The Mental Health Act 1983 in action: what evidence exists for psychological treatment of people subject to detention, how are sentencing decisions made in relation to R v Vowles, and are these decisions influenced by diagnosis or beliefs about the origin of mental health problems?

Baldwin, George (2022) The Mental Health Act 1983 in action: what evidence exists for psychological treatment of people subject to detention, how are sentencing decisions made in relation to R v Vowles, and are these decisions influenced by diagnosis or beliefs about the origin of mental health problems? Doctoral thesis, University of East Anglia.

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Abstract

Aims: The systematic review in this thesis portfolio aimed to investigate the efficacy of psychological interventions for those detained under the Mental Health Act (MHA) (1983). The empirical research project aimed to explore how Vowles sentencing criteria is applied to detention under the MHA and how beliefs about the origins of mental health and diagnostic labels, were associated with sentencing outcomes.

Methods: The systematic review synthesised all psychological outcome data reported from Randomised Controlled Trials (RCTs), Non-Randomised Controlled Trials (NRCTs) and Before and After Studies (B&As) for psychological interventions delivered under the MHA in England and Wales. The empirical research project used an experimental vignette to measure consistency of agreement with Vowles criteria, the associations between diagnosis and Vowles ratings and final sentencing outcome. Mediating beliefs about the origin of mental health difficulties were also measured.

Results: Forty-three studies (n = 5512) were included in the systematic review. The evidence was sparse, however the data showed improvements associated with Cognitive Behavioural Therapy (CBT) and group interventions in forensic settings. The empirical project found sentencing outcomes were inconsistent; 77.27% had a custodial element, 22.73% did not. Beliefs about the origins of mental health difficulties appeared to mediate some Vowles criteria ratings and were associated with different sentencing outcomes depending on diagnosis: biogenetic beliefs increased the likelihood of hospital for emotionally unstable personality disorder (EUPD) and of custodial sentences for schizophrenia.

Conclusions: The systematic review suggests that larger scale RCTs are needed in secure, acute and LD inpatient settings with longer term follow up, blind assessors and a combination of self-report and clinician measures, as well as incident, readmission and reoffending rates.

The empirical research project findings suggest that the sentencing of mentally disordered offenders (MDOs) requires additional safeguards against personal bias; further exploration in a senior judiciary sample is now required.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	26 Oct 2022 12:49
Last Modified:	26 Oct 2022 12:49
URI:	https://ueaeprints.uea.ac.uk/id/eprint/89365
DOI:

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