Understanding bullying between patients and prisoners in secure forensic settings: Individual and en

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Understanding bullying between patients and
prisoners in secure forensic settings Individual
and environmental impacts

• Professor Jane L. Ireland,
• Chartered Forensic Psychologist, Professor in
  Forensic Psychology, Violence Treatment Lead
• University of Central Lancashire and Mersey Care
  NHS Trust

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Outline

• Research to date
• What is bullying?
• History and how much goes on?
• What does it include?
• Different groups involved
• Victim reactions
• Theoretical underpinnings interactional model
• Applying this to intervention and management

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Secure Research to Date

• 7 core developments since 1997
• Distinguishing between groups
• Predicting group membership Descriptive,
  Intrinsic, Behavioural (e.g. Ireland Monaghan,
  2006)
• Refining methods of measurement
• Interviews behavioural checklists scaled
  measures (Ireland, 2005a)

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• Trying to link with wider aggression literature
  (e.g. Ireland Archer, 2004)
• Recognising the environment (Ireland, 2002)
• Recognising indirect aggression and its
  developmental advantage (Ireland et al, 2006)
• Use of term? Intra-group preferred? (Ireland et
  al, 2006)

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Use of the term Bullying

• Need to move away from school based definitions
• Need to account for direct and indirect
  aggression
• Broader definitions are more useful e.g.

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• An individual is being bullied when they are the
  victim of direct and/or indirect aggression
  happening on a weekly basis, by the same or
  different perpetrator(s). Single incidences of
  aggression can be viewed as bullying,
  particularly when they are severe and when the
  individual either believes or fears that they are
  at risk of future victimisation by the same
  perpetrator or others (Ireland, 2002)

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The Term Bullying

• underestimates extent of bullying
• emotive childish
• leads to limited definitions

PROBLEMS
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Problems across language.

• bully for you old English usage
• Spain no term
• Ijime - Japanese
• Ojibway indians
• Key-Kit-Tah-Mah placing fear in someone
• (Michael Esquash, 2008)

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Behaviours indicative of being bullied

• 55 patients engaged in at least one
• 50 indirect
• 32 direct
• 2 coercive
• Direct 30 verbal, 7.5 physical, 1.9
  theft-related

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Behaviours indicative of bullying others

• 64 patients engaged in at least one
• 53 indirect
• 43 direct
• 13 coercive
• Direct 36 verbal, 25 psychological, 21
  physical, 7.5 theft-related

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Different groups involved

• Bully/victims (34)
• Pure victims (30)
• Pure bullies (21)
• Not-Involved (15)

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• Move towards focusing on frequency of behaviour
  reported as well as presence to identify
  groups. Exploration of tendency as opposed to
  category.
• Proposal of a 4- quadrant approach used in other
  facets of individual differences (e.g.
  masculinity, femininity and androgeny Archer
  Lloyd, 2002) e.g.

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4-quadrant approach Tendency
Plus . use of median splits groups not seen
as homogenous
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• Traditional
• 6.1 Pure Bully
• 20.2 Pure Victim
• 60.8 Bully/Victims
• 12.9 Not-involved
• Median Split
• 14.7 above median bully
• 12.4 above median victim
• 32.1 above median bully/victim
• 27.9 casual/low frequency involvement
• 12.9 not-involved
• Ireland Ireland (2008)

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• Chronic groups
• Victim behaviours M 13.1/SD 20.4
• Bully behaviours M 7.9/SD 19.3
• SOhad to score above 23 to be placed into a
  victim group and above 28 for perpetration.
• 6 Chronic Bully n 36
• 10 Chronic Victim n 59
• 2.3 Chronic Bully/Victims n 14

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Reactions to Bullying

• Aggression
• Self-Isolation
• Self-Injurious Behaviour
• Other Responses

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• Caution expressed against psycho-pathologising
  (Ireland, 2005a). Tendency to do as a result of
  a focus on typologies.
• Why avoid psycho-pathologising?
• Bullying product of secure environment and
  individual, with environment reinforcing bullying
  e.g. Interaction Model (Ireland, 2002 2005).

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A comment on responses

• Recent research suggests it is the FEAR
• of bullying that promotes psychological
• distress NOT the actual experience of
• being exposed to aggression per se
• (Ireland Power, submitted).

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Theoretical Underpinnings Interactional Model
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Environmental Factors Physical

• 1. Material goods
• 2. Population Density
• 3. Supervision
• 4. Limited stimulation

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Environmental Factors Social

• 1. Aggression normalised adaptive
• 2. Organisational structure
• 3. Subculture
• 4. Supportive/indifferent attitudes

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Just a comment on attitudes

• Studies have recently begun to explore attitudes
  e.g..
• Once someone is a bully they are always a bully
• Patients wouldnt bully if the hospital did more
  to prevent it
• (Ireland, 2008 Ireland Clarkson, 2007)

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Most common attitudes..

• 6 most endorsed
• When someone is being pushed around it is best to
  ignore it
• Bullies are skilled at controlling others
• Bullying is a problem for staff to deal with
• Victims often lie about being bullied
• Some patients cant stop themselves from bullying
  others
• Patients wouldnt bully if the hospital did more
  to prevent it

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Staff more likely to endorse..

• Victims often lie about being bullied
• Patients who bully others are childish
• Patients report bullying to staff because they
  are desperate
• When someone is being pushed around it is best to
  ignore it.

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Patients more likely than staff to endorse..

• Once someone is a bully they are always a bully
• Patients wouldnt bully if the hospital did more
  to prevent it
• Bullying would not happen if victims stood up for
  themselves more.

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• 6 core groups of attitudes
• Victim responsibility.
• Justifying discouraging reporting bullying
• Views towards bullies negative
• Negative victim characteristics
• Isolating victims
• Respecting bullies
• Staff higher Staff lower

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Incentives to continue
Environment
Mediated by
Individual Characteristics Intrinsic Descriptive L
evel of physical /social skill
?materials victims not inform ?status ?boredom
BULLY
PHYSICAL
SOCIAL
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Applying this to intervention and management in
secure settings

• 3 preliminary steps

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• 1. Understand theory behind bullying
• Seeing it as an individual phenomena unhelpful
• Recognise adaptive function of bullying
• Recognise bullying can produce both fight
  flight fear responses in victims
• Recognise need for preventative as well as
  reactive approaches

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• 2. Consultation
• Dont develop solely staff-orientated
  strategies.
• Include patient involvement that is clearly
  built into the strategy.
• Ensure whole hospital approach from day one,
  including involvement of senior management

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• 3. Decide on management approach
• Ensure positive and not negative approach from
  day one (Ireland, 2007) e.g.
• Question should be NOT be
• How can we stop patient X from bullying
• Question should be
• How can we help patient X to interact more
  pro-socially with his peer group
• Will drive strategy development re. reactive
  strategies

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Core components of a practical intervention/manage
ment strategy

• Examples of some core components

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1. Profile

• Bullying should be given high management
  priority
• Anti-bullying coordinator role developed
• Ensuring awareness about bullying is raised
• Ensuring bullying remains on the clinical agenda
  - -
• e.g
• ECCHow can we ensure patient X continues to
  interact positively with their peers?
• PCT include bullying as an agenda item under
  general ward business

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2. Communication

• Publicity e.g. articles in patient and staff
  newsletters posters information leaflets
• Training
• Include bullying or ward relations as an
  agenda item in community/supervision meetings

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3. Supervision and Detection

• Encourage focus away from the victim having to
  report to looking for behavioural symptoms
• Encourage staff to make supervision patterns less
  predictable
• Identify location hotspots for bullying and apply
  preventative measures
• Increase supervision at times of high risk
• FOCUS ON REDUCING OPPORTUNITIES

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4. Determining reactive strategies

• Requires consistent approach and structured
  investigation process
• 1. Immediate responses
• Documenting Suspected Incidents
• Deciding if immediate action is required
• Inform the PCT

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5. Determining reactive strategies cont

• Intervention for bully and/or victim
• Determined by
• Functional Assessment of behaviour
• Development of action plan (written in RAID
  terms)
• For pure bullies focus should be on
  costs-benefits. For other bullies victim
  awareness may be beneficial

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6. Determining preventative strategies

• Will cross-over with reactive strategies. Focus
  here on social/physical environmental
  intervention e.g.
• Monitoring hotspots
• Increased supervision at specific times
• Monitoring material goods more closely
• Involving peer group as much as possible
• Should also include individual risk assessment
  approach

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7. Supporting patients

• Immediate support e.g. assisting to communicate
  difficulties
• Long-term support e.g. intervention
• Additional support e.g. including them more fully
  in investigations taking a collaborative approach

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Conclusion

• Bullying is an interaction between the
  environment and the individuals housed within it
• Bullying should be expected
• Strategies should address BOTH environment and
  individual
• Strategies need to be well resourced and planned
• Strategies need to include both preventative
  reactive approaches
• A whole hospital approach needs to be adopted