the forensic mental health tribes: identifying a research community

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The forensic mental healthtribes: identifying a researchcommunityKeith Soothill a , Kathryn Harney b , Adele Maggs c &Clair Chilvers ca Centre for Applied Statistics , Lancaster University ,Lancaster, UKb Bolton, Salford, and Trafford Mental Health NHSTrust , UKc Nottinghamshire Healthcare NHS Trust , UKPublished online: 27 Oct 2008.

To cite this article: Keith Soothill , Kathryn Harney , Adele Maggs & Clair Chilvers (2008)The forensic mental health tribes: identifying a research community, The Journal ofForensic Psychiatry & Psychology, 19:4, 441-459, DOI: 10.1080/14789940801947933

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RESEARCH ARTICLE

The forensic mental health tribes: identifying a research

community

Keith Soothilla*, Kathryn Harneyb, Adele Maggsc and Clair Chilversc

aCentre for Applied Statistics, Lancaster University, Lancaster, UK; bBolton, Salford,and Trafford Mental Health NHS Trust, UK; cNottinghamshire Healthcare NHSTrust, UK

This paper considers the gender, age, and professional groupings of theforensic mental health research community in the United Kingdom, asidentified by applications during the 12-year life (1996–2007) of theDepartment of Health Forensic Mental Health R&D Programme. Theresults indicate that psychiatry no longer has an almost monopolisticposition in pursuing research in this area. Nevertheless, psychiatristsretain a dominant position. In contrast, psychologists, while now havinga massive presence in this area, seem to do much less well proportionallyin obtaining grants. Other professional groupings now have a presencein this field, perhaps unimaginable even a decade ago. Discipline ratherthan gender is the crucial variable in identifying the likelihood of being asuccessful applicant. However, females are more likely to be in the roleof co-investigator than principal investigator. Finally, the age distribu-tion of this research community looks healthy and there is no imminent‘retirement problem’ which could adversely affect its development.Placing the findings within a wider context, the future is less clear. Thereare important structural issues which indicate the fragility of the forensicmental health research community. The authors conclude that, althoughmodest in its aims and scope, this study provides a basis for consideringthe future of forensic mental health research and its community ofresearchers.

Keywords: forensic mental health; R&D; research; professional; gender;age

Introduction

The focus on forensic mental health in the United Kingdom has changedover the past 15 years. The killing of Jonathan Zito by Christopher Clunis –a schizophrenic patient who had been discharged from hospital and whostabbed and killed Zito at a London Underground station on December 17,1992 – symbolises part of that change. Christopher Clunis had a long history

*Corresponding author. Email: [email protected]

The Journal of Forensic Psychiatry & PsychologyVol. 19, No. 4, December 2008, 441–459

ISSN 1478-9949 print/ISSN 1478-9957 online

� 2008 Taylor & Francis

DOI: 10.1080/14789940801947933

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of psychiatric illness, including previous displays of violent behaviour,before he killed Jonathan Zito. The inquiry team found the case was a‘catalogue of failure and missed opportunity’ and criticised doctors,psychiatric nurses, and social workers for failing to assess ChristopherClunis’s history of violence (Court, 1994).

This tragic event was not a solitary incident, but became a signal crime1

highlighting similar incidents. These tragic and high profile killings bypeople with mental illness were used to suggest that the community caremodel for mental health services had failed. However, Taylor and Gunn(1999) undertook a trend analysis of data from the criminal statistics forEngland and Wales between 1957 and 1995, which suggested that there hadbeen little fluctuation in the numbers of people with a mental illnesscommitting criminal homicide over the 38 years studied and a 3% annualdecline in the official statistics. Although Taylor and Gunn suggested thatthere ‘appears to be some case for specially focused improvement of servicesfor people with a personality disorder and/or substance misuse’, their mainconclusion was that there is ‘no evidence that it is anything but stigmatisingto claim that their living in the community is a dangerous experiment thatshould be reversed’ (p. 9). Nevertheless, the public mood had shifted andthere was corresponding government concern about whether the profes-sionals involved with forensic mental health could adequately meet thechallenge.

The professional approach to forensic mental health work was alreadyshifting at the time of the Clunis case. For well over a century, forensicmental health work had been seen as the almost exclusive territory of thosewho became known as forensic psychiatrists, with increasing assistance afterthe Second World War from psychologists and other support staff.Psychologists, in particular, were by the 1990s moving away from beingadjuncts to psychiatrists and keen to be seen to make a distinctiveprofessional contribution. For example, sex offending was an area ofincreasing public concern from the early 1990s where it was felt thatpsychologically informed behaviour therapies might make a significantlygreater impact than traditional treatments.

Territorial battles in the forensic mental health field reflected similarshifts within the health field generally. Beattie (1995, p. 11) pointed to astriking metaphor used to explain and understand boundary conflicts andchanges in the health arena. He noted:

Not long after the National Health Service Training Authority was establishedin the early 1980s, its Chief Executive identified as a priority the need for‘‘multiprofessional education’’ across occupational boundaries, observing that‘‘there is far too much ‘tribalism’ in the NHS for its own good.’’

This vivid anthropological metaphor has since resonated in and aroundthe NHS.

442 K. Soothill et al.

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The more recent insistence on a wider professional interest in the forensicmental health field – or what Rogers and Soothill (2008) call a variety ofprofessional voices – could result in much greater inter-disciplinary co-operation or, alternatively, much greater professional rivalry.

This article examines the gender, age, and professional profile of thecurrent forensic mental health research community. We first considersuccessful applications to the NHS Forensic Mental Health R&DProgramme over its 12-year life (1996–2007 inclusive). We focus on theprofessional background of the applicants, their ages, and their genders.How many professions are represented? Are there changes over time? Arethere young and emerging groupings? Is the traditional male dominance offorensic mental health – as in most other medical settings – beingchallenged?

To examine whether the success of particular groups is, at least partially,the result of them being more active applicants, we compare successful andunsuccessful applicants by considering all the applications made in responseto the three general calls made by the Programme in 2003, 2004, and 2005.Combining the successful and unsuccessful applicants helps us to identifyand to consider the profile of the current forensic mental health researchcommunity.

We need to make clear that this is not an evaluation of the process andoutcome of the Forensic Mental Health R&D Programme by those involvedin it, but an analysis of the community which contributed the research.

The Forensic Mental Health R&D Programme

The Programme had two main phases. From 1996 to 1999 it functionedunder the auspices of the High Secure Psychiatric Services CommissioningBoard. In April 1999 it became a national R&D programme under theauspices of the R&D Board.

In 1995–1996 a national exercise based on the findings of the 1994Culyer Report (Culyer, 1994) required NHS trusts to identify theirexpenditure on research and development so that this money could be‘top sliced’ from health authorities’ commissioning budgets and beseparately administered and monitored by the Department of Health.However, it was decided that the newly established High Secure PsychiatricServices Commissioning Board (HSPSCB), a non-departmental publicbody, would continue to be responsible for its own R&D spending outsidenational arrangements for an interim period. The HSPSCB, which includedrepresentatives from forensic psychiatry, health authorities, the HomeOffice, the prison service, and social services, took the lead in commissioningresearch within the special hospitals. The HSPSCB, which includedrepresentatives from forensic psychiatry, health authorities, the HomeOffice, prison service and social services took the lead in commissioning

The Journal of Forensic Psychiatry & Psychology 443

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research recognising the need for an improved academic base within thespecial hospitals.

Bids were invited from high secure hospitals in 1996 so, although theremit of research was known to be broader than special hospitals, thefinance was in the first instance either embedded within the special hospitalbudgets or spent in response to invitations to the special hospitals. Broaderinvitations for research bursaries, research fellowships, research reviews, andprojects followed.

This interim period ended, as planned, after three years when theProgramme became one of the NHS national research programmes in April1999 within the remit of the R&D Board. A new advisory committee wasestablished to revisit its objectives. The stated objectives of the newProgramme closely mirrored the original objectives: dealing with potentialor actual mentally disordered offenders, looking at the life course of theseindividuals, dealing with a range of settings in the NHS and criminal justicesystem, service-led research, development of an evidence base for NHS andcriminal justice system services, development of research and a researchculture, and influencing other funding bodies. The context in which theProgramme operated changed significantly as the formal link with theHSPSCB was broken.

A substantial priority setting exercise was undertaken with a wide rangeof stakeholders; expert papers were commissioned to provide overviews ofkey research areas and identify key research gaps and these, together withconsideration of national priorities, played a role in embedding forensicmental health research in the priorities and practice of the wider NHS.However, there was also a recognition that there should be a role forresponsive or investigator-led research in this area, and three calls wereissued.

When the new Department of Health (2006) strategy Best Research forBest Health was issued in 2006, it was decided that the Programme wouldcease commissioning with immediate effect and close in 2007.

The data

The material is based on data extracted from the Programme’s project files.This paper considers the 79 successful projects for which work commenced.The project calls ranged widely. The Programme’s calls for proposals after2001 covered a wide range of forensic mental health topics. These included:evaluation of novel interventions or innovative services for the treatmentand management of personality disorders among offenders and those at riskof offending; anti-social personality disorders in children and adolescents;developing an academic and research network in prisons; prison in-reachservices, and safe and appropriate transfer of care for prisoners; evaluationof pilot services for dangerous people with severe personality disorder (on


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behalf of the Home Office); cost benefit modelling; organisation andmanagement of services for dangerous and severe personality disorder;forensic learning disability; SSRIs in the treatment of sex offenders;evaluation of Criminal Justice Liaison and Diversion (CJLD) schemes forwomen offenders with mental health problems; evaluation of women’s highsupport community residential services and women’s secure services; anddelivering race equality in forensic mental health. In addition, there were sixcalls relating to schemes for research training fellowships, training bursaries,PhD studentships, and new investigators. Also, there were three calls forsystematic reviews of research relevant to particular areas of forensic mentalhealth.

A further important component of the Programme comprised the threeresponsive funding schemes offered in 2003, 2004, and 2005. These aimed toattract research proposals with the potential to improve the delivery offorensic mental health services. All 87 applications made in response to thesethree general calls are considered in this paper. This analysis enables us tocompare successful and unsuccessful applicants to the Programme.

In Table 1 the numbers of projects are displayed by the year they started.The division into three four-year periods shows that the numbers of projectawards made were similar in the first two periods, and that the majority ofawards were made in the last four-year period.

Table 1. Number of projects (1996–2007).

Year award started

Projects

No. %

1996 1 1.31997 6 7.61998 9 11.41999 1 1.3

Sub-total 17 21.5

2000 2 2.52001 1 1.32002 3 3.82003 9 11.4

Sub-total 15 19.0

2004 19 24.12005 7 8.92006 16 20.22007 5 6.3

Sub-total 47 59.5

Total 79 100.0


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Principal investigators and co-investigators of the projects awarded a grant

Each project application has a principal investigator (PI) and a hostinstitution; there is also an opportunity to present co-investigators (CIs),who are signatories to the application. CIs may or may not be part of theactive research team after the grant has been awarded, but they are animportant part of the ‘shop window’ presented for consideration.

There were 57 different PIs involved in the 79 project grants awarded. Ofthese, 45 (79%) obtained just one project grant during the life of theProgramme. As Table 2 shows, two PIs – both female and from the sameuniversity – obtained 11 grants between them. There was no CI in commonon any of their grant applications, so they can be regarded as heading twodiscrete teams operating from the same institution.

For the first time period (1996–1999), the available forms do not readilydistinguish between CIs and potential team members. Only 10 of the 17grants awarded in this period clearly indicated CIs. In contrast, all but onegrant in the second period (2000–2003) and all but two grants in the thirdperiod (2004–2007) involved CIs. The lower number of CIs in the first periodis almost certainly due to the lack of standardised recording on the forms.The average number of CIs rose from 2.5 per project in the second period to3.3 per project in the third period, showing increasing use of CIs insuccessful bids over the entire period.

The links and relationships between PIs and CIs can vary. CIs can rangefrom a revered senior colleague to a quite junior colleague involved in aproject for more experience. However, while researchers can be both a co-investigator (or CI) and a team member (the latter role is not included in thisstudy), these roles are very different. The CI is a co-signatory of the grantapplication, and has a quasi-legal status in agreeing with the funding bodyto deliver the project: in contrast, a team member has more of an employee/employer relationship with the PI and the host institution.

Table 2. Number of project grants awarded to principal investigators and co-investigators (1996–2007).

Principal investigators Co-investigators

Total Male Female Total Male Female

1 45 34 11 153 85 682 8 5 3 21 13 83 1 1 – 1 1 –4 1 1 – 2 – 25 1 – 1 1 1 –6 1 – 1 – – –

Total 57 41 16 178 100 78


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On the 68 projects with recorded CIs, there were 211 named CIs (anaverage of 3.2 per project). As Table 2 shows, 25 of the 211 were CIs onmore than one project, so in total there were 178 different CIs.

Two males and two females were named as CIs on three or moreprojects; both the males (but neither of the females) were also PIs on otherprojects. Also, 20 individuals were both a PI on at least one project and a CIon at least one other – importantly, all but four of these were psychiatrists.Three of the remaining four were psychologists and one had a nursingbackground; all are professors (one was promoted after the grant). This is acrucial statistic, for it demonstrates how certain psychiatrists still capture themain action in both spheres of operation – that is, both as a PI and as a CI.

In terms of gender, just over one-quarter of the PIs were female but,owing to the remarkable activity of the two female PIs mentioned above,females obtained just over one-third of the grants.

While not infallible as a person may have come into the field at a laterage, the age of the applicant is a surrogate measure of experience in the field.Were these grants awarded to bidders comparatively early in their careers, inmid-career, or in the twilight of their active research lives? As Table 3 shows,the age profile of the PIs at the time of their first award starting isextraordinarily balanced, with the 45–49 age group the most likely agegroup to be awarded a grant for both males and females. The totals columnshows that there are equal numbers receiving awards who are younger andwho are older than this age group. However, overall, female PIs tend to bemore concentrated in the 45–49 age group.

Focusing now on the age profile of the CIs, Table 3 shows that femaleCIs tend to be younger than male CIs. While the modal group for males is45–49 years, the modal group for females is 40–44 years. Perhaps moresignificantly, 23% of male CIs are under 40 years of age compared with 42%of female CIs. We cannot tell from the figures presented whether thepredominance of females in the younger age groups is due to increasinginvolvement of females in forensic mental health research or to them beingless likely to continue in forensic research after the age of, say, 40 years.

Identifying the professional backgrounds of the PIs is not an exactscience. Medical and nursing training can be preceded or followed by a widerange of research and academic training in different disciplines. However,Table 4 presents, based on submitted CVs, what seems to be the coreprofessional orientation of the 57 successful PIs. In the event, fewdesignations in Table 4 were contentious. So, for example, a male trainedas a nurse and subsequently awarded a Ph.D. for a doctoral thesis insociology with the current title of ‘Senior Lecturer in Sociology’ seems moreappropriately categorised as a ‘social scientist’ rather than as a ‘nurse’.

Table 4 shows the number of PIs (n ¼ 57) and the number of grantsawarded (n ¼ 79). Psychiatrists predominate – 36 (or 63%) of the 57 PIswere psychiatrists and 57 (or 72%) of the 79 grants were awarded to


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Table

3.

Ages

ofprincipalinvestigators

andco-investigators

attimeofaward

starting(1996–2007).

Principalinvestigators

Co-investigators

Male

Fem

ale

Total

Males

Fem

ale

Total

Age

No.

%No.

%No.

%No.

%No.

%No.

%

20–24

––

––

––

11.0

––

10.6

25–29

––

13.6

11.3

55.0

10

12.8

15

8.4

30–34

12.0

13.6

22.5

22.0

79.0

95.1

35–39

713.7

310.7

10

12.7

15

15.0

16

20.5

31

17.4

40–44

815.7

27.1

10

12.7

19

19.0

20

25.6

39

21.9

45–49

17

33.3

16

57.1

33

41.8

22

22.0

67.7

28

15.7

50–54

815.7

27.1

10

12.7

12

12.0

911.5

21

11.8

55–59

713.7

310.7

10

12.7

13

13.0

67.7

19

10.7

60–64

23.9

––

22.5

22.0

22.6

42.2

65þ

12.0

––

11.3

22.0

––

21.1

Noinform

ation

––

––

––

77.0

22.6

95.1

Total

51

100.0

28

100.0

79

100.0

100

100.0

78

100.0

178

100.0


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psychiatrist PIs. Psychiatrists were much more likely to be awarded morethan one grant over the Programme’s lifetime than members of otherprofessional groupings. Psychologists – with 14% of the PIs and 11% of thegrants – were the next most frequent beneficiaries of the Programme.

Of the 12 PIs who received two or more grants, all but one werepsychiatrists: the exception is a female psychologist. Hence, while there wereexceptions, psychiatrists continued to be the major recipients of multiplegrants in this forensic mental health programme, which undermines anyapparent shift in the professional composition of grant holders.

Turning to the professional background of the CIs: Table 5 indicatesthat, among the CIs, the three professional groupings of ‘psychiatrist’,‘psychologist’, and ‘other’ were fairly evenly balanced in terms of the

Table 5. Professional background of co-investigators (1996–2007).

Co-investigator Grants awarded

Professional background No. % No. %

Psychiatrist 59 33.1 76 36.0Psychologist 48 27.0 54 25.6Other 66 37.1 76 36.0Nurse (17) (9.6) (23) (10.9)Social scientist (18) (10.1) (19) (9.0)Health specialties (16) (9.0) (19) (9.0)Statistician (7) (3.9) (7) (3.3)Other (8) (4.5) (8) (3.8)

No information 5 2.8 5 2.4

Total 178 100.0 211 100.0

Table 4. Professional background of principal investigators (1996–2007).

Principalinvestigator Grants awarded

Professional background No. % No. %

Psychiatrist 6 63.2 57 72.2Psychologist 8 14.0 9 11.4Other 13 22.8 13 16.5Nurse (4) (7.0) (4) (5.1)Social scientist (7) (12.3) (7) (8.9)Health economist (1) (1.8) (1) (1.3)Service user (1) (1.8) (1) (1.3)

Total 57 100.0 79 100.0


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numbers of CIs. In fact, the ‘other’ category provided the most CIs, with 66(or 37%) of the total. However, when the actual numbers of grants awardedare considered, the number of psychiatrists equals that of the ‘other’category. This simply reflects the fact that, as with the PIs, psychiatrists weremuch more likely to have more than one award than the other professionalgroupings.

Combining the analysis of the PIs and the CIs shows that the successfulprojects involved a total of 213 different persons (127 males and 86 females)as either PI or CI (or both). Also, 20 persons were involved at some pointboth as PI and CI, 37 were involved as PIs only, and a further 156 were CIsonly. We consider these 213 persons as the main representatives of the FMHresearch community. First, however, how do these persons compare to thosewho failed to obtain a FMH project grant?

Comparing the successful and unsuccessful candidates

There were three major calls under the responsive funding scheme in 2003,2004, and 2005. The general context was highlighted in the remit: ‘Fullapplications are invited to undertake research which has the clear potential toimprove the evidence base for the provision of forensic mental health servicesin NHS, criminal justice and community settings.’ These calls produced amuch wider response than the more specific calls. A total of 87 applicationsemerged in response to these calls. As Table 6 shows, 40 (or 46%) were short-listed and 25 (or 29% of the original applications) were awarded a grant.Table 6 shows that a similar number of projects were short-listed each year.However, in 2003, all but one of those short-listed was awarded a grant, whilein 2004 and 2005 about one-half of those short-listed were successful.

The responsive funding scheme accounted for almost one-third of theproject grants awarded by the Programme. The main aim of this part of theanalysis will be to compare successful and unsuccessful applicants.

Of the 87 applications, 56% of the PI applicants were male and 44%were female. Of the 49 male PI applicants, 16 (or around one-third; 33%)obtained a grant, while of the 38 female PI applicants 9 (or around one-quarter; 24%) similarly obtained a grant.

Table 6. Three calls under the responsive funding scheme in 2003, 2004, and 2005.

Year No. of applications No. short-listed No. awarded

2003 35 13 122004 27 15 8*2005 25 12 5

Total 87 40 25

*In 2004, six were awarded for projects and two were awarded as fellowships.


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Comparison of professional groups produced more striking contrasts.Psychologists, with 40 applications, were the most prolific applicants,compared with psychiatrists with 33 and ‘other’ groups with 14. However,the psychologists’ success rate was markedly inferior with only 13% of theapplications resulting in an award; the ‘other’ groups were more successfulwith 21% being awarded a grant. Psychiatrists, in contrast, with a 51%success rate had a more than even chance of an award. In fact, two-thirds ofthe project grants went to psychiatrist PIs.

However, we were also interested in carrying out a more systematicstatistical analysis to try to assess any interactive effects. We based ouranalysis on the 23 successful project applications (disregarding the twosuccessful applications ‘captured’ by the fellowship programme – see note toTable 6) and the 62 unsuccessful applications. The 23 successful PIs had 63persons signed up as CIs, while the 62 unsuccessful PIs had 176 signed up asCIs.2 Taking into account multiple applications, this produced a total of 324applicants to consider (either as PI or CI). The analysis was based on year ofapplication, age at time of application (divided into those aged under 40,those aged 40–49, and those aged 50 and over), gender, and discipline of theapplicant (divided in terms of psychiatrist, psychologist, or other).

Chi-squared tests on each variable for all the applications showed thatyear of application (p 5 .001), discipline (p 5 .001), and age3 (p 5 .05)were all significant, while gender was not significant.

When PIs and CIs were considered separately, similar patterns emerged.For the 85 PIs, discipline was highly significant (p 5 .001), year ofapplication was significant but less so (p 5 .05), while the age and gender ofthe applicants were not significant. For the 239 CIs, year of application washighly significant (p 5 .001), discipline was significant but less so (p 5 .05),while again age and gender were not significant. We considered that the yearof application had little relevance to any potential issue of discriminationand hence it was omitted in the subsequent analysis.

Next, we carried out a logistic regression analysis, which controls forother variables in the analysis and allows us to identify any interactionsbetween variables. This produced some rather dramatic results. For both PIsand CIs separately, we identified that gender and its interaction with ageand discipline was not significant. There was, however, a significantinteraction of discipline with age. We represent the outcome of this analysisin Table 7.

Table 7 shows that, of the PIs aged under 50, no psychologist obtained agrant and only one from the ‘other’ disciplines was successful. In contrast,15 out of the 26 psychiatrists (58%) submitting an application as a PI weresuccessful. Among the CIs, the contrasts are not so stark. In fact, amongthose under 40 years of age, the ‘other’ disciplines did particularly well with10 out of 20 (or 50%) receiving a grant. Of those aged 40–49, psychiatristsand psychologists were equally successful (among these applicants, just over


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Table

7.

Interactioneff

ects

ofageanddisciplinein

term

sofsuccessoftheapplications.


Co-investigators

Applications

Successes

Probabilityofsuccess

Applications

Successes

Probabilityofsuccess

Aged

under

40

Psychiatrist

83

.375

16

3.188

Psychologist

10

0.000

36

5.139

Other

40

.000

20

10

.500

Aged

40–49

Psychiatrist

18

12

.667

34

13

.382

Psychologist

80

.000

24

9.375

Other

81

.125

25

6.240

Aged

50andover

Psychiatrist

62

.333

20

9.450

Psychologist

21

4.190

40

4.100

Other

21

.500

24

4.167

Total

85

23

.271

239

63

.264


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one-third were successful), while the ‘other’ disciplines were less so. Of thoseaged 50 or over, psychiatrists (with 45% of the applicants beingsuccessful) did particularly well compared with the other groups. Further,as Table 8 shows, the comparative lack of success among male psychol-ogists – of whom only around one in eight have successful bids as CIs – is ofinterest.

So what does this all mean in terms of understanding the success rates ofvarious types of PIs and CIs? The first point to make is that the success (ornot) of CIs is not independent of the success (or not) of PIs. In fact, we areimplicitly identifying the construction of the more successful teams whichcomprise a PI and (usually) some CIs.

However, considering PIs and CIs separately, the results demonstrate theremarkable success of psychiatrists as PIs in the bidding under theresponsive funding scheme. Those aged 40–49 did particularly well, withtwo/thirds of their applications funded. Furthermore, male and femalepsychiatrists did equally well, with over one-half of their bids funded. This isin sharp contrast to psychologists: the younger and middle-aged psycho-logists (i.e., those aged under 50) did disastrously, with no bids funded.While some psychologists aged over 50 were supported, they were still out-performed by psychiatrists and other disciplines in this age group.Overall, male and female psychologists seemed to do equally badly in thesefunding stakes. The numbers of PIs from ‘other’ disciplines werecomparatively small, so one suspects that chance fluctuations are crucialwith this group.

Among the CIs, where the numbers are larger, it is evident that the‘other’ disciplines did particularly well among the younger age groups; one-half of their applications were supported. The only other group which cameclose to this were the CI psychiatrists over 50 years of age; approaching one-half were supported. In contrast, most other groups did comparativelypoorly.

The puzzle – which was a surprise to the authors who were involved inthe process – is the disastrous showing by the psychologists who applied,whether as PIs and CIs. In contrast, the success of psychiatrists either as PIsor as older CIs is perhaps less of a surprise. The ‘other’ disciplines emergedmore successfully as young CIs. Successful teams seem likely to comprise apsychiatrist as PI with CI(s) from ‘other’ disciplines or an older psychiatristCI. Quite simply, psychologists seem rarely to be part of successful teams.However, a detailed consideration of the construction of successful teams isbeyond the scope of this article.

Meanwhile, an issue of concern to us was possible gender bias and, onthis topic, we can say with some confidence that, when other factors arebrought into account, there were no evident gender biases in the award ofgrants beyond noting that male psychologists are doing poorly both as PIsand CIs.


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Table

8.

Interactioneff

ects

ofgender

anddisciplinein

term

sofsuccessoftheapplications.


Co-investigators

Applications

Successes

Probability

ofsuccess

Applications

Successes

Probability

ofsuccess

Fem

ale

Psychiatrist

11

6.545

25

9.360

Psychologist

22

2.091

38

10

.263

Other

41

.250

34

10

.294

MalePsychiatrist

21

11

.524

45

16

.356

Psychologist

17

2.118

62

8.129

Other

10

1.100

35

10

.286

Total

85

23

.271

239

63

.264


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The forensic mental health research community

The Department of Health Forensic Mental Health R&D Programme hasprovided a range of funding opportunities for the forensic mental healthresearch community. This article has largely focused on those who havebeen successful in their applications, and certainly these will have gainedfrom the Programme – it should have helped to further their researchinterests, and possibly their careers. We have not obtained information onthe numbers and interests of those involved in forensic mental healthresearch who did not apply for funding from this Programme.

We are now trying to assess the general state of the forensic researchcommunity – its profile as at December 31, 2007 – by considering members’ages, gender, and professional groupings. We will focus on all those whoobtained project grants during the 12-year life of the Programme, whether asPIs or as CIs. Many of the PIs will have a very high commitment to forensicwork. CIs may be a bit different. For many – perhaps the majority – forensicmental health work will be their main interest; however, some (for example,statisticians) will be specialists in other fields whose expertise has beenbrought into the design and analysis of a forensic project.

The profile on December 31, 2007, of successful applicants to the FMHProgramme as PIs or CIs (or both)

Table 9 shows the age profile as at December 31, 2007, of those who havebeen successful applicants to the Programme. Of course some individuals’activity and interests may change. Some may have moved from research to a

Table 9. The ages and gender of all those who have been successfully involved asapplicants in the FMH Programme as principal investigators or co-investigators (orboth) on December 31, 2007.

Age

Male Female Total

No. % No. % No. %

25–29 3 2.4 6 7.0 9 4.230–34 1 0.8 8 9.3 9 4.235–39 9 7.1 9 10.5 18 8.540–44 18 14.2 21 24.4 39 18.345–49 26 20.5 17 19.8 43 20.250–54 27 21.3 7 8.1 34 16.055–59 22 17.3 12 14.0 34 16.060–64 9 7.1 4 4.7 13 6.165þ 6 4.7 – – 6 2.8No information 6 4.7 2 2.3 8 3.8

Total 127 100.0 86 100.0 213 100.0


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teaching or a practice role that does not leave time for research. Others mayhave retired while, sadly, some may have died. Nevertheless, the remainingpersons are likely to be pivotal players – who might be regarded as thebackbone of a research community in forensic mental health.

Table 9 indicates that these players are quite evenly divided in the fourage-groups between 40 and 59 years. The females, on average, are youngerthan the males, with the peak age group being 50–54 years (21%) for themales and 40–44 years (20%) for the females. This difference largely reflectsthe preponderance of females among CIs, while the more responsibleposition of PI will tend to be held by older persons and these are more likelyto be males. Whether this is a generational effect – that is, whether there willbe a higher proportion of older females becoming PIs in the next decade orso – is a moot point and cannot be answered by these data. However, thesedata do indicate that, in terms of age distribution, the potential researchcommunity in forensic mental health seems quite usefully spread between agood range of age groups.

Moving on to the professional groupings of these successful applicants,Table 10 highlights how psychiatrists in general – and male psychiatrists, inparticular – dominate as the main body of potential researchers in thisforensic mental health field. Just over one-third of the grants were awardedto psychiatrists (in fact, one-quarter of the grants were awarded to malepsychiatrists), while psychologists secured one-quarter of the grants (withfemale psychologists outperforming their male counterparts).

Among the other professional groupings, around one in 10 grants wereawarded to nurses and a similar proportion to social scientists. Male nursesseem to be considerably more successful than female nurses, while among

Table 10. Professional backgrounds and gender of all those who have beensuccessfully involved as applicants in the FMH Programme as principal investigatorsor co-investigators (or both).

Professional background

Male Female Total

No. % No. % No. %

Psychiatrist 56 44.1 21 24.4 77 36.2Psychologist 25 19.7 28 32.6 53 24.9OtherNurse 15 11.8 5 5.8 20 9.4Social scientist 12 9.4 13 15.1 25 11.7Health research 7 5.5 8 9.3 15 7.0Medical/geneticist 4 3.1 4 4.7 8 3.8Statistician 3 2.4 5 5.8 8 3.8Service user 1 0.8 – – 1 0.5No information 4 3.1 2 2.3 6 2.8

Total 127 100.0 86 100.0 213 100.0


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the professional groupings in the ‘other’ category, the gender balance ismore even.

Conclusions

The study has been modest in both aims and design. It has used availableproject files and not sought to supplement these with additional informa-tion. We have not attempted to evaluate the impact of the Programme oneither scholarship or practice.

However, we do know that the Programme had an impact, contributingto developing a forensic mental health research community by bringingresources to an academic area that would otherwise have had very limitedfunding. This study shows the profile of the research community thatdeveloped during the 12-year life of the Programme. It is not impossible, butit is unlikely, that this community would have developed without thefunding provided by the Programme.

We can say with some confidence that the forensic mental healthresearch community, before the recent structural changes in NHS R&Dfunding, looked more buoyant than it had done for decades. There are nowmany players in the field, rather than the three or four figures whodominated the meagre field of forensic mental health research in the 1960s.Instead of just a few male psychiatrists, females and other professionalgroupings now play a very significant part. The age distribution lookshealthy and there is no imminent retirement problem due to a particularpeak in an older age group. This is very encouraging.

Although psychiatry no longer has an almost monopolistic position inpursuing research in this area and several other professional groups areinvolved, nevertheless psychiatrists retained a dominant position. Psychia-trists were more likely to get awards and very much more likely to obtainmultiple awards than the other professional groupings. Psychologists nowalso have a massive presence in this area, but did less well proportionately inobtaining grants than psychiatrists. This may be because psychiatristsproduced better proposals and focused on topics more welcome to theadvisory committee, or it may be that the committee was, albeitunconsciously, biased towards accepting proposals from psychiatrists. Thestudy identifies, but does not answer, a question about the continuingdominance of psychiatry.

The logistic regression analysis indicated that the crucial variable inidentifying the likelihood of a successful project application in the course ofthe Programme is discipline rather than gender. Certainly, females nowa-days have a presence in the forensic field which would have been quiteunimaginable even a couple of decades ago, and yet some familiar patternscontinue. Females are more likely to be in the role of CI rather than PI.However, females involved in research in this study tend to be younger than


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the males, so perhaps there will be more female PIs as the females gain moreexperience. Or are females perhaps emerging more slowly from subordinateroles than some might expect?

The professional groupings categorised as ‘other’ in this study are toodifferent to be considered as a coherent group. There is little doubt that theirpresence – like that of females – is now evident in ways that would have beenunimaginable even a decade ago. However, again like females, it is not tooclear how the research base of these disparate professional groups will grow.It can be noted that the ‘other’ group includes nurses – still not representedproportionately to the numbers in their profession.

We must now consider the structural issues that are likely to affect allmembers of the forensic mental health research community to some degree.The permanence or otherwise of this community is open to question.

Funding from the Forensic Mental Health R&D Programme had aprotected status that everyone knew would end at some point. However, theprecipitate nature of the ending caused both surprise and concern. Surprisecan be dealt with, but concerns need to be addressed.

Structural issues highlight the fragility of the FMH research community.The Programme has clearly identified a few highly committed, over-worked,focused individuals. The hinterland of forensic researchers is much richerwith talent than many might have expected. However, our view is that theforensic mental health research community is currently very fragile.Researchers now compete for funding, against all health sectors, from theenhanced generic funding schemes available in England, and at the time ofwriting we have not seen any forensic research proposals achieve funding.Without research funding, clinical academic posts will not be viable and theevidence base for the provision of forensic mental health services – a majorgrowth area – will be impoverished.

Hopefully, this modest study about the ages, gender, and professionalgroupings of the FMH research community provides a basis for thinkingabout the future of forensic mental health research. There is much that isvery encouraging, but the fundamental changes in the funding of research inthe National Health Service are likely, in our view, to have the unintendedconsequence of undermining the substantial progress that has been made.

Acknowledgements

An earlier version of this paper was presented at the 7th Annual IAFMHSConference in Montreal, Canada, in June 2007. We appreciate the help of ProfessorBrian Francis in developing the statistical analysis and the three anonymousreviewers for their comments.This paper is written by persons involved in administering the Department of

Health Forensic Mental Health R&D Programme – Keith Soothill was formerlyChair, Kathryn Harney was Manager, Adele Maggs was Administrator and ClairChilvers was formerly Director of the Programme. Hence, we could be regarded ashaving a potential conflict of interest in writing this paper. After all, the programme


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was closed down, some of the authors were no longer employed in their formerpositions and the funding was spent elsewhere, no longer on forensic mental health.Certainly our aim is to try to ensure that the debate on the future of forensic mentalhealth research continues.

Notes

1. Martin Innes (2004) focuses on how ‘media coverage of a small number ofserious violent offences functions to articulate and animate social reactions tocrime and social control in contemporary social life’ (p. 15). He argues that theconcept of signal crimes ‘focuses upon the processes of social reaction throughwhich a criminal event comes to be defined as a problem and is thereby imbuedwith meaning for a public audience’ (p. 17).

2. In fact, the same persons could be both successful and unsuccessful PIs and/orCIs. This analysis focuses on the total number of applications.

3. Ten of the CI applicants had no recorded age, and these cases were discardedhere and for the logistic regression analysis.

References

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Department of Health (2006). Best research for best health: Introducing a newnational health strategy. London: DH Publications.

Innes, M. (2004). Crime as a signal, crime as a memory. Journal for Crime, Conflictand the Media, 1, 15–22.

Rogers, P., & Soothill, K. (2008). Understanding forensic mental health and thevariety of professional voices. In K. Soothill, P. Rogers & M. Dolan (Eds.),Handbook on forensic mental health (pp. 3–18). Cullompton, UK: Willan

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the forensic mental health tribes: identifying a research community

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