Dr Louise Tansey NHS Lanarkshire & NHS Lothian Louise.Tansey@NHS Dr David Gillanders

1. 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

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

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

4. 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.

5. “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

6. Results ** p<0.01

7. 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)

8. 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.

9. “Top 3” values for each sample:

10. 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