Transcript Pilot Dual Diagnosis Training: London Prison Service 2005-2006

Dual Diagnosis Training Project
for Criminal Justice
Liz Hughes
Centre for Clinical and Academic Workforce
Innovation (CCAWI), University of Lincoln
Outline of presentation
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Background to project
Methodology
Outcomes
Discussion and recommendations
Dual diagnosis
• The co-occurrence of two or more “diagnosable” disorders
(according to diagnostic criteria such as ICD10)
• Each disorder usually exerts an influence on the course of
the other (thus complicating the clinical picture)
• This term has been increasingly used to represent a group
of people who have mental health and substance use
disorders (although in reality it is more than two problems:
they usually have complex needs including physical, legal,
financial and social needs)
Background
• Significant developments in prison health care including
development and expansion of mental health and substance use
services
• Despite this, reports suggest that frontline staff are lacking
capabilities to deliver on the policy targets (SCMH 2006; DH
2005)
• Lack of integration between substance use and mental health
services
• In order for prison services to provide equivalence; substance use
and mental health services will need to work more closely together,
and have clear strategy for providing care for prisoners with dual
diagnosis
Prevalence
• No research into dual diagnosis specifically in prison.
• Psychiatric morbidity research suggests that rates of mental
disorders is much higher than general population
• 90% have substance use, mental health problem or both.
• Research has demonstrated that people with co-morbid mental
health and substance use problems have poorer outcomes when
compared to those with single diagnoses
• Re-offending rates are likely to be higher
• 32% of people who committed suicide in prison had co-morbid
disorders.
Prison Pilot 2006
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5 London prisons
Predominantly healthcare and CARATs
5 day course or blended learning
Manual/workbook as central teaching and
learning tool
Training needs 2006
• 80 questionnaires given to mental health and substance use staff at all
sites (29% returned)
• People were aware of the capabilities that were important for working
with this group, but most common response to what they actually do
was “referral”
• Barriers to care included lack of time, poor communication between
services, and security issues
• They lacked a theoretical framework for working with dual diagnosis
• Very few people had relevant training and experience (26%)
• None of the addictions staff reported any mental health training.
• They were unsure of their training needs.
Qualitative feedback 2006
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Manual was identified as one of the most useful things
People also liked the skills practice (role-play)
People wanted more on mental health
The 5 day training seemed to be the preferred mode of training
delivery.
• People in the blended learning had not been able to complete the
exercises in the manual within their working day.
• Service user feedback for manual was very positive.
• People felt that getting together with workers from other services
was very useful (both modes of training did this)
Skills for Health Demonstration Project:
Dual Diagnosis Training for criminal
justice staff
• Collaboration between Thames Valley,
University of Lincoln, DH (offender
health), and West London Life-long
Learning Network
• Members of above formed steering group
• Retrospective accreditation by Thames
Valley in the initial phase at levels 4 and 5
Project Aims
– Training needs assessment
– Mapping competences based on job descriptions using
learning design principals
– Review training materials Revise materials and HEI
accreditation
– Pilot the course in London area March 2009
– Evaluation
– Explore further opportunities for CPD and progression
with regional HEIs
Programme delivery
• Marketing of course and applications within
criminal justice settings in greater London area
• Screening process with 58 selected (required
management sign-off)
• 2 cohorts (run concurrently)
• Heterogenous group- mental health inreach,
healthcare, primary care, CARATS, offender
managers, DIP, Forensic medical examiner
Identifying Competences
• Skills for health website competence tool
• Combination of dual diagnosis capability
framework mapped to KSF (which guides NOS)
• Mapping occupational competences to job roles in
relation to dual diagnosis
• Gaps in JDs- e.g. mental health in-reach don’t
have substance use competences (DANOS) yet
will require competence to identify and perform a
screening assessment of substance misuse
Evaluation
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Data from participants applications
Baseline data from questionnaire sent to managers
Course evaluation occurs per session
Intensive post course evaluation using structured
interviews
Screening template re-rated
Further practice development opportunities and
progression
Course team evaluation and modifications to the
course
Skills for health evaluation template
Challenges
• Number of different types of workers involved
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Prison service
Health (primary health, mental health inreach)
Drugs (CARATs)
Offender managers
• Release for training
– No backfill monies
– Lack of suitable venues within prisons
• Implementation after training
– Ongoing supervision?
– Booster sessions
Challenges continued
• Access to offenders for interventions
– Movement of offenders- lack of consistency of care
– Access for face to face contact
– Lack of privacy
• Different competence frameworks
– Mental health NOS
– DANOS
– Health and social care