500 words minimum, masters level, apa format, discussion question, REVIEW ATTACHMENT

MAPPA and detained patients: views from professionals

about referral

Teresa Henson a * and Sharon Alicia Riordan

b,c

a St Andrew’s Healthcare, Billing Road, Northampton NN1 5DG, UK; b School of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;

c Reaside Clilnic, University of, Birmingham, Birmingham

Great Park, Rubery, Birmingham B45 9BE, UK

(Received 17 October 2011; final version received 3 May 2012)

Recent research indicates a positive correlation between Multi-Agency Public Protection Arrangements (MAPPA) and reduction in reoffend- ing. Multi-Agency Public Protection Arrangements were introduced in 2001 to assist with the supervision of dangerous offenders by improving collaboration between agencies involved in their management. Since then there has been research into the value of MAPPA, but this has focused on offenders in the community. Many patients detained in psychiatric hospitals have committed MAPPA eligible offences and current Government guidance does not assist those concerned in the care and treatment of this small but significant group. In this pilot study this quantitative research looks at the views of professionals in relation to MAPPA and identified that a revision of the National MAPPA Guidance to take account of the specific issues for offender-patients would be helpful to staff who manage them and that additional training to those staff may also be of benefit.

Keywords: MAPPA; risk assessment; risk management; detained offender patients

Background

Debate about protecting the public from ‘dangerous’ offenders has increased since the 1970s, notably with cases such as that of Graham Young (Bowden, 1996). However, the term ‘public protection’ has become particularly synonymous with the criminal justice agencies since the government White Paper, Crime, Justice and Public Protection (Home Office, 1990). Through- out the 80s and 90s the balance of human rights towards public protection moved slowly to produce restricted parole and longer prison sentences with the Criminal Justice Act, 2001 enshrining these principles in legislation. The Crime (Sentences) Act, 1997 had strengthened the preventative measures

*Corresponding author. Email: [email protected]

The Journal of Forensic Psychiatry & Psychology Vol. 23, No. 4, August 2012, 421–434

ISSN 1478-9949 print/ISSN 1478-9957 online

� 2012 Taylor & Francis http://dx.doi.org/10.1080/14789949.2012.692095

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and this continued in subsequent legislation such as the Crime and Disorder Act 1998, Criminal Justice and Court Services Act, 2000 and Sex Offenders Act, 1997.

Throughout this time period, Probation Services began to work more closely with other agencies such as Police, Health and Social Services and risk assessment and risk management became standard practice. Registra- tion of sex offenders enabled Police and Probation services to manage risks more effectively and the informal public protection systems were built on to be enshrined in statute by the beginning of this century.

Multi-Agency Public Protection Arrangements (MAPPA) were intro- duced with the Criminal Justice and Court Services Act, 2000, where Sections 67 and 68 set out the framework for the assessment and management of sexual, violent or other serious offenders in the 42 Areas of England and Wales.

Recent research undertaken by the Ministry of Justice illustrated that offenders subject to MAPPA management had a lower rate of reconviction than those released prior to MAPPA implementation (Peck, 2011).

Within health settings, there remains confusion and much debate around referral processes, despite now three hefty tomes of guidance (Home Office, 2002; National Probation Service, 2004; National MAPPA Team, 2009) and other guidance such as those published by the Probation Service in the form of circulars, (see Home Office, 2002; Scott, Grange, & Robson, 2006, amongst others).

MAPPA and mental health

The use of MAPPA in long stay psychiatric hospitals is currently at best cursory. Since its implementation, there has been research into the working and effectiveness of the MAPPA, but these have understandably been focused on offenders in the community who are supervised by the Probation Service.

The current available literature focuses very much on risk of serious harm to others by offenders living in the community being overseen by Probation and Police (see Kemshall, 2001; Kemshall, Mackenzie, Wood, Bailey, & Yates, 2005; Maguire, Kemshall, Noaks, Wincup, & Sharpe, 2001). However, the particular issues for those offenders with mental health issues and offender-patients in particular are not highlighted despite the clear evidence of ongoing failures in information exchange (Such as: NHS London, 2010; Russell Patterson; NHS South East Coast and Surrey County Council, 2009 Daniel Gonzales).

Inquiries

Inquiries since 1998 have identified the many failures of the Care Programme Approach (CPA) in homicides (Laurance, 2002). In relation

422 T. Henson and S.A. Riordan

to mentally disordered offenders, specific guidance was implemented in 2005 with the Offender Mental Health Care Pathway (DOH, 2005). However, despite almost 20 years of CPA, almost all the recent inquiries continue to cite the failures of agency collaboration as key to tragedies (Manthorpe & Stanley, 2004). Houlders (2005) argues that there are specific issues around CPA in relation to mentally disordered offenders where he identifies the balance between clinical care and risk behaviour and argues that the additional controls of MAPPA should apply.

However, MAPPA does not appear to be a significant feature in mental health inquiries. Indeed, an examination of 60 Independent Mental Health Inquires published between 2003 and 2010 identified only 6 of 24 individuals who were eligible for MAPPA registration were registered. Of greater concern was that when eligible individuals were not registered, no reference was made regarding MAPPA and no recommendations were made that registration should have applied.

Despite clear failings to register being highlighted as early as 2005 (North Central London SHA, 2005; NHS London, 2006) it does not appear that this has made any significant changes regarding registration as most of the later inquiries show. The Richard Loudwell Inquiry acknowledged that mental health services were not involved with MAPPA and made recommendations that MAPPA should be explicit in CPA documentation (South East Coast NHS, 2006) yet recent inquiries have highlighted that, ‘‘multi-agency public protection approach is not in place’’ (The Hayes, 2008, p. 48).

Confidentiality

Each profession has their own code of practice which includes confidenti- ality boundaries. Once in the MAPPA arena, that confidentiality then extends to the Police, Probation and a variety of other agency staff around the table, all adhering to their own confidentiality doctrines before the collated information is then recorded on the confidential Violent and Sex Offender Register (ViSOR) system, all of which calls into question the nature of confidentiality (National Offender Management Service, 2007).

The Royal College of Psychiatry (2004) produced their own guidance specifically in relation to MAPPA which attempted to provide some clarity for Psychiatrists. Re-iterating the circumstances when information can be disclosed without the patients consent, the guidance then goes on to list twenty separate points to consider when disclosing confidential information to MAPPA on the basis that ‘‘each case must be considered on its merits’’ (p. 7).

Neither of the major evaluations of MAPPA (Kemshall et al., 2005; Maguire et al., 2001) has addressed any of the issues regarding offender- patients or the ethical issues mental health staff face when considering a referral. However, there does appear to be an increasing requirement for

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mental health professionals to divulge information and many agencies have now developed information sharing protocols.

The literature review has highlighted the paucity of research into the MAPPA and in particular, the lack of examination into the way in which offenders with mental disorder, especially those who are detained, are considered within the process. Despite the latest guidance stating that all eligible detained patients should be identified within three days (National MAPPA Team, 2009), there is no clarity about those patients who are subsequently given leave away from the ward under section 17 of the Mental Health Act, 1983, leaving interpretation to the healthcare professionals’ discretion. It is hoped that this initial pilot study, conducted in one large independent psychiatric hospital, treating largely long stay offender-patients and providing no community outreach services, might inform future guidance to assist professionals in their quest for greater clarity in this area of work.

Method

Data were collected through a cross-sectional survey using a Likert Scale questionnaire that was developed by the researcher (Likert, 1932) from equal numbers of Doctors, Senior Nurses and Social Workers working at St Andrew’s Healthcare, Northampton Hospital site (SAH).

Ethical approval was gained from The National Research Ethics Service (NRES) and the study was conducted in line with SAH Research Policy (St Andrew’s Healthcare, 2011).

This pilot study used quantitative measures and was a two-tailed exploratory study with the professional groups identified as the ‘independent variables’ and the attitude scores the ‘dependent variables’. The data were analysed using SPSS.

Results

The response rate was 79% and the results showed a variety of experience of MAPPA from the participants (See Table 1).

(i) When should a referral be made?

A Kruskal–Wallis non-parametric test was used to analyse the significance between the three professions answering five questions regarding when referral to MAPPA should occur for eligible detained patients. The test revealed a statistically significant difference in question 7 ‘‘Eligible detained patients should be referred to MAPPA on admission’’ across the three professional groups (Gp1, n¼23: Doctors; Gp2, n¼22: Nurses; Gp3,

424 T. Henson and S.A. Riordan

n¼26: Social Workers), X2 (2, n¼71)¼7.92, p¼ .019. The Social Workers group recorded a lower median score (Md¼1) than the other two professional groups, which both recorded median values of 2.

Thirty-three per cent more Social Workers than Doctors believed that eligible detained patients should be referred to MAPPA on admission to hospital.

(ii) Who should refer?

Only 18% of respondents believed that Responsible Clinicians should make the decision to refer eligible detained patients to MAPPA whilst 69% believed that this should be a Multi-Disciplinary Team (MDT) decision.

(iii) The need for referral

Data show that the majority of respondents (total of all respondents: 90%: n¼64) disagreed with the statement that ‘Eligible detained patients do not need to be referred to MAPPA’.

(iv) Confidentiality

Sixty-five per cent of all respondents (n¼46) disagreed that referral to MAPPA went against patient confidentiality.

Table 1. Shows experience of MAPPA referrals by the sample.

Question Doctor Nurse Social worker Total

32. Have you referred an eligible detained patient to MAPPA?

Yes 10 2 24 36 No 12 20 2 34 Missing data 1 0 0 1

33. Have you attended an internal hospital MAPPA meeting?

Yes 7 8 25 40 No 15 14 1 30 Missing data 1 0 0 1

34. Have you attended a level 2 MAPPA meeting?

Yes 12 6 14 32 No 10 15 11 36 Missing data 1 1 1 3

35. Have you attended a level 3 MAPPA meeting?

Yes 8 4 11 23 No 13 17 14 44 Missing data 2 1 1 4

36. Have you received any training about MAPPA?

Yes 14 7 25 46 No 8 15 1 24 Missing data 1 0 0 1

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Risk

Analysis revealed a statistically significant difference in question 10 ‘‘I have found MAPPA meetings helpful to gain information which has helped to manage patient risk’’ across the three professional groups Gp1, n¼23: Doctors; Gp2, n¼22: Nurses; Gp3, n¼26: Social Workers), X2 (2, n¼71)¼9.3, p¼ .010.

Figure 1 shows that the majority of all respondents 96% (n¼68) agreed that MAPPA was ‘‘a good way to share risk’’, with 91% (n¼21) of Doctors, 95% (n¼21) of Nurses, and 100% (n¼26) of Social Workers agreeing or strongly agreeing with this statement.

Figure 1. Total number of responses to risk questions.

426 T. Henson and S.A. Riordan

(i) Knowledge of MAPPA

The test showed that 69% of respondents were unclear about what information is ‘proportionate and necessary’ to share’’. Only 39% believed that their profession had produced guidelines about MAPPA.

Analysis shows that 46% (n¼33) of all respondents believed that the referral form was relevant with 35% (n¼25) being unsure. Social Workers had the highest positive response rate at 62% (n¼16).

On the question of whether MAPPA was too bureaucratic, there were very similar answers against all the total responses showing 25% (n¼18) agreed, 37% (n¼26) unsure and 38% (n¼27) disagreed.

Conclusions

Through analysis of the collected data the researcher was able to establish some conclusions about the attitudes of staff working at St Andrew’s Healthcare (Northampton Site) which may contribute to their decision as to when to refer an eligible detained patient to MAPPA.

An expected outcome was that Social Workers were more informed, more trained and more experienced than the other two groups in relation to the MAPPA process. The responses of the three groups highlighted that although almost all Social Workers had received training about MAPPA, whilst only half of the Doctors and a quarter of the Nurses had done so. This may reflect the responses from the three groups and have training implications for the organisation.

Themes

When should a referral be made?

The research site has a duty to refer to MAPPA all eligible detained offender-patients (National Probation Service, 2004) and is identified as a ‘Duty to co-operate’ agency by section 325(3) of the Criminal Justice Act, 2003.

The available literature and research focuses on offenders living in the community and although mentally disordered offenders are included in this group, no specific mention is made of offender-patients in hospitals (Kemshall, 2001; Powis, 2002; Wood & Kemshall, 2007).

All professionals agreed that eligible detained offender-patients should be referred to MAPPA at some stage in their care pathway. However, their responses reflected the inconsistency of the guidance in relation to offender- patients where it appears that the specific issues of this small but significant group have been overlooked. Indeed, Peck concluded that further research should included offenders discharged from hospital (Peck, 2011).

The research showed that referral at the early stages of the eligible offender-patients’ care pathway was preferred by all of the professional

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groups surveyed with Social Workers (81%) being the group believing that admission was the stage to referral.

Secondary themes from the research tool have been identified that may have influenced the professionals’ opinions about when a referral of an eligible offender-patient should be made. These have been thematically separated and have helped to provide some understanding of why these views might be formulated.

Secondary themes

Who should refer

Analysis revealed an overwhelming view from the three professional groups that the decision to refer eligible offender-patients should be an MDT decision rather than an individual one.

The need for referral

Participants in each of the three professional groups agreed with the need for referral of eligible detained patients to MAPPA.

Confidentiality

Analysis of the data grouped together in this theme showed some interesting results. Sixty-five per cent of Doctors, 41% of Nurses and 46% of Social Workers did not agree that confidential medical information should remain confidential in relation to the MAPPA process. This was a concerning result and perhaps highlights the confusion about information sharing in the MAPPA process.

The MAPPA Guidance states that any information shared should be ‘proportionate and necessary’ for the management of the risk (National MAPPA Team, 2009). However, the results show that confidentiality is secondary to risk management in the MAPPA arena, with 89% of all respondents agreeing with this statement. Sixty-five per cent of all respondents did not believe that referring to MAPPA went against patient confidentiality, with 31% being unsure about this question. However, when all three questions were linked, it was clear that there was an overwhelming view within each professional group and combined to show that manage- ment of risk overrides issues of confidentiality in the MAPPA process.

Risk

Within the theme of risk, six items were identified. It was interesting to note that Doctors and Social Workers had a less favourable view of the Mental

428 T. Henson and S.A. Riordan

Health Framework being able to be used to manage risk than the Nurses. These are explored by Houlders (2005) who argues that there needs to be a balance between clinical care, offending and risk behaviour when formulat- ing the care plan. He notes that these key patient needs are not specifically addressed in guidance on CPA but rather, additional controls such as MAPPA and Home Office restrictions under section 41 (Mental Health Act, 1983), together with local procedures form the basis of the plan.

All three groups agreed that MAPPA was a good way to share risk and that the process might be helpful in this area. Although the granting of leave is ultimately the Doctor’s decision, it is the Nurses who are able to use their discretion as to if it is to be taken. Thus, the responsibility on the Nurses is great and therefore the need to have as much information relating to the patient’s risks is vital. Sixty-six per cent of respondents did believe that the MAPPA made a difference to the management of patients, while 27% believed that it made no difference.

Knowledge of MAPPA

There was agreement across the three professions that training about MAPPA was relevant to forensic psychiatric hospital staff. However, there remains confusion about what information should be shared to manage risk. This has been identified in the confidentiality and risk themes, highlighting that this may be an area that all staff need additional support in. Further exploration into the reasons for this may discover some inconsistencies between various documents published to assist staff, concern about contravening the Data Protection Act, 1998, fear of litigation or other reasons. Few Doctors were aware of the specific guidelines that had been produced by the Royal College in relation to MAPPA (Royal College of Psychiatrist, 2004; Royal College of Psychia- trists, 2006). Social Workers stated that they were aware that there were specific guidelines in relation to MAPPA, but it was not clear it this was an internal or external document. Nurses were not aware of any guidance from their own profession.

Administration

Social Workers within the Hospital had been identified as having the lead role in identifying eligible patients and making the referrals so may have had the most informed opinion about the referral form. Sixty-two per cent of Social Workers believed that the referral form was relevant to the eligible detained patient whilst Nurses were unsure about the referral form, which was unsurprising as they would have been less likely to have completed one. Doctors and Nurses reported being unsure across each of the variables in this theme.

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Limitations

It is acknowledged that the small study sample was limited to the number of staff employed at the research site and therefore the study could have produced bias in the conclusions. It is further acknowledged that the research site was a small and specialist resource and that the results from this study may therefore not be generalised, particularly to hospitals that operate community services, where views may be differently informed. For this reason, this study must be considered as a pilot study that could prepare the way for a larger study of pertinent features of the MAPPA processes within the detained forensic patient population across a larger number of hospitals within the United Kingdom. The study did not have enough power to demonstrate statistically significant differences across some variables.

The study did not identify the length of time professionals had been in their current post or the length of time since qualifying, what specific training participants undertook in relation to MAPPA or when this occurred. Nor did it identify the type of experience participants may have had in either forensic work or work in previous settings such as community work.

Within the hospital that was the research site there had been a large training project over the preceding two years in relation to MAPPA. The training was undertaken in partnership with Police, Probation, Health, Social Care and Housing in an attempt to improve relations between different agencies and to gain a better understanding of the roles of the different agencies. Staff working at the research site have had the opportunity to engage in the training project, although take up was variable. However, it is likely that staff working at the site may have a greater awareness of the MAPPA agenda than staff at other sites because of this. There is a MAPPA policy and protocols in relation to partnership working and a specific information sharing protocol that is available to all staff (St Andrew’s Healthcare, 2011).

With hindsight, it might have been better to just simply ask the question, ‘‘Identify the stage at which you believe an eligible patient should first be referred to MAPPA’’:

The sample did not identify if respondents worked in medium secure wards, low secure wards or open settings within the site and as a random sample of participants was taken, this was not specifically accounted for. Referral to a Level 2 or 3 MAPPA would be more likely from low secure and open settings so it is possible that the sample could have been biased towards medium secure workers from the random sample where referrals would have been unlikely.

Academic implications

This pilot study has been the first study, to the researcher’s knowledge, that specifically addresses the issues relating to MAPPA and eligible patients

430 T. Henson and S.A. Riordan

detained under the Mental Health Act, 1983. However, this study has highlighted that there are particular issues that pertain to this small but significant group that are worthy of further study.

The emergent themes in this research suggest further studies would benefit from a wider population across other hospitals with similar populations. From this could develop some clearer guidance in future Government publications that would greatly support professionals working in forensic settings and assist in risk management of offender-patients.

Study findings suggest that professionals remain unclear in areas of information sharing and confidentiality. Follow up studies would benefit from a more in-depth approach using both quantitative and qualitative methods so that themes could be explored in greater depth. This could prove useful in identifying training needs across the professions and could lead to a better understanding of the particular needs of professionals working in forensic settings.

Clinical implications

The results of this study have identified areas of ambiguity for professionals working in forensic settings who are currently being guided through the MAPPA process by Government guidance that does not greatly assist them (National MAPPA Team, 2009).

As the guidance is unclear, professionals working in forensic settings have used their own initiative and discretion about whether or not to refer, which is based on their own levels of knowledge and experience. This study did not identify different levels of experience, but it was clear from the analysis that there was a diversity of knowledge about MAPPA and in particular the information sharing aspect, despite a plethora of guidance from both Government and professional bodies (General Medical Council, 2000; Department of Health, 2003, 2009, 2010; Royal College of Psychiatry, 2004; Royal College of Psychiatrists, 2006).

Unlike prisoners, offender-patients ‘travel’ along a care pathway towards rehabilitation under recovery model principles (MacKeith & Burns, 2010; Rethink, 2005). This will inevitably include periods of time away from the hospital for the patient, with and without staff support.

Unlike the very clear systems that exist for offenders contained in prison, this is not the case for offender-patients; it appears that this small yet very significant group has been overlooked by policy makers, with the potential for this group to ‘fall between’ services, as highlighted by inquiries.

As a result of the findings in this pilot study, guidance from the National MAPPA Team could better reflect the specific circumstances of eligible offender-patients and the national MAPPA team could consider a parallel referral system for offender-patients that addresses the issues highlighted in this research.

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Government could consider a review of the legislation relating to the Hospital Managers and Mental Heath Review Panels to include MAPPA considerations when discharge is considered and Hospital Managers and Mental Heath Review Panels would then have a greater understanding of the MAPPA.

All staff working in secure hospitals could receive clearer advice about what is ‘proportionate and necessary’ to share to enable risk to be managed and that each discipline has clear guidelines that are endorsed by their professional body and clearer guidelines could be considered for medical staff in relation to the status of confidential medical information and the MAPPA process.

Finally, this initial pilot study has raised some interesting views about the referral of offender-patients detained under the Mental Health Act, 1983 from key professionals who work with them in one independent psychiatric hospital. Any steps that might increase public protection and reduce the risk of serious harm to others should be welcomed by professionals working in forensic settings. Further research into this fascinating overlooked area may bring about change and increase public confidence about mentally disordered offenders and their management.

Acts of law

Mental Health Act, 1983. Crime (Sentences) Act, 1997. Sex Offences Act, 1997. Crime and Disorder Act, 1998. Data Protection Act, 1998. Criminal Justice and Court Services Act, 2000. Criminal Justice Act, 2001. Criminal Justice Act, 2003.

Inquiries – in order of date of publication

The Independent review into the Care and Treatment of Mr Anthony Hardy (2005) North Central London SHA. Retrieved from http://www.nclondon. nhs.uk/publications/independent_review_into_the_care_and_treatment_ anthony_hardy.pdf [accessed 25.04.2009]

Report of the independent inquiry into the care and treatment of John Barrett (2006) NHS London. Retrieved from http://www.london.nhs.uk/webfiles/ Independent%20inquiries/John_Barrett_report.pdf [accessed 19.01.2009]

Care and Treatment of Richard Loudwell (2006) South East Coast NHS. Retrieved from http://www.southeastcoast.nhs.uk/publications/documents/ Independent_Inquiry_into_the_Care_and_Treatment_ofRL.pdf [accessed 25.04.2009]

432 T. Henson and S.A. Riordan

Independent External Review Report of the Circumstances Preceding the Escape of DH from The Hayes Independent Hospital (2008) The National Autistic Society

An independent investigation into the care and treatment of Daniel Gonzales (2009) NHS South East Coast and Surrey County Council. Retrieved from http://www.southeastcoast.nhs.uk/publications/documents/ 090127-Report.pdff [accessed 27.04.09]

An Independent Investigation into the Care and Treatment of RP (2010) NHS London. Retrieved from http://www.london.nhs.uk/webfiles/ Corporate/Mental%20Health%20reports/Legacy/RP%20report.pdf [ac- cessed 27.06.10]

References

Bowden, P. (1996). Graham Young (1947–90). The St Albans Poisoner: His life and times. Criminal behaviour and Mental Health, (Suppl.), 17–24.

Department of Health. (2003). Confidentiality: NHS codes of practice. London: Author. Retrieved from http://www.dh.gov.uk/prod_consum_dh/groups/dh_ digitalassets/@dh/@en/documents/digitalasset/dh_4069254.pdf

Department of Health. (2005). Offender mental health care pathway. London: HMSO.

Department of Health. (2009). Information sharing and mental health: Guidance to support information sharing by mental health services. London: Author.

Department of Health. (2010). Guidance on responding to people with mental III health or learning disabilities. London: National Policing Improvement Agency.

General Medical Council. (2000). Confidentiality: Protecting and providing informa- tion. London: Author.

Hart, C. (2005). Doing your masters dissertation. London: Sage Publications. Home Office. (1990). Crime, justice and protecting the public: The government’s

proposals for legislation. London: HMSO Cm 965. Home Office. (2002). Offender assessment system OASys: User manual. London:

Author. Houlders, A. (2005). Multidisciplinary aspects of the care programme approach. In

S. Wix & M. Humphreys (Eds.), Multidisciplinary working in forensic mental health care. (pp. 130–150). Harlow: Churchill Livingstone.

Kemshall, H. (2001). Risk assessment and management of known sexual and violent offenders: A review of current issues. Police Research Series Paper 140. London: Home Office.

Kemshall, H., Mackenzie, G., Wood, J., Bailey, R., & Yates, J. (2005). Strengthening the multi-agency public protection arrangements. London: Home Office.

Laurance, J. (2002). Pure madness: How fear drives the mental health system. In Faculty of Public Medicine Annual Scientific Conference September 2002, Kings Fund Lecture. London: Kings Fund.

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 140, 1–55.

MacKeith, J., & Burns, S. (2010). Recovery star approach. London: Mental Health Providers Forum. Retrieved from http://www.mhpf.org.uk/recoveryStar Approach.asp

Maguire, M., Kemshall, H., Noaks, L., Wincup, E., & Sharpe, K. (2001). Risk management of sexual and violent offenders: The work of public protection panels. Police Research Series Paper 139.London: Home Office.

The Journal of Forensic Psychiatry & Psychology 433

Manthorpe, J., & Stanley, N. (2004). The age of inquiry: Learning and blaming in health and social care. London: Routledge.

National Probation Service. (2004). The MAPPA guidance version 1.3 probation circular 20/2004. London: Home Office.

National MAPPA Team. (2009). MAPPA guidance 2009: Version 3 national offender management service public protection unit. London: Home Office.

National Offender Management Service. (2007). ViSOR – A secure, shared system that is helping police, prisons and probation to improve public protection. London: Ministry of Justice.

Peck, M. (2011). Patterns of reconviction among offenders eligible for Multi-Agency Public Protection Arrangements (MAPPA). Ministry of Justice Research Series 6/11. Retrieved from http://www.justice.gov.uk/downloads/publications/re search-and-analysis/moj-research/patterns-reconviction-mappa.pdf

Powis, P. (2002). Offender’s risk of serious harm: A literature review. London: Home Office.

Royal College of Psychiatrists. (2004). Psychiatrists and multi-agency public protection arrangements. Retrieved from www.rcpsych.ac.uk/members/currentis- sues/publicprotection.aspx

Royal College of Psychiatrists. (2006). Good psychiatric practice: Confidentiality and information sharing. Council Report CR133. Retrieved from http://www.rcpsych. ac.uk/files/pdfversion/cr133.pdf.

Scott, J., Grange, T., & Robson, T. (2006). MAPPA – The first five years: A national overview of the multi-agency public protection arrangements 2001–2006. London: National Offender Management Service.

St Andrew’s Healthcare. (2011). Research governance policy. Policy Number PCC 20: Issue Number 07.

Wood, J., & Kemshall, H. (2007). The operation and experience of Multi-Agency Public Protection Arrangements (MAPPA). London, HomeOffice. Retrieved from http://www.probation.homeoffice.gov.uk/files/pdf/Nottinghamshire%20 MAPPA%202007%20Report.pdf

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