Therapy for female personality disorder offenders in custody who pose a risk of serious harm
The 1 st  National  Personality Disorder Congress <ul><li>Dr R Kini – Clinical Director, Primrose Programme </li></ul><ul>...
Aims <ul><li>Provide a brief overview of some of the </li></ul><ul><li>psychological programmes available to </li></ul><ul...
Let us reflect for a moment Image from: Google Images  http://trendsupdates.com/understanding-borderline-personality-disor...
Let us reflect for a moment <ul><li>Hopelessness </li></ul><ul><li>Abandonment </li></ul><ul><li>Anger </li></ul><ul><li>F...
Let us reflect for a moment <ul><li>.....And if, we experienced </li></ul><ul><li>these feelings and thoughts </li></ul><u...
Self harming in female prisons  <ul><li>A report compiled by the NOMS Women’s team in October 2009 revealed the scale of s...
Scale of PD in female prisons  <ul><li>50 % female prisoners have PD (Meltzer, 2008) </li></ul><ul><li>In 2007, the MoJ an...
DSPD –  Setting the context Michael Stone Josie Russell Images from Google Images – www.michaelstone.co.uk Megan Russell D...
Personality disorder: No longer a diagnosis of exclusion Policy implementation guidance for the development of services fo...
National Service Framework <ul><li>Responsibility to provide evidence based effective services for all those with severe m...
Women at Risk The mental health of women in contact with the judicial system 6 JANUARY 2006 Care Services Improvement Part...
Baroness Corston’s Report – March 2007 A report by Baroness Jean Corston of a review of women with particular vulnerabilit...
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 <ul><li>A review of female prisons in 2008 carried out by the NOMS women’s tea...
Some of the interventions in female prisons <ul><li>Safety Awareness Futures and Empowerment (SAFE): A psycho-educational,...
Context & Overview <ul><li>Male – 2 high secure hospital programmes </li></ul><ul><ul><li>Separate units </li></ul></ul><u...
Multiple Stakeholders M O J D 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.dan...
PRIMROSE TREATMENT MODEL 16 WEEKS ASSESSMENT PHASE  Dialectical Behaviour Therapy TRAUMA THERAPY LIFE MINUS VIOLENCE WELLN...
Inclusion Criteria <ul><li>Women aged 18 years or more </li></ul><ul><li>A minimum of 3 years left of sentence to serve wi...
Referral and Assessment Criteria <ul><li>Referrals can include female offenders who: </li></ul><ul><li>Are in denial of th...
Inappropriate Referrals <ul><li>Women whose main risk is that of self-harm or suicide </li></ul><ul><li>Women who cannot b...
Referral Process Primrose referral form Referral documents Inform prior to transfer Letter / Report to referrer Assessment...
Referral Documentation <ul><li>Fully completed referral form </li></ul><ul><li>Offence Details : PNC ID; Judges summing up...
Primrose pathway Assessment Treatment Needs Analysis 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 & Enga...
Workforce Development CLINICAL SKILLS TRAINING PLACEMENTS & VISITS  CHARTERSHIP& DIPLOMAS KNOWLEDGE SKILLS FRAMEWORK  CONT...
INDEPENDENTCOUNSELLING PSYCHO DYNAMIC SUPERVISION & EDUCATION RECOGNITION & AWARDS  SUPERVISION
Challenges & Learning Points <ul><li>Multiple stake-holders – Interface of Governance systems </li></ul><ul><li>Recruiting...
Mental Health Act Mental Health Act 2007 CHAPTER 12 Code of Practice Mental Health Act 1983
Challenges & Learning Points <ul><li>Pros & Cons of the integrated prison model </li></ul><ul><li>Psychological therapy – ...
Acknowledgements <ul><li>Our thanks to ....... </li></ul><ul><li>Dr R Haigh for inviting us to speak at the conference </l...
Contact Information <ul><li>Dr R Kini  0191 3764156 </li></ul><ul><li>Clinical Director, Primrose Programme </li></ul><ul>...
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Therapy for female personality disorder offenders in custody who pose a risk of serious harm

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Dr Ranjit Kini and Dr Susan Cooper. First National Personality Disorder Congress, Birmingham, 19-20th November 2009.

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Therapy for female personality disorder offenders in custody who pose a risk of serious harm

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

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