Management plans – the case vignettes

We have repeatedly returned to the case vignettes in this guide. They are disguised cases, and deliberately adjusted to illustrate learning points. Below, is described the management plans for three of the vignettes. Note the ways in which the cases do or do not follow the basic principles for psychologically informed management plans.

Peter

To recap, Peter is the offender with an extensive – but apparently intermittent – history of sexual offending against pubescent boys. The most notable feature of his childhood was the contrast between his emotionally cold home life, and his vibrant and idealised participation in frequent sexual play with his male peers at boarding school (where he was sent after his explosive temper tantrums were felt to be unmanageable in mainstream schooling).

Peter has predominantly narcissistic traits, with some antisocial features, particularly rule-breaking and excessive alcohol use, and one episode of paranoid psychosis (losing touch with reality, believing his food was poisoned) after he was thrown out of the prison SOTP for arguing with the group leaders: they would not accept his reasoning regarding the ability of young boys to seek out and enjoy sexual contact with men and, under some pressure, he ultimately broke a chair in a rage.

Peter is being released from prison to approved premises. He has achieved notoriety as he claims he is writing a book about man-boy love, and is in frequent correspondence with a notorious child killer. As a consequence, there is considerable agency anxiety about him and he is subject to the oversight of a level 3 MAPPA panel. At the meeting, it is clear that there is a split emerging, with the police and Local Authority emphasising the risk he poses to children, in contrast with the probation team who feel Peter is deliberately provocative. A compromise was reached, when it was agreed that the police would concentrate on pursuing the option of a SOPO (sex offences prevention order), while probation would focus on the management of the licence.

The probation team linked up with a local psychologist and agreed the following approach:

  • To allocate Peter to reasonably experienced keywork and probation staff, who (somewhat tongue in cheek) were both absolutely forbidden from discussing the question of children’s sexuality, or victim empathy, with Peter. The rationale was that these features had led to a breakdown in management in the past, by enflaming Peter’s core traits and triggering destructive competitive impulses. Furthermore, offence-related cognitions only have a weak link with re-offending risk in the literature, and there was little evidence that they were amenable to change in Peter’s case.
  • To ensure that Peter’s risk management plan was evenly balanced between avoidance and approach goals; i.e. he was not allowed to do a few risky things (loiter in parks), but he would be actively encouraged to do other things (undertake research in the local library once a week) which provided meaningful structure and maintained his self-esteem, in a way which could be monitored.
  • To limit the risk management targets to two key areas. First, from the probation officer’s point of view, alcohol and impulsive decision making at times when a potential victim was available was the combination of triggers most likely to lead to future offending. Peter agreed with this (although he did not define it as offending, but as the likelihood of him getting caught). Second, Peter’s primary concern was not to return to prison – he realised the likelihood of getting out again was slim – and he was motivated to avoid this. Collaboration on these two issues was achieved in supervision.

There was a problem in Peter’s progress, six months after release, when the probation officer – busy and frustrated – could not restrain her irritation at yet another attack on her professional integrity (Peter having suggested that he would be better suited to a more educated probation officer who would be more able to understand his philosophy, and who derived more enjoyment from her job!) She angrily responded by challenging his ‘philosophy’, expressing her views about the damage he had caused his victims, and agreed that perhaps he needed another officer. However, it was to the credit of the probation officer, that with the supervision and support of her line manager, she was able to talk with Peter in a subsequent session, both owning her own feelings of anger, but also explaining (calmly and without any accusation) how his constant criticisms were destructive to their relationship. Although Peter never acknowledged his behaviour, this incident seemed to mark a positive shift in their relationship. Three years later, Peter completed his period on licence without apparently offending, was living independently – albeit requiring support because of his extreme isolation – and was seeing a psychologist once a month for what might be described as supportive psychotherapy.

Mark

To recap, Mark was in many ways a typical antisocial offender, with a history of behavioural problems from early childhood, a delinquent adolescence, and a long string of acquisitive and violent offences behind him – largely robberies. He had had significant problems with class A substance misuse which was usually the main trigger for his offending, but he also associated with a fairly criminal subgroup, and certain traits relating to antisocial PD – reckless sensation seeking (core trait) and impulsivity (secondary behaviour) – were probably also highly relevant. He scored very high on the OASys PD variables.

Having received a fairly long custodial sentence, Mark settled down after a turbulent start (with adjudications for violence and drug dealing). He seemed to mature, and completed drugs related programmes receiving positive reports; mandatory drug testing was negative for the two years prior to his release. He was released on a two year licence, with the usual conditions, including a need to address his offending behaviour, his substance misuse, engage with Employment and Training, and reside at an Approved Premises. He was managed within the main Offender Management team, and expected to report on progress regarding engagement with Think First (a thinking skills programme), the community drug worker, signing up for further training and seeking employment.

Six months into his licence, Mark appeared to be compliant and motivated although he had not made much progress with his requirements: there had been confusion regarding appointments with the drugs worker, and he was vague about his intentions regarding work or training. Although the probation officer had given up asking probing personal questions of him – as he always became defensive and uncommunicative at these times – he was otherwise pleasant and cooperative. He had started Think First, and received a good report for his participation in the first few sessions, although the course leaders had had to ask him not to hang around with the other group members after the sessions. The probation officer also noted a three week period when Mark’s level of self care – usually excellent – appeared to deteriorate; he had explained that he had been a little bit under the weather, with flu and low mood, and his appearance soon improved.

In month seven of his licence, Mark was arrested and subsequently charged with the murder of an elderly man in his home. It transpired that he had returned to using cocaine, and – with a couple of friends – had been planning the robbery of a jewellers shop. They took flick knives with them, but the jewellers was closed when they arrived; in frustration (and somewhat irritable and edgy) Mark had gone off to rob someone. He broke into a house that appeared to be empty, but was surprised by the elderly resident who stood in the doorway with what appeared to be a pair of scissors in his hand. Trapped in the room, shocked and panicky, Mark got out his knife and thrust it wildly at the man as he pushed him aside to run out of the house.

With a further offence committed by someone on her caseload, the probation officer will have been devastated, and under extreme stress. The question we might ask is whether, with the complacent benefit of hindsight, we might have done anything different ourselves. The first problem is that Mark – particularly within an urban environment – is an entirely unremarkable and common probation case, thousands are like him. The second problem is that he was cooperative, albeit rather superficially, in his dealings with probation. We probably have to come to the rather uncomfortable conclusion that this was an entirely unpredictable event – or that one could only predict it if one included literally hundreds of similar offenders into the ‘potential SFO bag’. On the other hand, there may be some learning points from this case (although it is uncertain that knowing them would have avoided the outcome):

  • Catastrophic harm most commonly arises as a result of carrying a potentially lethal weapon, not from personality characteristics of the offender; focusing on harm reduction (educating against the carrying of weapons) is both potentially useful and defensible.
  • If someone has been behaviourally disturbed from a very early age (primary school years) and has a family history of substance misuse, take a more cautious approach to apparent maturation in adult years – there is a powerful pull back to inherent traits.
  • Look beyond compliance in antisocial offenders as they can be rather chameleon-like; Mark learnt at an early age to present himself as compliant to his mother, whilst persistently subverting her authority at the same time. Put more emphasis on objective evidence of behaviour rather than relying on self-report.

Robert

Robert’s background and offence were detailed in chapter one. In summary, he was an only child, with a history of mental illness in the family; by his peers he was considered to be a loner and ‘weird’, he was bright but a poor achiever, and worked for years in the Civil Service (athough disliked by peers and he made little progress). He was rigid and suspicious in his views, drank heavily, and was prone to brooding on grievances. He only had one intimate relationship, and after a few months, during a row when his partner threatened to leave him, he killed her in a sudden rage. In prison, he objected to sharing a cell, was officious and litigious if prison rules were breached, and refused to participate in group work, but otherwise caused few management problems.

Robert clearly fits the diagnostic category of schizoid personality disorder with paranoid traits. If thought of in terms of core and secondary traits (see Table 4.2), he has a self concept of being self-sufficient and righteous, viewing others as either intrusive or unimportant to him, and tends to remain unemotional, isolated or unengaged with others. If forced to engage, his style is largely suspicious of others.

The probation officer managing the life licence brought Robert to consultation with the forensic psychologist. The officer had tried to develop a management plan which addressed anticipated problems, but was dismayed to find that Robert was becoming increasingly irritable and withdrawn. The plan included:

  • Co-working Robert with another team member, to anticipate complaints and litigious action.
  • Putting in a condition that he attend IDAP (the domestic violence programme) as he had not completed group work in prison
  • Placing Robert in a hostel in order to ensure that he was well monitored
  • Recommending that he engage with the psychology service for additional individual therapy
  • Attend a community alcohol project and a Employment and Training agency.

So why might this entirely sensible and straightforward plan have been going awry, and was Robert’s risk increasing as a result? The problem was that the probation officer had intuitively designed a risk management plan which confronted Robert’s core traits and exacerbated his habitual responses as a result. The plan would have been experienced by Robert as intrusive and provocative, provoking him into a suspiciousness and defensiveness demeanour; he would have been unsettled by having to report to a number of separate agencies and individuals, and would have loathed the relative chaos and proximity to others of an approved premises. His capacity for stubbornly refusing to participate in a group would have been substantially greater than the officer’s capacity to persist doggedly with this request! It was therefore agreed to:

  • Reduce his supervision to a single worker; however the probation officer could not comply with the psychologist’s suggestion of reducing the sessions to fortnightly.
  • Robert was fast tracked into independent accommodation.
  • He was removed from the IDAP waiting list.
  • He was breathalysed for alcohol on a random basis, but it was agreed that he would only need to attend an alcohol service if he started drinking again.
  • He met with the forensic psychologist on a six weekly basis, simply to monitor his mental state and talk about relationships if possible.
  • The probation service made every attempt not to change his probation officer, even when she moved teams locally, and supported him in finding work as an office clerk.

Interestingly, the lower the intensity of the intervention, the better Robert responded, and concerns about his risk diminished.