Psychological Therapies with Women in Forensic Mental Health Settings Dr Patricia Mooney Consultant Clinical Psychologist Rowanbank Clinic CLINICAL FORUM: WOMEN IN FORENSIC MENTAL HEALTH SETTINGS 07 February 2014, SPS College, Polmont

Background Moving away from offence focussed interventions towards work based on underlying needs –Similar needs may underpin different offences –Same type of offence may have different underpinning needs Forensic Matrix doesn’t explicitly mention women –Evidence base in forensic literature mostly studies men –Evidence base for psychological therapies generally doesn’t specifically study women Same therapeutic approaches used as with men –Overall frequency of which type of approach used may differ Similar methods of delivery than men –Though individual needs or vulnerabilities are considered

Psychological Approaches Cognitive Behavioural Therapy (CBT) Cognitive Analytic Therapy (CAT) Schema Focussed Therapy Mentalisation Based Therapy (MBT) Positive Behaviour Support (PBS) /Applied Behaviour Analysis (ABA) Less so Dialetcial Behaviour Therapy (DBT)

Methods of Delivery Individual work with ward psychologist Individual work with other therapist –e.g. through Psychological Therapies Service or ward staff Group work Systemic/ ward based work –e.g. psychological formulation sessions –behaviour support/management plans

Case Examples

Considerations High level of complexity –High rates of sexual abuse histories –Mix of personality difficulties and mental health problems –Elevated rates of Borderline Personality Disorder Family issues –Higher rates of women were main caregiver prior to offences Multiple and possibly competing psychological needs –e.g. victim and victimiser Ward dynamics * Issues not exclusive to women, though arguably more prevalent

Conclusions Broadly similar approaches as with male forensic patients Gender brings some further considerations Worth considering links between services to build on evidence base? Challenging but rewarding work Questions?