Transcript Assessment and Treatment of Personality (Disorder)

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Joint venture between NHS & NOMS
Part of the National Offender Personality
Disorder Pathway: residential specialist
service for prisoners with personality related
needs
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Mersey Care and HMP Garth
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Dedicated partnership staff recruitment
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To promote a safe, positive & empowering
environment (EE)
To enhance the capacity of the workforce
To improve psychological health & wellbeing, functioning & interpersonal skills
To reduce the likelihood of repetition of risk/
serious offending
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Men over 21 years of age
Serving a sentence of imprisonment of at least two years still left to
serve / less than 20 years
Assessed as presenting a high likelihood of offence repetition & high
risk of harm to others (range of offences)
Evidence of significant personality related needs
There is a clinically justifiable link between personality needs and
risk / offending
Evidence of motivation and ability to engage and benefit
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Officer staff
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Prison officers
3 x Supervising officers
1x Custodial Manager
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Prison services
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Workshops, Education, Healthcare, Substance use
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Resources (physical):
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48 beds (3 spurs) + Dining area (3 x 1:1, 3 Group rooms)
No. 1 landing: 3x office space, 3x group rooms
Dedicated garden area
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Clinical Lead
Clinical Operational Manager
7 Psychologists (1xB8b, 3xB8a,3xB7), 2
Psychol Assts
2xOT, 2xOTA
2x Social Worker
2x Nurse Therapists, 1x CreativeTherapist
1x0.8 Psychiatry
Research Asst
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3 month admission assessment phase
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Collateral / collaborative history
Mental Health Assessment (SCID-1)
Personality Assessment (IPDE)
Clinical and risk assessments (HCR, RSVP +)
Health / Criminal Justice/ Probation records
Observation / interaction feedback
Team and individual formulation
Change and Identity Group
Initial engagement
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Therapeutic alliance
Stabilisation of acute difficulties / adjustment
Motivational work
Development of collaborative formulation
Identification of obstacles to treatment
Individualised Formulation based treatment / risk plan
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The system as therapy and therapeutic
Current interactions are a reflection of personality needs,
patterns of trauma and offending
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Current interactions are used as an opportunity to learn
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Providing and developing secure attachments
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Behaviour is functional and meaningful
‘every contact counts’
‘every interaction is a potential therapeutic interaction’
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Livesley (2012) phases of containment &
change (framework)
Establishing
safety
Containment of symptoms
Regulation & control
Exploration & change
Integration & synthesis
STRUCTURE: Establish & maintain structure and
clarity.
 RELATIONSHIP: Collaboration, co-operation,
mid /long term focus, (mis)trust as the norm.
 CONSISTENCY: and flexibility; frameworks for
change and adaptation; individual difference.
 VALIDATION: Listening , hearing, responding
 MOTIVATION: Ambivalence, fear and conflict part of the process.
 SELF-REFLECTION: graded expectations;
individual differences; complexity.
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◦ Evidence based 1:1 psychological therapy
◦ Psycho-Ed and Skills based intervention groups
◦ Short-term responsive therapies for specific needs
◦ Substance use service / group work (partnership)
◦ Exploratory psychotherapy groups - model specific
◦ Drama, art, music based therapies
◦ Attachment / trauma based milieu
◦ Enabling Environment principles and practice
◦ Community Meetings
◦ Meaningful Activities
◦ Cultural factors
◦ Family liaison / involvement
◦ Medication within formulation based intervention
◦ Community project work (HOOT,GOOP, Dining
Hall)
◦ Healthcare
◦ Whole team involvement and joint
work/partnership
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Individual Treatment Plans
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Review of outstanding needs
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Pathway Progression
◦ Formulation based plan based on men’s clinical and risk
needs and progress and future goals /pathway
◦ Aims to maximise strengths, self-awareness and independent
choice /management of difficulties
◦ Aims to enhance range of coping skills, psychological health
and functioning
◦ Assessment and identification of progress / outstanding
treatment and management needs (9,18,23, 24+mth reviews)
◦ Sentence planning and CPA links
◦ Referral and preparation for engagement in future pathway
eg. accredited programmes/ PIPE/ normal location
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Sharing of information
Recovery & Relapse Prevention
Maintenance & Outreach
Consultation / integrated formulation and planning
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Personality / risk profile –
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Reducing re-offending
IPDE, PCL-R, HCR, RSVP
vs nature and level of risk /
offending needs
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Clinical /risk assessments:
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Behavioural assessment –
emotional coping, problem
solving, interpersonal skills, treatment engagement/ motivation, self
worth, trauma, occupational /educational functioning
adjudications
incident data (IRs, ACCTs, CABs,
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I am positive that the help and feedback on this wing will start me
down a path of being able to have a life in which I can engage better
and socialise with others. I am positive that I can get help to help
myself. This is what I asked for before coming to prison. This is the
start for me to change my life as much as I can in a positive way.
If yer coming to the Beacon, its not an easy ride. The big thing’s
called engagement, this is nowhere you can hide.
We are understood by the staff around us.
There are positive interactions between staff and prisoners; this is a
noticeable difference to the usual prison experience.
Facing ourselves and our past can be difficult but positive.
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4
7
2
1
9
3
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substance use
risk / allegations
own request
cognitive functioning
engagement / treatability
mental health
Total – 26
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Co-development and co-production
Integrating within institution and OPD
Pathway
Balancing therapy with security: cultures
Clinical /offence / security mix
Thresholds for admission/de-selection
Expectations: prisoners <-> staff:
Outreach / in-reach resources
Respite / time out: prisoners/staff
anxiety – expert uncertainty