Current & Future Configuration of Forensic Psychiatric Services in Tayside Dr Tom White Lead Clinician, Low Secure Service Clinical Lead Joint Secure Project & North of Scotland Forensic MCN

Agenda What are Forensic Mental Health Services? Way Forward – Estate Drivers For Forensic Services Progress Local Regional

What is distinct about Forensic Psychiatry? Patients exhibit significant comorbidity - - Major Mental Illness + - Substance/alcohol misuse - Personality disturbance Assessment of risks (violent, sexual offending) based on Structured Clinical Judgement Management of risk using enhanced CPA as vehicle and MAPPA as Governance Delivery of offence-focused treatments in addition to treating mental illness (anger, deviant cognition distortions)

MEL (99) 5 Spectrum of Secure Services for MDO National HIGH secure services Regional MEDIUM secure services Local (health board) LOW secure services, IPCU, Community Forensic Mental Health Team

Estate Future Current 35 bed male low secure 27 bed low secure male 32 medium secure male beds (regional) National network approach to female services Regional/National treatments – sex offender Current 27 bed low secure male Day Centre/team

Drivers for Forensic Services 1 Mental Welfare Commission Inquiry into case of Mr L and Mr M (March 2006) Clear readmission arrangements for CD patients Improve clinical leadership “there should be a systematic approach to risk assessment and management” Improve Clinical Governance arrangements

Drivers for Forensic Services 2 HDL (2006) 48 Forensic Mental Health Services “The primary determinant of appropriate level of security is the best estimation of risk posed” Policy - Secure Care Standards National Overview of Patient flow - Regional Governance Group in North of Scotland – Database prepared Forensic subgroups of Regional Planning groups North of Scotland Regional/Planning Governance arrangements agreed June 2008. First Annual Report in draft

National Driver 3 NHS CEL (13) 2007 Guidance for Forensic Services NHS Boards will: Ensure they have appropriate local arrangement for Clinical Governance for Forensic Mental Health Services. (We have sustained Quality Improvement groups with focus on low secure standards.) Implement the enhance CPA for patients for whom they are the responsible authority All First Minister patients in forensic service being managed by enhance CPA Majority > > 790% of non-restricted patients managed by enhanced CPA (NHS Boards hosting regional services must be able to demonstrate robustness of CG arrangements to fellow NHS Boards)

National Drivers 4 CEL (19) 2008 Multi Agency Public Protection Arrangements (MAPPA) NHS Boards will identify a senior manager responsible for providing assurances on the quality of operation of CPA and statistical information to the MAPPA annual report. Annual MAPPA report completed CPA procedure under review – collaborative approach All restricted patients are potentially subject to MAPPA All Restricted patients notified/referred to MAPPA All sex offender patients referred Duty to establish joint arrangement for assessment and management of risk Dr White/Stuart Storrie members of P&K Public Protection Forum and National MAPPA Steering Group

Progress (Local) Forensic Quality Improvement Group Low Secure Standards Enhanced CPA audit MAPPA audit

Progress (Local) 2. Enhanced Multidisciplinary working Appointment of Forensic Pharmacist (June 2009) Funding identified to appoint Forensic Psychologist 3. Bed Management Meeting 4. Securing additional Operational Management

Regional Initiatives 1. Training a. 2008-2009 Risk Management Authority – Risk Management planning (Perth, Dundee Nov 2008-February 2009) HCR-20 training November 2008 SVR-20 training June 2009 b.2009 – 2010 National Network Psycho-education package “Coping with Mental Illness” Assessment of Drug and Alcohol Misuse

Regional Initiatives 2 2. Promoting Regional Clinical Governance Initiatives Medium Secure Admission Criteria North of Scotland Policy & Procedure Resource Agreed low secure Clinical Governance reporting structure based on National Network low secure standards 3. Enhancing patient flow National Conflict Resolution Group Way Forward Structure Database of all patients out of area

WAY FORWARD Enhancing our ability to systematically assess comorbid conditions Enhancing risk assessment Appointment of Forensic Clinical Psychologist Training nursing staff Improve infrastructure to support enhanced CPA and MAPPA referral/notification Increase capacity to deliver offence related treatments Manage flow within/from low secure service – Bed Management Proposal Consolidate Network approach to reduce isolation by incorporating low secure service standards