Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

Implications for research and clinical practice are discussed, including the utility of the EPS as a measure of clinical need and treatment outcome.

BackgroundThere is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.AimsThis study identified and developed the domains that should be used to measure treatment outcomes for this population.MethodA systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.ResultsThe final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.ConclusionsTo index recovery, services need to measure treatment outcomes using this framework.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Psychopathy has emerged as one of the constructs most predictive of violence risk in the forensic field. The Psychopathy Checklist-Revised (PCL-R) has previously been\ud found to have acceptable reliability and validity in a sample of offenders with intellectual disability, but its predictive validity in this group has yet to be established. This prospective study examined the relative ability of the PCL-R and two other instruments, the Historical Clinical Risk-20 (HCR-20) and the Emotional\ud Problem Scales’ Behaviour Ratings Scale, to predict officially recorded institutional aggression. A sample of 60 offenders with intellectual disability in a high security\ud forensic psychiatric setting was followed up for a period of 12 months. The PCL-R 20-item total, the PCL-R 13-item total, and PCL-R Factor 1 and Factor 2 scores did not significantly predict any type of aggressive behaviour. In contrast, the two more clinically based measures significantly predicted both interpersonal physical\ud and verbal/property aggression. A primary justification for using the PCL-R in forensic settings is the evidence for its association with violence. Further studies examining the relationship between psychopathy, aggression, and violent recidivism in broader samples of offenders with ID are therefore imperative