Exploring the relevance of values to clinical interventions, especially those with mentally disordered offenders Dr Louise Tansey NHS Lanarkshire & NHS Lothian Louise.Tansey@NHS.net   Dr David Gillanders The University of Edinburgh & NHS Lothian Acknowledgements

Acknowledgements Dr David Gillanders, University of Edinburgh Colleagues at the Orchard Clinic, NHS Lothian All the participants

Contents Background “Valued living” in a non-clinical sample Do Mentally Disordered Offenders (MDOs) have different values? Observations about ACT in forensic settings.

Background Currently within mental healthcare in Scotland there is an increasing emphasis on ensuring well-being, and supporting people to be able to pursue the life they want regardless of psychiatric symptoms: “Well Scotland Initiative” The Recovery Model Within forensic mental health, The Good Lives Model (Ward, 2002) is becoming increasingly influential. Although the concepts of values are emphasised, there is a lack of a framework within which to work clinically with individuals. There is an assumption that living consistently with values with facilitate mental well-being and QoL, but little research has investigated this empirically.

“Valued living” in a non-clinical sample Participants (n = 134) completed a variety of measures: Quality of life (WHOQOL-Bref, The WHOQOL Group, 1996) Values (VLQ, Wilson et al., 2010)* Experiential avoidance (AAQ2, Bond et al., 2009) Cognitive fusion (CFQ13, Dempster, 2009) Psychological distress (CORE-OM, Evans et al., 1998). Gender: Male (37.3%) Female (62.7%) Education: Secondary school (12.7%), Tertiary education (87.3%) Marital status: Single (44%), living as married (11.2%), married (42.5%), divorced (2.2%) * altered scoring

Results Consistency living with personally meaningful values Experiential avoidance -.25** Cognitive fusion -.27** Psychological distress -.42** Quality of life .45** ** p<0.01

Are the values of MDOs different to those of a non-clinical population? Compared to the non-clinical sample, the MDO sample had higher rates of cognitive fusion (d = .63), experiential avoidance (d= 1.59) and psychological distress (d = 1.51). The MDO sample had lower rates of subjective quality of life (d = 1.51) and consistency living with important values (d = 1.35)

Further analysis of the VLQ: No significant difference between the importance attributed to each value between the samples. Some differences in consistency living with important values. The scores for consistently were significantly lower ( p <0.05) for the MDO sample in the following values: Intimate relationships, parenting, work, education/training, recreation/fun.

“Top 3” values for each sample: Non-clinical sample MDO sample 1st Parenting Recreation 2nd Intimate relationships Physical health 3rd Friends

Observations about ACT in forensic settings Difficulties facilitating valued living Improve engagement Choosing values Establishing values Self-as-context vs. self-as-content Setting encourages assumption of healthy normality. Risk assessment