Transcript Offenders with personality disorder: a way forward?

Resettle :
A Joint Criminal Justice/ Health
Partnership Approach to High Risk
Offenders with Personality Disorders
Wakefield, 31st October 2013
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Aims of the presentation
• Consider the commissioning context and
new opportunities;
• Describe services provided at Resettle
and the benefits of an integrated service
model;
• Pose some questions for the future.
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Personality Disorder in the CJS
• High costs of unmet need and unaddressed risks;
• Nature of offences eg domestic abuse;
• High levels of co-morbidity eg substance misuse;
learning disability; mood disorders eg depression/
anxiety; socio economic disadvantage;
• Origins in early relationships and experiences linking
with ongoing difficulties into adulthood;
• The 3 ‘P’s: pervasive, persistent and problematic
behaviours;
• Associated with risk of harm - to self and others;
• Potential for high levels of interpersonal conflict and
impact on communities.
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Prevalence of Personality Disorders
Estimates vary but around:
• 1 to 10% of the general population
• 25% of whom have multiple mental health issues
• 50% – 70% of male prison population
• 30% of female prison population
• Co-morbid needs eg substance misuse
Much PD is unidentified in prison; leading to
unmet need and unaddressed risk factors on
release with associated public protection issues.
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PD: The Wider Context
National Drivers:
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Breaking the Cycle (Transforming Rehabilitation)
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Changes in commissioning – NHS and NOMS
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Offender PD Strategy and Implementation Plans
Mental Health:
Criminal Justice:
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Future of Probation
Services
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PD: No longer a diagnosis
of exclusion
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MAPPA: public
protection
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NICE Guidance
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Mental Health Act (New)
NOMS: Cocommissioning
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New Horizons
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No Health without Mental
Health
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National Offender Personality Disorder
Strategy (1)
• To reduce the risk of serious harm to
others and serious further offending;
• To improve psychological health and
wellbeing and tackle health inequalities;
• To develop leadership in the field of
health, criminal justice and social care;
• To create a workforce with appropriate
skills, attitudes and confidence.
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The National Offender PD Strategy (2)
• Population is a shared responsibility across a range of
agencies and commissioners;
• Workforce development: equipping staff with the right
skills, attitudes and confidence to work with this group of
high risk and challenging offenders;
• Planning and service delivery is based on a whole
systems pathway approach across both NOMS & NHS;
• Improved risk assessment, case management and
pathway planning led by offender managers;
• Treatment and pathway is psychologically informed and
led by psychologically trained staff; focusing on
relationships and the wider social context in which
people live.
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Wider issues for commissioning services
• Commission in collaboration or continue a fragmented
approach? What can we learn from the PD Strategy and
pathway approach?
• How can the complex health and social care needs of
challenging offenders be met and access to services
achieved?
• Context and impact of significant structural and
transformational changes across all sectors;
• Commissioning to achieve shared outcomes and reduce
inequalities needs the whole offender journey to be
considered.........
• Safe transitions between custody and community are
critical..... and present a challenge to emerging
commissioning structures?
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The Resettle Project
• Jointly commissioned / funded / delivered (DoH / MoJ);
• Initially part of the former Dangerous and Severe
Personality Disorder programme (DSPD);
• Pilot project subject to RCT research;
• Probation referrals: serious violent / sexual offences;
• All participants are subject to Multi Agency Public
Protection Arrangements;
• Link between personality disorder and risk;
• Implementation and learning lessons from adopting an
integrated approach from the outset .......
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The Resettle approach:
some key elements
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Prison In-Reach work and ‘through the gate’ support are essential;
Induction followed by intensive support and interventions on release;
Collaboration with Approved Premises;
Psychologically informed practice eg case formulation and risk /
therapeutic reviews;
Skilled, resilient and confident staff from different organisations;
Integrated service model; including ‘out of hours’ support and
contact post exit from the programme;
Programme of therapeutic interventions alongside pro-active risk
management;
Staff in the multi disciplinary team receive regular support and
supervision.
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In addition:
• Dedicated ETE worker on site;
• Sessions delivered by Substance Misuse
services;
• Links to Accommodation/ Support providers;
• Police officer seconded to the team;
• Volunteer support arrangements;
• Out of hours Crisis Line;
• Chance to fine tune the core programme as the
pilot stage progressed.
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........and some lessons learned...
• Consent and high level commitment is possible;
• Progress takes time, commitment and patience;
• Importance of valuing and respectful
relationships which promote hope;
• Positive impact of promoting and encouraging
self belief and self determination;
• Significance of supported and paced social
reintegration for those who may have spent the
majority of their adult life in prison;
• Importance of staff support and supervision to
understand emotional reactions to clients.
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Working with High Risk of Harm Offenders
with Personality Disorder
NW Prisons
Imprisonment
Conviction and
/ or Recall
Exit
Custody
Sentence
Planning
Release
Community
Sentence
Planning
Community
Support /
Recovery /
Management
Community
Identification /
Assessment of
Personality Disorder
(OPD Community
Liaison Service)
Merseyside
Probation Trust
Approved
Premises /
PIPE
Resettle: In Reach activity
Resettle: Complex case reviews
Resettle: Motivational Work
Resettle: Specialist Interventions
to address both risk and need
Resettle: Case Formulation
Resettle: Case Consultation
Resettle: ROTL with support
Resettle: Crisis Line
Resettle: Collect from custody
Resettle: Resettle Plus Volunteers
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And for commissioners.....
• Investment in an integrated pathway and service model
has potential for a range of savings with a shared
population of service users;
• Strong and committed governance and cross sector
ownership can reap dividends whilst also reducing health
inequalities;
• Opportunity for some innovative thinking to model the
connections between achieving health and wellbeing
outcomes and reducing harm to local communities with
high harm offenders with complex needs;
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The Future Resettle
• A new contract specification and expectations;
• Retain intensive risk management alongside attention to
personality difficulties and need;
• Integrated multi agency working as part of an integrated
OPD pathway;
• Opportunities to rethink the ‘service fit’ in a time of
financial constraint;
• A chance to plan more widely for integrated and efficient
commissioning of whole pathway services;
• Safer local communities and public protection: from
Resettle into what? And for how long?
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[email protected]
[email protected]
[email protected]
Tel: 0151 494 4390
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