Mary McMurran University of Nottingham

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Prison Research Programme

• Mary McMurran
• University of Nottingham

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Aims

• To give an overview of my research
• Focus on useful outcomes

3
Acknowledgements

• Research colleagues
• Professor Vince Egan Dr Eleni Theodosi Dr Jo
  Sellen
• Dr Bryany Cusens Anna McCulloch Mary Jinks
• Dr Gary Christopher
• Funders
• NHS National Programme on Forensic Mental Health
  RD
• Alcohol Education and Research Council
• European Research Advisory Board
• Prisons
• HMP Cardiff HMP Usk
• HMP Parc HMYOI Glen Parva
• NOMS Cymru (Wales)

4
Themes

• Alcohol-related violence
• Motivating offenders to engage in treatment
• Social problem solving and personality disorder

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Alcohol-related violence
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UK drinking culture

• Binge drinking
• Alcohol-fuelled crime and disorder spiralling out
  of control

7
Alcohol-related violence

• Investigation of alcohol-related violence
• Alcohol Use Disorders Identification Test
• Drinking Expectancy Questionnaire
• New questionnaire
• Alcohol-Related Aggression Questionnaire
• A 28 item questionnaire measuring an individuals
  proneness to alcohol-related aggression

McMurran, M., Egan, V., Cusens, B., Van den Bree,
M., Austin, E., Charlesworth, P. (2006). The
alcohol-related aggression questionnaire.
Addiction Research and Theory, 14, 323-343.
8
Alcohol-related violence

• HMP Cardiff
• Prisoners are heavy, problematic drinkers
• Mean AUDIT (N126) 17.36
• 81 of the sample hazardous drinkers (scoring 8
  or more)
• 50 severe alcohol problems (scoring 16 or more)
• Alcohol-related violence offenders are very
  heavy, problematic drinkers
• AUDIT
• Alcohol-related violence 21.07
• Violence not alcohol-related 13.11(Plt.01)

McMurran, M. (2005). Drinking, violence, and
prisoners health. International Journal of
Prisoner Health, 1, 25-29.
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Alcohol-aggression expectancy

• If I drink, then I become aggressive
• Less strongly associated with violence than
• I drink to increase my confidence
• Implications for treatment

McMurran, M. (2007). The relationships between
alcohol-aggression proneness, general alcohol
expectancies, drinking, and alcohol-related
violence in adult male prisoners. Psychology,
Crime and Law, 13, 275-284.
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Types of alcohol-related aggression

• Angry heavy drinkers
• Interventions for alcohol-related aggression
• Aggressive with or without drinking
• Intervention for alcohol-related aggression may
  not work
• People who may be provoked to violence in
  drinking contexts
• May benefit from crime risk reduction advice
• Hostile, fearful people who may be pre-emptive
  strikers or victims
• May respond to skills training

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Types of alcohol-related aggression

• HM YOI Glen Parva
• More systematic examination of types of
  alcohol-related violence
• Appetitive Aversive
• Impulsive Excitement Explosive
• Controlled Coercive Revenge

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COVAID intervention

• Control Of Violence for Angry Impulsive Drinkers
• A 10 x 2 hour structured cognitive-behavioural
  treatment programme
• Group and individual versions

McCulloch, A., McMurran, M. (2008). Evaluation
of a treatment programme for alcohol-related
aggression. Criminal Behaviour and Mental
Health, 18, 224-231.
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Angry aggression system
Trigger
Thoughts
Feelings
Behaviour
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Angry aggression system
Trigger
Thoughts
Feelings
Behaviour
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Angry aggression system
Trigger
Thoughts
Feelings
Behaviour
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COVAID

• So far, small N and single case evaluations
• COVAID is promising no contraindications
• Have developed content, manuals, and training
• Delight Training
• www.delight.co.uk

McCulloch, A., McMurran, M. (2008). Evaluation
of a treatment programme for alcohol-related
aggression. Criminal Behaviour and Mental
Health, 18, 224-231. McMurran, M., Cusens, B.
(2003). Controlling alcohol-related violence A
treatment programme. Criminal Behaviour and
Mental Health, 13, 59-76.
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COVAID

• NOMS Cymru
• Randomised controlled trial
• COVAID cf Treatment as Usual
• Reconviction follow up

Woo Hooooo!!!
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Motivating offenders to engage in treatment
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Review of treatment non-completion

• Cognitive-behavioural treatment studies
• Data for
• Completers, i.e., allocated to Tx and completed
• Non-Completers, i.e., allocated to Tx but did not
  complete
• Untreated, i.e., not allocated to Tx
• Groups unlikely to differ on risk
• randomly allocated, risk matched, waiting list
  control
• Reoffending or reconviction data

McMurran, M., Theodosi, E. (2007). Is
treatment non-completion associated with
increased reconviction over no treatment?
Psychology, Crime and Law, 13, 333-343.
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Non-Completion Rates

• Total Institution Community
• __________________________________________________
  __
• Samples 16 8 9
• __________________________________________________
  __
• Completers 7744 6149 1595
• Non-completers 2385 1056 1329
• Untreated 9434 5443 3991
• __________________________________________________
  __
• Percentage non-completion
• 24 15 45

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Effects

• Treated vs untreated
• Mean effect size d 0.11 (95 CI 0.07 to 0.15)
• The treatments in this study show a modest effect
  in reducing recidivism
• Untreated vs non-completers
• Mean effect size d -0.16 (95 CI -0.13 to
  -0.22)
• The treatments in this study show a modest but
  negative effect
• Non-completers are more likely to be reconvicted
  than untreated

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Could non-completion make people worse?

• Removing people may
• Increase anti-authority attitudes
• Decrease confidence in treatment
• Increase feelings of exclusion
• Dropping out may
• Reduce confidence in ability to benefit from
  treatment
• Early termination may highlight problems but not
  introduce coping skills

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How do we motivate people for treatment?

• Goals are one motivational construct
• Good Lives Model - positive, constructive goals

Professor Tony Ward New Zealand
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Theory of Current Concerns

• Cox Klinger (2004)
• A goal-based approach
• A current concern is an active goal
• People generally strive for satisfaction in the
  following life areas

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Personal Concerns Inventory

• Home and household
• Employment and finance
• Partner , family and relatives
• Friends and acquaintances
• Love, intimacy, and sex

• Self-changes
• Education and training
• Health and medical matters
• Substance use
• Spiritual matters
• Hobbies, pastimes and recreation

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Personal Concerns Inventory

• Semi-structured interview
• Identify goals in life areas
• Rate goals
• Importance
• Likelihood
• Knowledge
• Control
• Happiness
• Commitment

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Prisoners goals

• HMP Cardiff
• 129 male prisoners

• Stop offending
• Learn self-control
• Find and keep jobs
• Have stable accommodation
• Quit drink and drugs
• Change support networks
• Find new leisure pursuits
• Gain work experience
• Have good family relationships
• Get fit and healthy

Theodosi, E., McMurran, M., Sweeney, A.,
Sellen, J. (2008). What do prisoners want?
Current concerns of adult male prisoners.
Psychology, Crime and Law, 14, 267-274.
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Personal Concerns Inventory

• Adaptive motivation
• High - Commitment, Happiness, Likelihood
• Maladaptive motivation
• Low - Commitment, Happiness, Likelihood
• High adaptive motivation may predict entry into
  treatment and engagement with treatment
• ... and hence to reduced reoffending

Sellen, J.L., McMurran, M., Theodosi, E., Cox,
W.M., Klinger, E. (in press). The validity of
the offender version of the Personal Concerns
Inventory with adult male prisoners. Psychology,
Crime and Law.
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Personal Concerns Inventory

• HMP Usk
• Not just an assessment of motivation
• Also a motivational assessment
• People thought about their lives
• Clarified goals
• Considered the role of offending
• Provides a framework for a motivational interview

Theodosi, E., McMurran, M. (2006). Motivating
convicted sex offenders into treatment A pilot
study. British Journal of Forensic Practice, 8,
28-35.
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Social problem solving
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Social problem solving

• Social problem solving is
• the self-directed cognitive-affective-behavioral
  process by which an individual attempts to
  identify or discover solutions to specific
  problems encountered in everyday living
• An effective solution is
• one that provides an outcome that is acceptable
  or satisfactory to all parties. ..it accommodates
  the interests and well-being of all concerned
  parties

DZurilla T., Nezu, A. (2007). Problem solving
therapy A positive approach to clinical
intervention. New York Springer.
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Social problem solving deficits

• Associated with
• Aggressiveness in children
• Anxiety, depression, worry
• Substance misuse
• Distress in prisoners
• PTSD
• Suicide/self harm
• Offenders

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Book

• McMurran, M. McGuire, J. (Eds). (2005). Social
  problem solving and offending Evidence,
  evaluation and evolution. Chichester Wiley.

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Social Problem Solving Inventory-Revised

• 25 item self-report checklist
• Problem solving orientation and style
• Five scales and a total score
• Positive Problem Orientation (PPO)
• Negative Problem Orientation (NPO)
• Rational Problem Solving (RPS)
• Impulsive/Careless Style (ICS)
• Avoidant Style (AS)
• Social Problem Solving index (SPS)

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Are prisoners poor social problem
solvers? HMP Cardiff

Hayward, J., McMurran, M., Sellen, J. (2008).
Social problem solving in vulnerable adult
prisoners Profile and intervention. Journal of
Forensic Psychiatry and Psychology, 19,
243-248.  
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Problems associated with poor social problem
solving

• HMP Parc
• Adult male prisoners (N68)
• Social Problem Solving InventoryR (SPSI-R)
• Hospital Anxiety and Depression Scale (HADS)
• Negative Problem Orientation predicts anxiety and
  depression
• NPO feelings of nervousness, threat and fear in
  response to problems
• May protect prisoners against conflict
• High levels of fear and anxiety
• ?inhuman
• ?poor coping with imprisonment
• ?ineffective participation in rehabilitation
  programmes

McMurran, M., Christopher, G. (in press).
Social problem solving, anxiety, and depression
in adult male prisoners. Legal and
Criminological Psychology.
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Developing the therapy

• Arnold Lodge
• NHS Secure Unit, Leicester, UK
• Personality Disorder
• Treatment Unit (PDU)
• Men detained under the Mental Health Act

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Stop Think!

• Bad feelings?
• Whats my problem?
• What do I want?
• What are my options?
• _____________________________________________
  ______________________________
• Option Advantages
  Disadvantages
• __________________________________________________
  _________________________
• _________________________________________
  __________________________________
• Whats my plan?
• How am I doing?

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Vulnerable prisoners N28 12 sessions HMP
Cardiff
Hayward, J., McMurran, M., Sellen, J. (2008).
Social problem solving in vulnerable adult
prisoners Profile and intervention. Journal of
Forensic Psychiatry and Psychology, 19,
243-248.  
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Prison inreach

• HMP Nottingham
• Nottinghamshire Healthcare NHS Trust - inreach
  service
• New focus on developing treatments for prisoners
  with personality disorder
• Introducing Stop Think!

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Conclusions

• Prison research
• Is possible
• Can be useful
• Prison staff
• Are extremely helpful
• Thank you!
• Prisoners
• Are mostly willing and helpful participants
• Could be more involved in research
• Setting priorities, research design, and
  conducting research

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Thank You

• Mary.McMurran_at_nottingham.ac.uk