A New Model for the Delivery of Forensic Community Mental Health

ServicesBIGSPD, Manchester, 23rd March 2012

Presented by:Memtaz Begum Forensic Social Worker Jon Carey Senior Forensic Practitioner/ PhD student, Durham University

Service Developments by all members of the Forensic CMHSRidgeway Roseberry ParkMiddlesbrough

Forensic Community Mental Health Team

Secondary CMHT Prisons Forensic Inpatients

MDT AssessmentsReportsAdvice

11 Clinical SessionsForensic CPN's

Social Work SupportTransition & follow up

Referral

Clinic(Under 2 weeks from referral)

Further Specialist

Assessment

Formulation/CPA Meeting(4 weeks from clinic)

Intervention

Discharge

InterventionNFAAdvice/Supervision

Roseberry ParkSandwell Park

West ParkLanchester Road

Pathway through the new Forensic Community Mental Health Service

ReferralReferral Criteria

New Referral Form

10 Historical Items(HCR20 informed)

Current PresentationInclude behaviour/ risks that

have triggered referral

Assign to Clinic(Max 2 weeks)

Reject More information

The Forensic CMHT considers a new referral.

Clinics

Two FCMHS membersF-CAM

Care co-ordinator + Patient

Roseberry Park West Park Sandwell Park Lanchester Road

Other activities:

Clinical SupervisionTrainingAdvice

1. Introduction/ Information Leaflet2. Confidentiality3. Clinical/ Risk Interview (HCR20)4. Protective Factors (SAPROF)5. Psychometrics, (BPRS,SAPAS, DUDIT/ AUDIT, Quality of Life Scale *1)6. Professional Discussion/ decision

Clinic Outcomes

No further action(Letter within a

week)

Clinical Supervision

Contract:Time limited

Straight to Intervention

Further Specialist

Assessment

Advice

Further Specialist AssessmentSupplementary Psychometrics

Personality Disorder: MCMI-III; IPDE; PCL-sv

Substance Misuse: C-BIT

Mental Illness: PSYRATS; BDI

Stalking: SAM

Trauma/ PTSD: CAPS

Fire Setting: FAFS Sexual Risk: SVR20Intelligence: WASI

Violence: ERM/ FESAI; RM2000

Formulation/ CPA Review

Discuss triggers, protective factors

Treatment options Develop a care plan

Summary Report

Summary of the assessment + outline of the agreed Care Plan

Advice/Clinical supervision

CareCo-ordination

by FCMHS

Intervention/Co-working

No further action

Very High RiskMAPPA 2-3Ex-Secure Care

Interventions:Various timescales

Offence Related

Work

DBT/ CBT:6-24

months

Alexithymia Group:1 day

JIGSAWongoing

ERM/ FESAI:6-10

sessions

ASRO:20

sessionsPSST

Discharge

Quality of Life Scale *2 PARIS Entry Discharge Letter

After 6 + 12 monthsQuality of Life Scale *3 + 4

Forensic Community Mental Health Team

Secondary CMHT

Durham Cluster of Prisons

Frankland/ Durham/ Low Newton

Forensic Inpatients

MDT AssessmentsReportsAdvice

11 Clinical SessionsForensic CPN's

Social Work SupportTransition & follow up

Referral

Accept Reject

Assessmentwith Prison Team

within 7 days

No further actionAdvice and

supportInterventions

Critical Case Panels

Complex Case Review

Co-facilitated withPrison MH Team

Discharge

Training/ supervision

Discharge

Further SpecialistAssessment

As needed

Discharge

Request more information

The new Forensic Community Mental Health Service for the Durham Prisons

Reaction in the team was mixed

Pre-release and Aftercare service

Referral (if no previous involvement)6 months prior to release

Review (if assessed previously)6 months prior to release

Accept Reject

6 months prior to release

6 months post release

Referral to Secondary services

Collaboration of needs assessment

Pre-release plan

Community support and interventions

Liaison with external agencies- MAPPA, Probation, Housing, Police

Possible FCMHS Care Co-ordination

Discharge Plan

Release Pathway through the new Forensic Community Mental Health Service for the Durham Prisons

Forensic Inpatient ServiceRidgeway

Roseberry Park

Memtaz BegumForensic Social Worker23rd March 2012

Current Social Work provision

• 10 wards • Medium and Low Secure -135 patients• 1 Senior Social Worker• 6 Social Workers• S117 Responsibility for out of area

patients

New model includes…

•Admission packs•Weekly clinics•Discharge packs•Shared care post discharge

New model includes

• Community focused interventions• PSST, ASRO, DBT and others • Care co-ordination

On-going work of the team

• AMHP role• Social Supervision • BIA • Child Visiting• Appropriate Adult• MHT & Managers Reviews

Thanks…any questions?

Dr Brian Docherty, OBE, kindly provided some of the picture slides

Roseberry Topping, Great Ayton, Middlesbrough

Glossary:

AUDIT Alcohol Use Disorders Identification TestBDI Becks Depression Inventory BPRS Brief Psychiatric Rating Scale CAPS, Clinician Administered PTSD Scale CBIT Cognitive-Behavioural Integrated Treatment DUDIT Drug Use Disorders Identification Test ERM Early Recognition MethodFESAI Forensic Early warning Signs of Aggression InventoryFAFS Functional Assessment of Fire SettingF-CAM Forensic Collaborative Assessment ModelHCR20 Historical/ Clinical/ Risk 20 IPDE, International Personality Disorder Examination PCL-sv Psychopathy Check List, shortened versionQoLS Quality of Life ScaleRM2000 Risk Matrix 2000SAM Stalking Assessment & Management GuideSVR20 Sexual Violence Risk 20SAPAS Structured Assessment of Personality – Abbreviated ScaleSAPROF Structured Assessment of Protective FactorsWAIS III Wechsler Adult Intelligence Scale, 3rd Edition