Sexual Offences, Crime and Misconduct
Submitting InstitutionNottingham Trent University
Unit of AssessmentPsychology, Psychiatry and Neuroscience
Summary Impact TypeLegal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Studies In Human Society: Criminology
Psychology and Cognitive Sciences: Psychology
Summary of the impact
In just six years, research by the Sexual Offences, Crime and
Misconduct Research Unit, conducted in conjunction with the Her
Majesty's Prison Service and National Health Service Forensic Services,
has produced key benefits for the management and treatment of offenders
and the training of professionals within the prison service and NHS by:
(i) developing, evaluating and improving treatment interventions for
high-risk sexual offenders; vital for successful rehabilitation and
(ii) research-based training to reduce corruption and professional
(iii) identification of offenders at risk of suicide and other
The Sexual Offences, Crime and Misconduct Research Unit (formed
2007) is a collaboration between NTU Psychology, HMPs Whatton Nottingham,
Lowdham Grange and Brixton and Rampton High Secure Hospital. Research
focuses on national priorities including sexual offending, offender mental
health, and staff-offender relationships. Funders include ESRC, Ministry
of Justice, NHS and National Offender Management Services.
Offender Rehabilitation: One of Winder's three ESRC CASE
studentships (Blagden, see section 3) with HMP Whatton focuses on
constructive engagement with sex offenders in denial, a critical issue for
treatment providers. Deniers are excluded from sex offender treatment
programmes making a sizeable population of incarcerated sexual offenders
ineligible for treatment. Deniers typically serve longer sentences and are
more likely to reoffend (recidivism 17.9%) than those undergoing treatment
Winder's team redefined denial, capturing the underlying psychological
and motivational components and identifying amelioration strategies
[Reference 1]. This work contested existing advice to `challenge' denial,
arguing from evidence that the denier needs to construct desirable
identities to facilitate personal change. Further work showed that
treatment professionals' perception of denial negatively impacting their
clinical work, impeding constructive dialogue with offenders. Winder
challenges the traditional approach to treating and managing deniers and
offers new ways for working with this client group [Reference 2].
Offender Mental Health: Prior to joining NTU from HMP
Brixton in 2011, Slade investigated the value of the `Cry of Pain Model'
in identifying offenders at risk of self-harm [see REF2 Output 1].
Since her arrival at NTU she has extended this research, mapping suicide
tendencies in the high-risk population of offenders entering prison.
HMPS's policies and treatment of this group have been based on static risk
factors or retrospective research. Slade identified the presence of
suicide permissive cognitions, greater feelings of defeat, increased
external locus of control and times-in-prison to effectively predict risk.
However stress, social support and depression levels, all part of the `Cry
of Pain Model', do not predict suicide. Her mapping of personality
disorder traits of new offenders is now being used to target resources and
treatment to reduce re-offending [References 3, 4].
Offender Management:Hamilton works with professionals in
Dangerous and Severe Personality Disorder units and since 2008 she has
held a shared appointment with the Forensic Prison Service and NTU.
Initially Hamilton spent one day in five working in prison but since 2012
80% of her time is committed to HMPS and she retains a 0.2fte contract
with the university.
Staff working with such offenders suffer assaults, burnout and emotional
exhaustion and corruption. Staff/offender relationships can also lack
clear and acceptable boundaries and behaviours. Using her unique insider
position as a psychologist in a pilot Dangerous and Severe Personality
Disorder,service Hamilton developed the `The Boundary Seesaw Model'
[Reference 6], which frames intrapersonal and interpersonal boundary
difficulties as central to the manifestation of psychopathology. The model
provides a tool to monitor boundary movements and breaches. Personality
disorder awareness training, using this framework, focuses on trainees'
perceptions of personal security and vulnerability rather than seeking to
increase liking or acceptance of offenders, and this has proved to be
References to the research
1. Blagden, N., Winder, B., Thorne, K. & Gregson, M. (2011).
"No-one in the world would ever wanna speak to me again": An
interpretative phenomenological analysis into convicted sexual offenders'
accounts and experiences of maintaining and leaving denial. Psychology,
Crime and Law. 17(7, 563-585. doi: 10.1080/10683160903397532 Journal
ISSN 1068316X; Impact Factor 1.31; Q2 status; Paper citations 4.
2. Blagden, N., Winder, B., Gregson, M. (2013). Working with
denial in convicted sex offenders: A qualitative analysis of treatment
professionals' views and experiences and their implications for practice.
International Journal of Offender Therapy and Comparative Criminology.
57(3) 332-356. doi: 10.1177/0306624X11432301
Journal ISSN 0306624X; Impact Factor 1.05; Q2 status; Paper citations 0.
3. Slade, K. & Elderman, R. (2013). Can theory predict the
process of suicide on entry to prison? Predicting dynamic risk factors for
suicide ideation in a high-risk prison population. Crisis: The Journal
of Crisis Intervention and Suicide Prevention.
Journal ISSN 1985-2013; Impact Factor 1.80; Q2 status; Paper citations 0
4. Forrester, A., Exworthy, T., Chao, O., Slade, K. &
Parrott, J. (2013). Influencing the care pathway for prisoners with acute
mental illness. Criminal Behaviour and Mental Health, 23(3),
217-226. doi: 10.1002/cbm.1870
ISSN 1992-2013; Impact Factor 2.00; Q1 status; Paper citations 0.
5. Hamilton, L. (2010) The Boundary Seesaw Model: Good Fences
Make for Good Neighbours, in Using Time, Not Doing Time: Practitioner
Perspectives on Personality Disorder and Risk (eds. A. Tennant and K.
Howells), John Wiley & Sons, Ltd, Chichester, UK. doi:
6. Maltman, L., Stacey, J. & Hamilton, L. (2008) Peaks and
troughs: an exploration of patient perspectives of dangerous and severe
personality disorder assessment. Personality and Mental Health, 2,
7-16. doi: 10.1002/pmh.17
ISSN 19328621; Impact Factor 1.18; Q2 status; Paper citations n/a
Competitive grants supporting this work in conjunction with
Winder, B. (Director of Studies) & Gregson, M. (2006). ESRC
Case Studentship for N. Blagden "Understanding denial in sexual offenders:
Implications for policy and Practice." Successful completion 2010.
Seymour-Smith, S. (Director of Studies) & Winder, B. (2007).
ESRC Case Studentship for S. Pemberton "Investigating (Mis)Understandings
of Sexual Consent and Refusal in Adult Rapists. Successful completion
Winder, B. (Director of Studies), Gregson, M. & Hamilton,
L. (2010). ESRC Case Studentship for A. McNally "Internet sex
offenders: Deviant collectors, voyeurs or predators?" In progress.
Details of the impact
Offender Rehabilitation: Research by Winder et al. is of
national significance producing tangible differences in offender
rehabilitation through the reform of sexual offenders in treatment in
England and Wales.
Reach: The Sexual Offences, Crime and Misconduct Research Unit
assisted the steering group responsible for designing and validating all
sex offender programmes in England and Wales. Members included the Head of
Evidence and Offence Specialism (National Offender Management Service),
the Head of Probation Programmes in England and Wales, and Clinical Leads
for all sex-offender behaviour programmes.
Effect: The unit's research has strongly influenced sex offender
treatment nationally. "We took considerable account of SOCAMRU's
research findings and thinking on this topic in our recent (2010-2012)
redesign of treatment programmes for sexual offenders. The research
developed and carried out by SOCAMRU, in collaboration with colleagues
at Whatton prison, on sex offenders who deny their offences .. convinced
us to change the policy we have had for the last 20 years to exclude
"deniers" from treatment programme .. and had a general impact was on
our whole approach to treatment of sex offenders" [Evidence 1b].
"The research has led to changes not only in a local level, but has
had national implications (e.g. denial work by Winder and Blagden has
changed national policy for working with deniers — previously a group
excluded from treatment" [Evidence 1c].
Offender Mental Health: Slade's research conducted after
moving to NTU extends earlier work to predict potential suicides
[Reference 3, 4].
Reach: Slade's research on suicide has influenced policy decisions
at HMP Brixton and Thameside. "As a result of your (Slade's) PhD
research and training event, the psychology team have implemented the
learning into everyday practice" [Evidence 2b]. It has also assisted
the development of new arrangements for the delivery of clinical
psychology services across the Scottish prison estate. [Evidence 2a]. In
2013 Slade delivered three workshops on `Self-harm and suicidal behaviour
` to relevant professionals.
Effect: Slade has influenced the new mental health policy at HMP
Thameside by creating "new local policy arrangements within mental
health services across a number of prisons and is also being used to
shape new service provision ... and consider new ways of delivering
services to assist in transferring prisoners with acute mental illnesses
to hospital in a more efficient manner" [Evidence 2b].
Offender Management: Hamilton's Boundary Seesaw Model
has had a major impact on the Forensic Division at Nottinghamshire
Healthcare Trust. This model and other ideas explicated in Hamilton (2010)
were developed into a full training programme to develop staff's critical
appreciation of boundary management and risks. "The BSM was approved
as the framework for training led by Laura Hamilton" [Evidence 3a,
minute 3.8 p.3].
Reach: Hamilton's work is core to the Trust's Clinical Boundary
Procedure ratified in 2012,13 [Evidence 3b]. The Boundary Seesaw Model
is now the predominant training model across the Forensic Division at
Nottinghamshire Healthcare Trust (the largest UK forensic division, with
over 2500 staff), and has become standard practice in specialist units
outside the Forensic Division at Nottinghamshire Healthcare Trust:
Millfields Medium Secure Unit (2008), Oswin Medium Secure Dangerous and
Severe Personality Disorder Unit (2009), Meadowview, Private Low Secure
Unit (2010), High Secure Hospitals Nurses Forum (2010), Broadmoor High
Secure Hospital (2011). In 2013, approval was given to include the Boundary
Seesaw Model in the Department of Health and Ministry of Justice's
nationally commissioned Knowledge and Understanding Framework training
programme which supports more effective work with personality disorder
[Evidence 3e]. A section on boundary management was also commissioned for
the Named Nurse Workbooks [Evidence 3d]; the core training process for
newly qualified nurses across Nottinghamshire Healthcare Trust. This work
is referenced in NICE clinical guideline 77 (2009).
Effect: In 2011 the BSM "formed the basis of Nottinghamshire
Healthcare Trust's (Forensic Division) management of professional and
workplace Boundaries procedure. It has been adopted as the core-training
model. Hamilton was asked to return to clinical practice to oversee the
development of training, training for trainers and roll out."
As of July 2013 782 members of staff have been trained in the BSM and
further training is scheduled with a view to training the whole of
Forensic Division (N=2653). An introductory training package (Level 1
Core) piloted with early adopters across the Forensic Division received
positive evaluations from participants and stakeholders. A new role of
Boundary Lead (all senior clinicians) ensures the delivery and development
of the BSM training. Level 2 training is currently under development.
There is clear impact on practice [Evidence 3b to e].
Sources to corroborate the impact
- For Winder:
a. HMP Whatton has supported the Unit's work through a number of direct
grants (see REF 4) but also through three ESRC Case student awards. It
is the work of one of those students, now Dr Blagden, which is cited
here [References 1, 2].
b. Corroborating letter from the Head of Evidence and Offence
Specialism, Commissioning Strategies Group, National Offender Management
Service confirms the Impact of Winder's research on practice and policy
relating to offenders in denial.
c. Corroborating letter from the Governor HMP Whatton Service confirms
the Impact of Winder's research on practice and policy relating to
offenders in denial.
- For Slade
a. Corroborating letter from the Acting Regional Psychologist for
Greater London Regional Psychology Service confirms the importance of
Slade's research on identifying and working with offenders at risk of
self-harm and suicide.
b. Corroborating letter from the a Consultant and Honorary Senior
Lecturer in Forensic Psychiatry South London and Maudsley NHS Foundation
Trust identifies how Slade's research [Reference 3, 4] is shaping
service provision and service models at HMP Thameside.
- For Hamilton:
a. There is a clear existence proof of the value of Hamilton's work. In
2012 Rampton Secure Unit asked for a change in Hamilton's contract so
that she now works 80% of her contract within the facility. She was also
promoted to Acting Consultant Forensic Psychological in recognition of
her specialist knowledge and expertise regarding workplace and
professional boundary management. She holds the position of Boundary
Training Lead for the Forensic Division and sits on Rampton Hospital's
Boundary Leads Committee. This role involved developing a suite of
training programmes. See the Peak Unit Internal Evaluation report of Boundary
Seesaw Model Training 2011.
b. Nottinghamshire Healthcare (Sept 2013). Management of Work place
Boundaries/ Progress Report. This report shows the timeline from the
Initial work by Hamilton to the embedding of the Boundary Seesaw
Model across the Peak Unit's CPD practice.
c. Nottinghamshire Healthcare (2012, 2013) Management of Professional
Workplace Boundaries. Low secure and Community forensic directorate
FO/R/ 86 & Rampton Hospital FO/C/28 internal ratified procedure
documents show how the Boundary
Seesaw Model is being rolled-out through the regional units.
d. Nottinghamshire Healthcare (2010). Named Nurse Workbook. Boundary
Seesaw Model section developed by Hamilton Page 27-53. Practice
based on the Boundary Seesaw Model occupies a third of this
training manual emphasising the importance of the model in current
e. Corroborating letter from Nurse Consultant, Nottinghamshire Health
Care. Her letter of support confirms the impact of Hamilton's research
on the policy and practice within the forensic division of