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Therapeutic Approaches to
Fire-setting behaviour in people with
Developmental Disabilities
30th March 2012
Dr. Harm Boer and Dr. Nicola Murphy
Introduction
Background
Fire setting
Treatment
Janet Shaw Clinic
Conclusions BBC
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Background
Jonathan Martin - The Man Who Burned
York Minster www.bbc.co.uk/dna/h2g2/A4187649
No LD, but history of repeated mental illness
set fire to York Minster in 1829 and was sent to
Bedlam on the grounds of insanity
Courts often request psychiatric reports to
assess dangerousness Prins 2005
About half of boys between 5 and 10:
Fire play – few set serious fires Murphy and Clare 1996
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Fire setting statistics for 2008 www.communities.gov.uk
UK England
2008 2008
Total fire deaths 451 341
All dwelling fire deaths 353 262
Accidental dwelling fire deaths 294 214
Non-fatal casualties 12,215 9,401
Total fires 328,000 252,000
Dwelling fires 50,000 39,000
Accidental dwelling fires 41,000 33,000
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
PLD (People with LD) and arson
PLD may be more likely to set fires Walker and
McCabe 1973
Looked at people detained in hospital for
arson
Taylor (2002): 20% of LD hospital male
inpatients had convictions for arson
Wheeler et al (2009) found few fire setters
amongst offender referrals of to CTLDs
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
PLD (People with LD) and arson
Kelly et. al (2009) conducted research with LD patients
from Brooklands and an MSU at Ridgeway Partnership
trust.
a) Perceived inability to effect social change and
b) Childhood experiences of fire and fire setting were positive
risk factors.
No evidence for an association between family problems
and fire-setting.
Fire-setting and Learning Disability
30th March 2012 Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Arson Associated with
Low intelligence
& social disadvantage
Young (single) men
Reluctance to prosecute women
Complex Motives
Anger and revenge
Difficulties in
Expression of emotion
Interpersonal relationships
Conflict resolution
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Therapeutic Work Slide 1
There are few studies on therapeutic work
on PLD e.g. Taylor et al, 2002; Hall et al, 2005
Taylor: 8 men and 6 women in 3 groups
Patients detained in low secure hospital
Mild and Borderline LD
40 cognitive-behavioural sessions of 2 hours
Improvements on outcome scales (e.g. Fire
Interest Scale and Fire Attitude Scale)
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Therapeutic Work Slide 2
Hall et al (Calderstones)
6 men with mild or borderline LD
16 weekly sessions of 90 minutes
Cognitive behavioural
Outcome scales e.g. FIRS and FAS
Results “very favourable”
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Janet Shaw Clinic
MSU for PLD
15 beds
Part of Forensic Service at Brooklands
Brooklands – 120 beds for PLD
Forensic Service – 56 beds
Low secure:
Three male units – 10,6 and 10 beds
Three units for women – 5, 5 and 5 beds
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
JSC: Offences, Mental Disorder
Offences charged with:
Arson: 30% (24)
Sexual offences: 28% (22)
Murder/ Manslaughter: 4% (3)
Mental disorder
Psychotic disorder 33% (26)
Mood disorder 11% (9)
Pervasive developmental disorder 4% (3)
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
The Brooklands Fire Setters Treatment
Programme (FSTP)
1. Getting Going/Establishing the group
2. High Risk Me/Low Risk Me
3. Fire Education
4. My Feelings
5. Making Excuses
6. Life Mapping
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Programme Content (Cont.)
7. Talking about my offence
8. What happens to me when I offend
9. What my offending does to others
10 –16. Relapse prevention
17. Am I cured?
18. Ending the group
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
The Brooklands Fire Setters
Treatment Programme (FSTP)
Cognitive - Behavioural
Establishes the complex motives
12 - 18 months approx
7.5 hours of group work per week
Post Programme follow up support
Modular interlinked manual
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Results of FSTP
22 Subjects
19 male, 3 female
Mean IQ: 66 (WAIS-R)
Mean Age: 31
4 Groups
First group shorter pilot group
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
FSTP: Environmental Changes
0
2
4
6
8
10
12
14
16
18
Secure Open
hospital
Staffed
community
Independent
community
Pre-Treatment
Post-Treatment
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Individual Offence-Specific
Treatment
Clinical Psychologist
Long-term
Aim is to address all of factors contributing
to Arson offences
30th March 2012
Fire-setting and Learning Disability Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Formulation
Offence cycle
Antecedent factors and triggers
Cognitions, emotions and
behaviour at the time of fire
Understanding of Arson
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Intervention Cognitive distortions:
Minimisation (I only set fire to a
derelict house)
Denial (I was not there)
Blame (I was drunk, I had an argument)
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Intervention Fire education
Consequences of Arson
Victim awareness
Visual material: ‘Arson taskforce’ material,
videos, TV excerpts, newspaper cuttings
30th March 2012
Fire-setting and Learning Disability Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Intervention How to achieve power and control
through non-offending means
How to resolve conflict more
appropriately
How to problem solve more effectively
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Offence-related interventions
Attachment
Abuse issues
Substance misuse
Self-esteem
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Case Study: ‘Simon’
53 year old man
2 counts of common assault
3 counts of Arson
FSIQ 54
Cognitive abilities mean he cannot
access FSTP
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Case Study: ‘Simon’
Aim of treatment was to:
respond appropriately to
provocation and conflictual
situations
Reduce risk of Arson and Assault
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Case Study: ‘Simon’
Difficulty identifying his own thoughts
Problems sequencing
Rigid beliefs about aggression and violence
Did not understand fire could kill people
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Questions
How might you help Simon to identify his own feelings? Other people’s?
How would you help him to link these with thoughts and situations?
How might you help him to learn about the consequences of fire?
How will you help him to remember the work?
What risks might you need to be aware of when working with Simon?
30th March 2012
Fire-setting and Learning Disability
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012
Conclusions
Some evidence of treatment effectiveness of
both group and individual treatment
Much more research is needed
E.g. Is a long programme such as FSTP at
Brooklands better than much shorter groups?
Outcome studies
What works?
Faculty of LD RCPsych & BPS
Meeting, 30/03/2012