Therapy for female personality disorder offenders in custody who pose a risk of serious harm
Dec 21, 2014
Therapy for female personality disorder offenders in custody who pose a risk of
serious harm
The 1st National Personality Disorder Congress
Dr R Kini – Clinical Director, Primrose Programme
Dr S Cooper – Consultant Forensic Psychologist
Birmingham
19 November 2009
Aims
• Provide a brief overview of some of the
psychological programmes available to
personality disordered offenders in custody
• Present the Primrose Dangerous and Severe Personality (DSPD) programme as a service vignette
Let us reflect for a moment
Image from: Google Images http://trendsupdates.com/understanding-borderline-personality-disorder/
Let us reflect for a moment• Hopelessness• Abandonment• Anger• Fear• Being marginalised• Stigma• Feeling “bare”• Disempowerment• Frustration
Let us reflect for a moment
.....And if, we experienced
these feelings and thoughts
after a minute’sreflection......
what might it be like for
them in a lifetime?
Image from: Google Images http://www.ehow.co.uk/how_4424135_
identify-personality-disorders.html?cr=1 Copyright © 1999-2009 eHow, Inc
Self harming in female prisons
• A report compiled by the NOMS Women’s team in October 2009 revealed the scale of self harming in female prisons in E & Wales
• 24,686 incidents of DSH during 2008
• Over half of those incidents were carried
out by 6% of the prison
population• Approximately 70% of
self harm episodes are precipitated by a personal problem, often linked with past and present trauma
• 16% of women self harmed Vs 3% men (Baroness Corston)
Scale of PD in female prisons
• 50 % female prisoners have PD (Meltzer, 2008)
• In 2007, the MoJ analysed a sample of 321 PD women serving >2 years prison sentence to study the proportion of various PD
• Half the sample met the criteria for Anti-social PD
• Just over a quarter met the criteria for Borderline PD
• 15% met the criteria for Paranoid PD
• Approximately 10% met the criteria for DSPD
DSPD – Setting the context
Michael Stone Josie Russell
Images from Google Images – www.michaelstone.co.uk
Megan RussellDr Lin Russell
Personality disorder:No longer a diagnosis of exclusionPolicy implementation guidance for the development ofservices for people with personality disorder
National Institute forMental Health in England
National Service Framework
• Responsibility to provide evidence based effective services for all those with severe mental illness; including people with personality disorder who experience significant distress
Women at RiskThe mental health of women in contact with the judicial system
6 JANUARY 2006
Care Services Improvement Partnership CSIPHealth and Social Care in Criminal Justice
Baroness Corston’s Report – March 2007
A report by Baroness JeanCorston of a review of women with particular vulnerabilities in the criminal justice system
NICE Guideline for ASPD – Jan 2009
NICE Guideline for Borderline PD January 2009
Lord K Bradley’s Report – April 2009
Some of the interventions in female prisons
• A review of female prisons in 2008 carried out by the NOMS women’s team
• Alternatives to Self Harm (ASH): Psycho-educational CBT based programme; 2-3 weeks duration; HMP Holloway
• Carousel: 8 week rolling CBT based programme; Eastwood Park
• Holloway Skills Training (HOST): a rolling DBT based programme; 4 x 8 week modules; HMP Holloway
Some of the interventions in female prisons
• Safety Awareness Futures and Empowerment (SAFE): A psycho-educational, problem therapy based programme; structured group sessions; 3 days; Bronzefield & Peterbourough
• Choices Actions Relationships Emotions (CARE): S Kennedy; piloted at HMP Downview
• 22 different OBPs including ETS, CALM, and Cognitive Self Change Programme (CSCP)
• TC – SEND• Primrose DSPD
Programme, includes adapted elements of Chromis programme for DSPD men
Context & Overview
• Male – 2 high secure hospital programmes– Separate units– MHA legislation– Rampton Peaks Unit
(60 beds)– Broadmoor Paddock
(48 beds)
• Male – 2 high secure prison programmes– HMP Frankland
Westgate Unit (80 beds)– HMP Whitemoor
Fens Unit (70 beds)
• Female – – HMP & YOI Low
Newton (12 beds)
Multiple Stakeholders
M O JD O H
T E W V NHS F T
HMPS
DSPD
Service Model
Image from:The frustrating No-Man’s-Land of Borderline Personality Disorder
Harold W Koenigsberg, Larry J Siever www.dana.org/news/Cerebrum/detail.aspx?id=3372
PRIMROSE TREATMENT MODEL
16 WEEKSASSESSMENT
PHASE
Dialectical Behaviour Therapy
TRAUMATHERAPY
LIFEMINUS
VIOLENCE
WELLNESS RECOVERY ACTION PLAN (WRAP)
12 WEEKSTREATMENT
NEEDSANALYSIS
(TNA)
GENERICTREATMENT
Inclusion Criteria• Women aged 18 years or
more• A minimum of 3 years left
of sentence to serve with no current or pending appeals
• High risk of serious harm to others (e.g. violence, arson, cruelty to children)
• Severe PD linked to offending behaviour
• IQ – able to participate in psychological treatment
Referral and Assessment Criteria
Referrals can include female offenders who:
• Are in denial of their offence
• Potentially pose a risk of serious harm to others but are not disruptive
• Lack motivation to engage in psychological treatment (although not ideal)
• Are unwilling to be referred (although not ideal)
Inappropriate Referrals
• Women whose main risk is that of self-harm or suicide
• Women who cannot be managed on “normal” prison wing location
• Active major mental illness
• Individuals who have not undergone transgender reassignment and a period of readjustment
Referral Process
Primrose referral form
Referral documents
Inform prior to transfer
Letter / Report to referrer
Assessment
Written undertaking
Admission panel
Referral Documentation
•Fully completed referral form•Offence Details : PNC ID; Judges summing up; Reports - Pre and Post Sentence, Life Sentence Planning, Parole board, OASys, LIDS•Prison Security Information: Adjudications, Bullying, Hostage Taking, Fire Setting, Attempts to escape•Clinical reports: Psychology, Psychiatry, PCL-R, IPDE, HCR-20
Primrose pathway
Assessment
TreatmentNeedsAnalysis
Treatment
Time frame : Two to three years
WORK FORCE
CLINICAL OPERATIONAL ADMIN
6.7 WTE 6 WTE 2.5 WTE
Competency based roles
DBT
LMV
Trauma Therapy
CHROMIS M & E
MTC
Role Play
WRAP
Core and auxiliary treatments
Dialectical Behaviour Therapy
Life Minus
Violence
Trauma Therapy
CHROMIS Motivation &Engagement
Mobile Team
Challenge
PrimroseRole Play
Wellness & Recovery Action Plan
Workforce Development
CLINICAL SKILLS
TRAINING
PLACEMENTS&
VISITS
CHARTERSHIP&
DIPLOMAS
KNOWLEDGESKILLS
FRAMEWORK
CONTINUINGPROFESSIONALDEVELOPMENT
SECURITYSKILLS
TRAINING
INDEPENDENTCOUNSELLINGPSYCHO DYNAMIC
SUPERVISION & EDUCATION
RECOGNITION & AWARDS
SUPERVISION
Challenges & Learning Points
• Multiple stake-holders – Interface of Governance systems
• Recruiting and retaining a capable, skilled and motivated workforce
M O JD O H
T E W V NHS F T
HMPS
DSPD
Mental Health Act
Mental Health Act 2007
CHAPTER 12
Code of PracticeMental Health Act 1983
Challenges & Learning Points
• Pros & Cons of the integrated prison model• Psychological therapy – issues of voluntary engagement• Therapeutic milieu in custodial environment• Security Vs Clinical Focus – Move to hybrid approach• Elitist Vs Transferrable care models – Progression
pathways • Changing policy drivers?
AcknowledgementsOur thanks to .......
• Dr R Haigh for inviting us to speak at the conference
• Nick Benefield, Lead DoH PD Programme & Ian Goode, Operational lead DSPD Programme
for their support to the Primrose DSPD Programme
• Dr Ray Travers, former Clinical Director of Primrose DSPD Programme for his pioneering work and excellent contribution to the development of this unique service
Contact Information
• Dr R Kini 0191 3764156
Clinical Director, Primrose Programme• D Agnew 0191 3764156
Operational Lead, Primrose Programme• A Airey 01642 283374
General Manager, Forensic Directorate, TEWV NHS Foundation Trust
• Dr S Cooper 0191 3764156
Consultant Psychologist, Primrose Programme• T Noutch 0207 2170653
Ministry of Justice, Lead for Primrose Programme