Low secure service for Scottish women The Ayr Clinic Clinical Forum: Women in Forensic Mental Health Setting 07.02.2014 Pradeep Pasupuleti, Laura Stevenson.

Low secure service for Scottish womenThe Ayr ClinicClinical Forum: Women in Forensic Mental Health Setting07.02.2014

Today’s talk

• Introduction• Service at the Ayr Clinic• Our Experience• Future plans

The Ayr Clinic, Partnerships in Care

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The Ayr Clinic

• 2008• 34 beds• 2 admission wards and 1 rehab ward• Low secure service

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The Ayr Clinic, Partnerships in Care

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Female service• Admission ward and mixed-sex rehab ward• MDT model• 2008-2013• Total admissions - 95• Total female admissions- 27• Discharges- 14• Longest admission- 4 years 7 months• Shortest- 1 month

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The Ayr Clinic, Partnerships in Care

Arran ward 6

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Patient profile• Story of Miss S- 25 years old, inpatient since the age of 15,

transferred from IPCU, prolific self harmer specifically inserter, vague psychotic symptoms

• Story of Miss A- 21 years old, in care since the age of 9, prison transfer, serious offender, violence as primary defense, self harm behaviour, psychotic episode

• Story of Ms M- 46 year old, schizophrenia, violence towards family members, transfer from a local open ward, unsuccessful community rehabilitation

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The Ayr Clinic, Partnerships in Care

Challenges- Patient related• Patient mix• Hybrid nature of needs• Complex personality disorder, Dual diagnosis, primary MI• Extreme levels of self harm• Problems in forming and maintaining relations

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The Ayr Clinic, Partnerships in Care

Challenges- security related• Forensic v low secure• Paradoxical effect• Enhanced relational security• Physical security• Risk management v recovery• A missing step into community

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The Ayr Clinic, Partnerships in Care

Challenges- Staff related • Recruitment• Staffing • Confidence and morale• Higher observations v Therapeutic relationships• Training• Sickness• Supervision

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The Ayr Clinic, Partnerships in Care

One size doesn’t fit all!• Patient-involved v Patient-centered model• Physical environment• Tailored procedural security• Zonal and modified zonal observations• Well supported relational security – fora, RP, supervision,

training• Ward programme

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The Ayr Clinic, Partnerships in Care

An average day on ArranA semi-structured model• Morning briefing meeting• Rehabilitation v Recreation, striking a right balance• Low intensity/and open skills-based groups v Higher intensity

groups and 1:1 work• Mindfulness, Relaxation, Social skills/communication group,

Managing Emotions• DBT skills group and 1 to 1, Anger Management, Anxiety

Management, Coping with mental illness, D&A programmes

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The Ayr Clinic, Partnerships in Care

Ward Bingo! 13

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Feedback• Improved ward dynamics• ‘experience of safety’ by patients using EssenCES

questionnaire (Essen Climate Evaluation Schema)

• Improved attendance at patient fora• Reduction in the number of incidents• Reduction in observations

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The Ayr Clinic, Partnerships in Care

Pre Christmas celebrations 15

Relationships group

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The Ayr Clinic, Partnerships in Care

Future• Sustainability factor• Co-production models• My shared pathway• My risk management • Vocational education and training• Real work opportunities• Strong focus on physical health• Development of broad based Mentalisation Model

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The Ayr Clinic, Partnerships in Care