of the first standardized CBT group designed specifically to target deliberate firesetting in male prisoners (the Firesetting Intervention Programme for Prisoners; FIPP). Fifty-four male prisoners who had set a deliberate fire were referred for FIPP treatment by their prison establishment and psychologically assessed at baseline, immediately post treatment, and three-months post treatment. Prisoners who were treatment eligible yet resided at prison establishments not identified for FIPP treatment were recruited as Treatment as Usual controls and tested at equivalent time-points. Results showed that FIPP participants improved on one of three primary outcomes (i.e., problematic fire interest and associations with fire), and made some improvement on secondary outcomes (i.e., attitudes towards violence and antisocial attitudes) post treatment relative to controls. Most notable gains were made on the primary outcome of fire interest and associations with fire and individuals who gained in this area tended to self-report more serious firesetting behavior. FIPP participants maintained all key improvements at three-month follow up. These outcomes suggest that specialist CBT should be targeted at those holding the most serious firesetting history.

Male imprisoned firesetters have different characteristics than other imprisoned offenders and require specialist treatment.

OBJECTIVE: This study investigated whether a group of firesetters (n = 68) could be distinguished, psychologically, from a matched group of non-firesetting offenders (n = 68). METHOD: Participants completed measures examining psychological variables relating to fire, emotional/self-regulation, social competency, self-concept, boredom proneness, and impression management. Official prison records were also examined to record offending history and other offense-related variables. A series of MANOVAs were conducted with conceptually related measures identified as the dependent variables. Follow-up discriminant function and clinical cut-off score analyses were also conducted to examine the best discriminating variables for firesetters. RESULTS: Firesetters were clearly distinguishable, statistically, from non-firesetters on three groups of conceptually related measures relating to: fire, emotional/self-regulation, and self-concept. The most successful variables for the discrimination of firesetters determined via statistical and clinical significance testing were higher levels of anger-related cognition, interest in serious fires, and identification with fire and lower levels of perceived fire safety awareness, general self-esteem, and external locus of control. CONCLUSIONS: Firesetters appear to be a specialist group of offenders who hold unique psychological characteristics. Firesetters are likely to require specialist treatment to target these psychological needs as opposed to generic offending behavior programs.

Explanations of firesetting in mentally disordered offenders: a review of the literature.

This paper reviews current explanations of firesetting in adult mentally disordered offenders. In particular, attention is given to contemporary research that has examined developmental and background characteristics, personality and associated traits, motivation for firesetting, neurobiological explanations, psychiatric diagnoses, and frequency of self-injurious behavior, including suicide. The likelihood of recidivism and associated risk factors is also considered. Evaluation of the existing research has highlighted that even though a significant proportion has been conducted with psychiatric populations, little is understood about firesetting by mentally disordered offenders. In addition, little research has been conducted that compares mentally disordered firesetters to both other mentally disordered offenders and non-mentally disordered offenders. Recommendations are made for future research to further develop knowledge of this behavior.