Roxanna Short

Background: In the United Kingdom, the Offender Personality Disorder (OPD) Pathway provides a psychologically informed pathway of services—from screening to formulation to referral to treatments/interventions—for men and women whose offending is linked to their complex mental health needs. Evidence shows that individuals from most ethnic minority groups in the United Kingdom are over‐represented at all stages of the criminal justice system (including arrests, cautions and convictions). Such individuals may, however, be disadvantaged in terms of their access to and engagement with this specialist service. Aim: To examine the extent to which self‐reported ethnicity was associated with progression through discrete stages of the OPD Pathway in London. Methods: Linked administrative data from 8816 men who screened into the OPD Pathway from 2011 to 2022 were used to examine the association between self‐reported ethnicity (categorised as White, Black, Asian or mixed) and the last known recorded Pathway stage (screened‐in and no further work, case consultation/formulation, referral to services, accessing service and completion). Results: Adjusting for baseline risk, time on the OPD Pathway and London borough, we found that those who self‐identified as Black (compared to White) were under‐represented at all stages of the Pathway (compared to baseline), suggesting that these individuals tended to get ‘stuck’ at the early Pathway stages. Conclusions: These findings add weight to suggestions of probably disproportionate disadvantage among men identifying as Black in accessing important dedicated services for offenders with personality disorder. Our data have been used to inform exploration of programme changes, and next steps will include exploration of what has driven this under‐representation of non‐White ethnic groups across the service and whether more sensitively informed strategies can improve equitable access and benefits.

1. Substance misuse is one of the leading reasons children enter child protection (CP) proceedings in the UK, yet the complex trauma and mental health difficulties that frequently co-occur with add...

Emerging adulthood (ages 18–25) is a challenging period because of recent societal changes (e.g., later age of marriage) and ongoing biological and neural development. Those in this age range who have committed offences pose unique challenges to the criminal justice system and particularly the probation service. Whilst most young people desist from offending during this period, reoffending rates remain high. Unfortunately, there is limited evidence about how best to support emerging adults who are on probation. The Youth to Adulthood Hub (Y2A Hub) is a unique intervention embedded within one diverse probation area in London, England which uses a holistic approach aimed at fostering engagement. This intervention includes practical support (e.g., housing, employment), and tailored psychological support delivered in a trauma and culturally informed manner. Administrative data was used to compare the rates of attendance at statutory probation meetings between individuals who had received support from the Y2A hub ( N = 73) and a control group of individuals ( N = 860) from similar probation areas, controlling for age, ethnicity, and risk levels, using a multivariable binomial regression model. The results suggested that the Y2A was associated with a significant increase in engagement with probation and a reduction in unacceptable absences. The Y2A hub is a promising approach for addressing the needs of criminally justice involved young adults but further evaluation is warranted.

Background: Euthymic bipolar disorder (BD) is associated with general and domain-specific cognitive impairment, which predicts poor occupational and social functioning. Methods: We searched Embase, Medline, and PsycInfo for articles published between database inception and June 2024, examining cognitive domains in euthymic BD. We conducted meta-analysis, meta-regressions, including premorbid IQ, demographic, and clinical variables. Newcastle Ottawa Scale, I ² statistic, and funnel plots/Egger’s and Begg’s Test were used to assess quality, heterogeneity, and publication bias, respectively. The Benjamini-Hochberg (BH) procedure was utilised for multiple comparisons. Results: We identified 95 groups from 75 studies ( N = 4,404 BD & 4,037 HC). BD showed significant impairment in general cognitive functioning (Hedge’s g = −0.58, 95%CI: −0.79, −0.37, p <.01), verbal memory (Hedge’s g = −0.70, 95%CI: −0.79, −0.60, p <.01), executive function (Hedge’s g = −0.69, 95%CI: −0.78, −0.60, p <.01), visuo-spatial memory (Hedge’s g = −0.68, 95%CI: −0.83, −0.53, p <.01), attention/processing speed (Hedge’s g = −0.64, 95%CI: −0.75, −0.54, p <.01), working memory (Hedge’s g = −0.61, 95%CI: −0.74, −0.49, p <.01), and premorbid IQ (Hedge’s g = −0.24, 95%CI: −0.36, −0.12, p <.01). Demographic and clinical factors were not associated with cognitive performance, except for a statistically significant, but small positive correlation between years of education and lower impairment in verbal memory, β = .066, adjusted p <.05. Conclusions: Our findings highlight cognitive domains impaired in euthymic BD, indicating targets for interventions. Substantial variance is unexplained, warranting focus on larger samples of individual-level data.

Background: People from ethnically minoritised backgrounds are significantly over‐represented within the criminal justice system, as are those with personality difficulties. The offender personality disorder pathway offers services for people with personality difficulties associated with serious offending and aims to work in a culturally attuned way with individuals from ethnically minoritised backgrounds. Aims: To establish a baseline of how culturally informed formulations are within our services. Methods: Twenty‐one formulations from community services were audited, and two audits of 23 and 24 formulations, respectively, were carried out in our custodial service. Training was implemented between these two audits. Formulations were audited using two tools: the London Pathways Partnership (LPP) formulation audit tool and the London Pathways Unit (LPU) culturally informed formulation (LPU‐CIF) audit tool. The latter was not used in the community audit. Results: There was a broad range of means on the LPP formulation audit tool and the LPU‐CIF and both were below adequacy. There was a narrower range of scores on the LPU‐CIF. The LPU‐CIF scores increased across all items between the two audits but were below the threshold of adequacy. Conclusions: The audits suggest that formulations across both services are easily understood, psychologically informed and include developmental histories. However, they do not adequately consider people's cultural experience and protected characteristics. Although not without limitations, these audits highlight a need for further training to develop staff's confidence and competence when developing formulations for people under our service.

Previous literature increasingly recognizes the prevalence of childhood trauma (CT) history in forensic settings. Patients in forensic settings are likely to engage in self-harm, violence, and encounter multiple hospital admissions. We aimed to investigate CT history in a low secure forensic population and examine associations between specific types of CTs and three clinical outcomes: self-harm, in-hospital violence, and number of hospital admissions. A retrospective case file review was employed. A data capture sheet was developed using items from two Childhood Trauma Questionnaires. Data was collected from case files of male patients within a low secure forensic setting ( n = 93). CTs were documented if they occurred before the age of 18 years old. Associations were examined between CT and the clinical outcomes using a series of logistic regression analyses. Eighty-five percent of patients had experienced CT and 60.3% had been exposed to two or more types of CT. There were no significant associations between CT and the clinical outcomes. Findings expose the high prevalence of CT experienced by patients in a low secure hospital. Additionally, high rates of CT with low rates of PTSD also suggest potential diagnostic overshadowing. Findings are discussed with reference to trauma-informed care treatment approaches in forensic settings.

Offenders with personality disorder cause disproportionate harm to society and pose significant challenges for those responsible for their care and rehabilitation. Personality disorders are heterogeneous in terms of symptoms, as well as their pathways to offending behaviour. Thus, there is limited evidence regarding effective interventions. One solution might be to focus on how interventions are delivered as well as what is delivered. Within the non‐offender personality disorder literature, the identification of potential mediators of change has enabled interventions to focus on ‘how’ they are delivered (e.g., therapeutic alliance) rather than the intervention itself. We explore the evidence and present a scoping review of the available literature on the mechanisms of change in psychological treatments for offenders with personality disorder. Only one study was found in the scoping review, highlighting a significant gap in the evidence base. We discuss the implications of this finding and potential future directions.

In electroencephalographic (EEG) data, power-frequency slope exponents (1/ f ^β ) can provide non-invasive markers of in vivo neural activity excitation-inhibition (E:I) balance. E:I balance may be altered in neurodevelopmental conditions; hence, understanding how 1/ f ^β evolves across infancy/childhood has implications for developing early assessments/interventions. This systematic review (PROSPERO-ID: CRD42023363294) explored the early maturation (0-26yrs) of resting-state EEG 1/ f measures (aperiodic [AE], power law [PLE] and Hurst [HE] exponents), including studies containing ≥1 1/ f measures and ≥10 typically developing participants. Five databases (including Embase and Scopus) were searched during March 2023. Forty-two studies were identified (N _participants =3478). Risk of bias was assessed using the Quality Assessment with Diverse Studies tool. Narrative synthesis of HE data suggests non-stationary EEG activity occurs throughout development. Age-related trends were complex, with rapid decreases in AEs during infancy and heterogenous changes thereafter. Regionally, AE maxima shifted developmentally, potentially reflecting spatial trends in maturing brain connectivity. This work highlights the importance of further characterising the development of 1/ f measures to better understand how E:I balance shapes brain and cognitive development.

Purpose: Risk of violence by UK military personnel, both towards non-family and family, has been found to be higher post-deployment. However, no UK research to date has attempted to examine relationship conflict and intimate partner violence (IPV) in this period. This study estimated the prevalence of and risk factors for post-deployment relationship conflict and partner violence in UK military personnel. Methods: We utilised data on military personnel who had deployed to Iraq and/or Afghanistan (n = 5437), drawn from a large cohort study into the health and well-being of UK military personnel. Results: 34.7% reported relationship conflict (arguing with partner) and 3.4% reported perpetrating physical IPV post-deployment. Males were more likely than females to report relationship conflict. There were similar rates of self-reported physical IPV perpetration among males and females. Among our male sample, factors associated with both relationship conflict and physical IPV perpetration post-deployment included being in the Army compared with the Royal Air Force, higher levels of childhood adversity, higher levels of military trauma exposure and recent mental health and alcohol misuse problems. Being over 40 at time of deployment (vs being under 25) and having deployed in a combat role were also associated with relationship conflict, but not physical IPV perpetration. Conclusions: Deployment-related variables and mental health and alcohol misuse problems were found to be key factors associated with post-deployment relationship conflict and IPV. Services providing health or welfare support to military personnel must collaborate with mental health services and consider history of deployment, and particularly deployment-related trauma, in their assessments to improve identification and management of intimate partner violence and abuse in military communities.