Breaking the barriers between offenders and academia

Julia Griem, Eleanor Hind and Tom Stephenson want to promote communication between clinical academics and individuals who have an offending history. Julia, an NIHR Maudsley Biomedical Research Centre PhD Student, took part in NIHR Maudsley BRC’s ‘BRC in the Community’ showcase last year. Here, she writes about her and her colleagues’ experiences in the Forensic Research Group (part of the Forensic and Neurodevelopmental Sciences department at the IoPPN). The group focuses on individuals with an offending history.

Individuals with an offending history are typically underrepresented by existing patient involvement programmes. We want to break down barriers which affect the feasibility, relevance, acceptability, and accuracy of our research. We expected barriers such as:

• the assumptions academics have about pertinent research questions,
• the environment research takes place in,
• and the worries participants have discussing potentially sensitive topics (for example, difficult or traumatic life experiences).

We believe increasing communication between researchers and service users with offending histories might help to break such barriers down.

We planned to interview past participants who live in the South London community on their experience of taking part in research. We were keen to find out:

• what they enjoyed about taking part,
• what could have been improved,
• and more importantly, what they hoped future research would address.

This approach led to an insightful conversation with Tony, who was happy for our interview to be filmed and shared. Watch the interview here (7:30 mins).

Emerging themes

We also wanted to speak to people currently under probation, in prison, and in forensic hospitals. We have not yet arranged meetings with those currently in prison. However, we spoke to people in low, medium, and high secure hospitals, as well as people in an Offender Personality Disorder Service User Group who had past experiences of imprisonment. Various themes relating to the above barriers emerged from these discussions.

First, it appeared that most individuals with a history of violent convictions feel there is a limited understanding about what drives their violent and aggressive behaviour. They expressed a wish for more research to:

• explore what triggers these violent behaviours,
• why the thoughts and urges can be so intrusive and overpowering,
• and why they are often linked with developing or maintaining social status, pride, and personal gain.

Similarly, there was also an impression that the motivations and emotions around self-harm within prisons were poorly understood. They welcomed more research that focused on the causes of these self-harming behaviours. This will help to direct our future research plans, including a study examining the role of prison-specific factors on self-harm (for example, staffing levels, purposeful activities, and bullying/harassment).

Secondly, individuals identified the need for researchers to consider how the study environment might affect the willingness and comfort of participants. In particular, the unfamiliarity and institutional atmosphere of university buildings. These buildings were described as intimidating and increasing feelings of distrust.

People living in the community suggested that attending a university and having a clear visual plan of the entire process prior to the main research appointments would help. For people in hospital, the option to have a trusted member of staff, friend, or family member come along to make the experience less daunting was also suggested.

Regarding research that is conducted within prison, individuals suggested that having more privacy and discretion might increase the appeal to participate. It was suggested that using past participants to help recruit new participants might make the recruitment process easier. It would help to show potential participants that peers had a positive experience. This was particularly important in this setting, where service users felt there was likely to be significant distrust of researchers given their links with institutions. Including individuals with lived experience of prisons in the recruitment process was felt likely to help bridge this gap.

Finally, the discussions with service users suggested that we – as researchers – often fail to predict how participants will feel after being asked to discuss difficult personal experiences during assessments. For example, they may feel quite vulnerable or exposed after sharing traumatic childhood experiences or may want reassurance that their information is confidential and secure.

While the risk of harm from our research is usually deemed quite small and would be communicated in participant information sheets, the timeframes for research are often too tight to allow proper rapport to be built. However, the individuals expressed their need to have more time to build up trust with the researcher. They also wanted to be informed in advance about exactly what kind of questions will be asked.

In line with this, some expressed that more thoughtful follow-ups, such as checking in with and debriefing the participant on several occasions, would help with feelings of vulnerability and exposure after undergoing personal and sensitive interviews. Indeed, even after our group consultation exercise, some of the people we spoke to suggest a formal debrief at the end of such sessions. These latter two themes provided very helpful ideas that should improve the facilitation of research and Patient and Public Involvement in the future.

Together, we felt that these conversations made considerable headway in breaking down the barriers between clinical academics and individuals with an offending history.

It helped us gain a new perspective from the individuals that our research focuses on.

The individuals also expressed their gratitude for being involved in these conversations as they felt more valued and included. Many expressed a wish to be involved in such endeavours in the future.

We hope that such conversations will continue to be promoted and nurtured in the future. We would like to create a service user forum that more properly represents this underserved population of individuals with an offending history and improves forensic research at the IoPPN.