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The focus of this thesis was to examine ways of better understanding the experiences and needs of gang members. Psychological theories of gang membership highlight the interaction between individual, peer, and sociocultural processes which occur in the context of the gang. As such, broadly speaking, each chapter considers one of these factors in turn. Chapter 2 focuses on the individual-level factor of mental health problems. It is the first systematic literature review undertaken to date, which explores the association between mental health problems and youth gang members. A positive association was found between young male gang members and a range of mental health problems. Limitations are noted including the type of comparison samples used, variations in sample sizes and measurement instruments. Chapter 3 relates to the impact of peer-related factors and presents an empirical study with gang-involved youth, based in London, United Kingdom (UK). Using Interpretative Phenomenological Analysis (IPA), the study gained an in-depth understanding of the experiences of social support as perceived by five male gang-involved youth. Three superordinate themes were identified: “For me, it’s just how life was”; “The gang and I: A sense of belonging” and “Finding a new path”. The findings are discussed with respect to clinical implications, whilst outlining suggestions for further research. Chapter 4 has a socio-cultural focus in that it provides a critique of Children’s Report of Exposure to Community Violence (CREV, Cooley, Beidel, & Turner, 1995) and the Children’s Report of Exposure to Community Violence-Revised (CREV-R, Cooley-Strickland et al., 2009); these are self-report screening tools which measure exposure to community violence in children. The critique concluded that the measures would benefit from wider sampling with different populations, including youth who are gang-involved, in addition to revising some of its items that affect the way it currently measures exposure to community violence.

Over the last thirty years, academics have focused attention on the ambiguity surrounding what constitutes a gang as well as the engagement factors for joining a street gang. Whilst the rehabilitation of street gang offenders and understanding the reasons to desist from this lifestyle is paramount to counteract the effects of gang membership, less attention has been given to these areas. The first chapter discusses some of the definitional issues that have arisen from exploring gang phenomenon and a historical account of the theories that underpin gang membership. The second chapter introduces the first systematic literature review to have been undertaken on gang disengagement in order to understand the factors which increase the likelihood that an individual will leave a gang. This review highlighted that there is not one definitive reason as to why individuals choose to leave and a range of factors are detailed. An empirical project is presented in Chapter 3; with the first study focusing on the impact two generalised violent offender behaviour programmes (RESOLVE and Self Change Programme; SCP) had on both adult violent gang and adult violent non-gang offenders. Findings suggested that both sets of RESOLVE participants were found to have made treatment gains for impulsivity, anger and aggression, and treatment readiness. A statistically significant difference was observed for vengeful thinking, with gang participants showing a greater change in scores. SCP data showed statistically significant differences post treatment with lower levels of impulsivity, anger, vengeful thinking and beliefs supportive of aggression and an increase in treatment readiness. For non-gang participants, statistically significant differences were found post treatment for impulsivity and aggression. No significant interaction was observed between offender typologies, suggesting that the two groups have similar presentations. The second study explored the views of gang members who had completed either of the programmes mentioned in order to gain further insight into gang membership. Three major themes emerged which centred on what a street gang is; motivators to join; and motivators to disengage. The results are discussed with reference to current practice, the limitations, and recommendations for further research. Chapter 4 presents a critical analysis of the Psychological Inventory for Criminal Thinking Styles (PICTS, Walters, 1990). Although the PICTS continues to be used for research purposes and within forensic practice, the review found that caution should be exercised in its use and preferably in conjunction with other measures. This was partially due to the need for further independent research being needed across different cultural samples and the reported reliability and validity. The thesis conclusions are presented in Chapter 5 with reference made to the need for further research into gang membership, especially within the UK.

Introduction: The rehabilitation and management of mentally ill offenders represents a significant challenge for secure facilities and is an important issue for public safety. Considering the high financial costs associated with secure care and the complex clinical presentations of forensic patients, the importance of ensuring that the most effective and evidence-based treatment practices are in place is both an issue of ethical and fiscal concern. Over the past decade, there has been a shift within psychology to a 'third wave' of Cognitive Behavioural Therapy (CBT). The aim of this systematic review is to review the current evidence for the use of this third wave CBT in forensic mental health settings, with a view to assessing its current impact as well as discussing the potential benefits such an approach might bring Method: A systematic search for studies involving third wave CBT in forensic mental health settings was conducted Results: A total of nine papers were included in the review. The review focussed on Acceptance and Commitment therapy, Dialectical Behaviour Therapy, Meta Cognitive Therapy, and Compassion Focussed Therapy. Overall, the quality of the studies that met the inclusion criteria was assessed as 'fair'. Conclusion: The findings across the nine studies evaluated, suggest that third wave therapies may be effective in forensic settings, however the evidence base is in its infancy and therefore further research is required before this can be concluded with more confidence.

This thesis aims to provide a detailed understanding of treatment engagement amongst forensic populations. Following an introduction outlining the current theoretical thinking in the area, Chapter 2 presents a systematic literature review exploring reasons for completion/non-completion of treatment from an offender's perspective. Consensus regarding reasons for treatment completion/non-completion was found. Reasons provided supported the majority of factors outlined in the Multifactor Offender Readiness Model (MORM), a model of treatment readiness. Research in this area was limited; no papers exploring adolescents' perspectives were identified. Implications for practice are discussed and areas for future research highlighted. Furthering existing research, Chapter 3 presents a mixed methods research study exploring the reasons why young people, detained in a secure hospital setting choose to attend/not attend sessions. Using thematic analysis several themes were identified. Factors relating to the young person, treatment and the organisation were identified, supporting the MORM. Chapter 4 presents a critical review of the Corrections Victoria Treatment Readiness Questionnaire (CVTRQ), a measure of treatment readiness developed using the internal factors of the MORM. This chapter explores the overall development and psychometric properties of the CVTRQ, highlighting its strengths and limitations. An overall discussion of the work presented is provided in Chapter 5.

Exploring and understanding the practice of accurately assessing offenders is an important area of research for forensic practice and the risk management of offenders. This thesis aims to explore different approaches to offender assessment, specifically their clinical utility in forensic mental health settings. The first chapter, provides an introduction to the importance of accurate offender assessment, and presents current models proposed within the literature. The second chapter, provides a systematic review of historically used approaches in the assessment of risk, and compares their predictive accuracy and clinical utility in relation to a mentally disordered offending population. The third chapter, critically appraises a widely used assessment tool to assess risk within forensic mental health settings, the HCR-20 (Version 3.0; Douglas, Hart, Webster & Belfrage, 2013). The fourth chapter, moves way from specific tools used in current practice and instead explores clinicians current understanding and use of newer concepts in offender assessment (IOW/IOA), through a qualitative research study. Finally, the fifth chapter presents a thorough discussion of the overall content, findings and conclusions of this thesis. Findings have important implications for the practice of assessing and managing offenders effectively.

Research has suggested that primary psychopaths may be more instrumentally violent, and secondary psychopaths more reactively violent. The aim of the thesis was to conduct a systematic literature review identifying studies of importance within the area of psychopathy and violence. Results for this review concluded that there is a primary and secondary psychopathy distinction and that primary psychopathy is associated with instrumental violence and secondary psychopathy is closely linked to reactive violence. Therefore the research aims were to compare subtypes of psychopathy in terms of instrumental and reactive violence. The study subtyped pre-diagnosed psychopaths using a dimensional measure of personality, the Multidimensional Personality Questionnaire (MPQ-BF) (Patrick, Curtin & Tellegen, 2002). A total of 40 participants with a high psychopathy score and a history of violent offences were recruited. Results from the research were analysed using model based cluster analysis which replicated previous findings of two distinct psychopathy groups. Findings suggested the primary psychopath group (n = 12) had a trend towards instrumental violence, while secondary psychopath group (n = 28) were more evenly distributed amongst instrumental and reactive violence subtypes. This is broadly consistent with previous findings in terms of the characteristics of psychopathy subtypes and, to a lesser extent, their expected propensity for different types of violence. Finally, the MPQ-BF was analysed and critiqued to establish its validity and reliability within research. It was concluded that there was a need for the questionnaire to be normed on a number of varying populations to increase generalisability.

This thesis examines crime analysts’ experiences of working with the traumatic material of others. Initially, the challenges faced by employees working with the traumatic material of others are considered. A systematic review of the literature was conducted, with emphasis on the nature of psychological effects of working with traumatic material upon non front line staff working within the criminal justice system. Current research was identified as varied, inconsistent and inconclusive due to the heterogeneity of the studies. The Hospital Anxiety and Depression Scale was examined for it’s utility in measuring for well-being within crime analysts. The measure was investigated in terms of its reliability and validity, with reference to its use within clinical and general population settings. Finally, an empirical research study exploring the work of crime analysts employed within the criminal justice system, exposed to the traumatic material of others is described with particular focus on factors that exacerbate their experiences and those factors that are protective to them. The study employed a qualitative approach and template analysis. Results revealed respondents were reporting both positive and negative factors within their work. Their accounts suggested that they were using individual, self-taught approaches to how they managed these factors. Broader organisational issues impacted upon how analysts experienced and managed their exposure to traumatic material. The difficulties of drawing conclusions from cross sectional studies are highlighted throughout the thesis. The utility of the findings are discussed in relation to theoretical and practical implications, with consideration of future research.

This thesis examines factors associated with length of hospital stay for mentally disordered offenders, detained within the medium secure psychiatric estate. Following an introduction, Chapter two presents a systematic literature review examining the current literature on factors that predict length of stay for patients detained in medium secure hospitals. Mixed results were found. There was limited convergence across clinical and forensic variables investigated, but greater consensus on what is not associated with length of stay. The limited research available and inconsistencies found indicates the need for further research. Chapter three comprises an empirical research study, investigating which variables within a population of male mentally disordered offenders predict length of stay within a regional, medium secure psychiatric hospital. Preliminary analyses revealed statistically significant relationships between length of stay and nine variables. Effect sizes were small to medium. Logistic regression revealed a statistically significant relationship between length of stay of two years or more and having a diagnosis of schizophrenic disorder. Chapter four presents a critical review of the Historical, Clinical, Risk–20 Violence Risk Assessment (HCR-20) (Version 2), a widely adopted risk assessment framework utilised within forensic psychiatry and the standardised measure used within the empirical study. The review explores the literature on the reliability and validity of the HCR-20, and considers its strengths and limitations. A discussion of the work presented concludes the thesis.

This thesis explored the application of risk assessment in sexual offenders with intellectual disabilities. A systematic review of the literature appraised the quality and methodology of research examining the predictive validity of risk assessment instruments, this highlighted a lack of research taking into sexual offenders with intellectual disabilities. The empirical research paper explored the predictive validity of the RRASOR, SVR-20, RM2000-V and the ARMIDILO instruments using a retrospective design on a sample of special needs offenders with intellectual disabilities. Comparisons with mainstream offenders highlighted the difference between the instruments ability to accurately predict risk between the two groups of offenders. The findings suggest that the ARMIDILO can be useful when predicting risk for an intellectual disabled population. In the next chapter a risk assessment instrument, the RRASOR, was critically reviewed. Following on from this, a case study using an individual approached to risk assessment in an intellectually impaired sexual offender was demonstrated. This chapter emphasises that comprehensive assessment would be a prerequisite to working effectively with offenders with intellectual disabilities in order to address specific intervention needs. A social skills intervention aimed to reduce the level of dynamic risk posed. This chapter also served to outline some of the difficulties associated with risk assessment and management in routine clinical practice. The final chapter concludes by discussing the implications of the findings for clinical practice and offers some directions for future research.

The identification and management of individuals with a perceived high risk of future violence is of great priority for mental health professionals and the criminal justice system. The overall aim of this thesis is to examine the validity of the assessment and treatment of violence in forensic populations with a specific focus on the contribution of dynamic risk factors in predicting recidivism. Chapter One presents a conceptual literature review which provides an overview of the development of violence risk assessment approaches, and examines the predictive validity of dynamic factors in predicting violent recidivism. The review demonstrates the ability of dynamic risk factors in predicting future community and institutional violence. Chapter Two provides a critique of the HCR-20 Risk Assessment Scheme and highlights that despite some apparent shortcomings of the HCR-20, the instrument remains the best known and best researched, empirically based guide to violence risk assessment. In Chapter Three a prospective research study examines the predictive validity of the HCR-20 Risk Assessment Scheme in a UK sample of patients under the care of a community forensic mental health service. The study aimed to examine the ability of the HCR-20 total scores and individual sub scale scores to predict future acts of violence. The study demonstrates that the historical factors of the HCR-20 are highly predictive of future re-offending within this population and also highlights the importance of the clinical scale in predicting future violent acts. This work adds to current knowledge and understanding of the risk assessment and management process in UK samples. A case study is presented in chapter Four which evaluates the impact of the ETS programme on the cognitive deficits identified in a violent adult male offender (client A) serving a sentence at HMP Birmingham. By Mariam Azam-Zanganeh.

This thesis examines issues related to cervical cancer epidemiology and prevention through screening, with the aim of informing policy regarding setting up an organised cervical screening programme in Hong Kong. There are five studies described here. The first, a case control study, indicated that screening is effective in preventing invasive cervical cancer among Chinese women. In addition, the main risk factors identified in other studies, were confirmed as risk factors in this population. Secondly, a cross-sectional study examined the pattern of cervical screening in Hong Kong. The screening system at that time achieved poor coverage, was inefficient, inequitable and potentially harmful. Thirdly, a cross-sectional study of practitioners showed the diversity in provision of services and the lack of consensus among practitioners in the management of abnormal smears. Fourthly, the use of an industrial quality management technique in monitoring quality, using inadequate smear rates as an indicator is assessed. It demonstrated that this is an efficient and useful method that can be applied to monitoring a screening programme. The last study was a randomised controlled trial showing that when women are given balanced information on cervical screening, with information on both the harms and benefits, relatively fewer chose to attend. The implications of these studies in relation to setting up a screening programme are discussed.