Transcript Dual Diagnosis - Safe in East Sussex

Bradley Review Terms of Reference
• To examine the extent to which offenders with
mental health or learning disabilities could, in
appropriate cases, be diverted from prison to
other services and the barriers to such
diversion
• To make recommendations to the
government, in particular on the organisation
of effective court liasion and diversion
arrangements and the services needed to
support them
Bradley-Key Recommendations
• 82 recommendations accepted by the
government
• Early identification and assessment of mental
health problems or learning disabilities
• Review responsibility for health services in
police custody
• Section 135/136 Places of Safety
• Criminal Justice Mental Health Teams to ensure
continuity of care
Key Recommendations
• Common Assessment Tools
• Improved data collection and sharing of
information
• Commissioning and planning of services
• Improved Training at every stage of the Criminal
Justice System
• National Joined up approach with the
establishment of a National Programme Board
and National Advisory Group
• Regional and local partnerships
• Better use of existing resources
• Leadership
Lord Patel of Bradford
Independent Group looking at
drug treatment in prison
1. Improve quality
2. Increase innovation
3. Achieve efficiencies
Challenges
136 adult prisons – 84,000 prisoners have Complex
problems:
• 10% of those sentenced have a diagnosed severe and
enduring mental illness
• 69% of those who enter prison have taken drugs in
previous 12 months
• 40% report injecting drugs in period preceding
imprisonment
•Twice as likely to commit suicide than non dependent
prisoner
Challenges
Dual Diagnosis
• 74% of users of drug services and 85% users of
alcohol services have experienced mental health
problems
• 44% of mental health service users reported drug use
and were assessed to have used alcohol at
hazardous or harmful levels in the past year
• In week following release, male offenders are 37
times more likely to die of drug overdose. Women are
69 times more likely
Recommendations
• Unified cross government drug treatment and
intervention strategy
• National Health and criminal justice outcome
model with aim of reducing reoffending and
improving rehabilitation
• Streamlined communications system
• National drug treatment and interventions
framework (communities and prison)
• Establishing effective links with wider criminal
justice, health and social care system
Recommendations
• Streamlined commissioning system
• Collaborate and jointly commission at a local
level to ensure the needs of drug users in prison
and on release are met
• Commissioners and local partners focus on
increasing social capital of users and carers
through ‘Recovery Champions’ and appropriate
community groups
The Local Picture
Information from Court Assessment & Diversion 2007
FIG.3
Brighton
Chichester
The Brighton area has
traditionally been the busiest
area for Court Liaison work
and despite the inclusion of
the West Sussex figures
Brighton remains the most
significant area. A simpler
way of viewing the workload
distribution is.
Crawley
Eastbourne
Hastings
36% Brighton & Hove
29% West Sussex
33% East Sussex
PCT Area
13%
1%
Bexhill & Rother
2%
2%
1%
36%
12%
5%
17%
11%
London Area
Other
Sussex Downs & Weald
Worthing
In practise with two bases in
Worthing and Hellingly, the
Hellingly assessors have
worked mainly in the East and
Brighton and Hove. The
Worthing assessors have
worked mainly in the West &
Brighton.
East Sussex-The way forward
• Build on learning and areas of good practice from the
Brighton Mental Health Court Pilot
• Mental Health Nurse available daily at court
• Comprehensive pro-active screening and assessment
• Creative use of community orders
• Court review processes
• Involvement of MHCP post sentence
• Develop a collaborative approach to the assessment and
management of dual diagnosis cases
• Develop flexibility to embrace new areas of practice such as
learning disability or dual diagnosis with substance misuse
as the primary need
Facilitated Discussion
Based on the presentation and your experience…
• What are your thoughts on the the mental health needs
of offenders in East Sussex? (e.g. is this larger/smaller
than expected)
• Are there areas of East Sussex where you think there is
more or less need?
• Are there any groups of offenders who are more likely to
have an unmet mental health need? (e.g. older
offenders, BME groups of offenders)
• Do offenders experience any further barriers in
communicating their mental health needs and seeking
support?
Workshop Part 2
Mental Health Services for Anxiety and Depression
Health in Mind
Primary Care Mental Health Workers
• 22 in post
Provide:
• Assessment and onward referral
• Advice, signposting & support
• Brief intervention
• Providing advice to Primary Care staff
Social Care
Direct
GP
Signposting
Day Services
PCMHW
Consultant
Advice
CRHT
Urgent 4
hours
Recovery
Step 2
7 Day LTSU
Step 3
Mental Health Services for Anxiety and Depression
CBT Therapists
• 11 qualified, 32 in training
Provide:
• 1:1 Therapy for anxiety disorders and depression
• Workshops – Mindfulness, Mind over Mood, Self-esteem,
Anger management
Criteria: Mild to severe anxiety and depression, low to
moderate risk, moderate impact on functioning, able to
develop a collaborative alliance & develop a focus for
therapy
Facilitated Discussion
In your experience…
• Is there good awareness of the Health in Mind service and its
access routes within your service?
• Do offenders have any specific needs that might present a barrier to
accessing the Health in Mind service?
• What elements of the Health in Mind service are likely to be the
most beneficial for offenders in the community?
• Are there elements of the Health in Mind service that are less likely
to benefit offenders in the community?
• Are there other means of supporting offenders with mental health
needs such as anxiety or depression? What are the
advantages/pitfalls with these?
Coffee Break
(15 minutes)
Workshop – Part 3
Integrated Offender Management
• Discusses people who have the greatest
need and are most likely to reoffend at
weekly multi-agency meetings
• Aims to put a package of support around
clients that meets their needs holistically
• Ensures intervention is directed where the
need/harm is greatest
Facilitated Discussion
How can the service you represent link in
with the Integrated Offender
Management approach to ensure the
mental health needs of offenders are
met?