1. Accessing Mental Health Services, within IOM

2. Dr Andrew Newman, Clinical Psychologist Daniel Wakefield, Specialist Probation Officer

3. Probation - 1 Senior Probation Officer, 7.5 Probation Officers, 2 Probation Service Officers & 2 Administrators Police 1 Detective Inspector, 1 Detective Sergeant & 5 Detective Constables Psychology - 1 Consultant Clinical Forensic Psychologist, 1 Clinical Psychologist, 1 Forensic Psychologist in training & 1 Assistant Psychologist Consists Of

4. Agenda Introduction Basic information Case studies Continuum exercise and discussion Questions

5. Mental Health and Offending One in four will have a mental health difficulty at some point in their life. Sub-divided under the umbrella of mental health services: Psychosis, Neurosis, Addiction, Personality Disorder, Neurodevelopmental, Learning Disability, Brain Injury and Dementia. Mental health is bigger risk for self than others. Drug and alcohol biggest link to offending. Comorbidity

6. Mental Health and Offending over 90% of prisoners had one or more of the five psychiatric disorders studied (psychosis, neurosis, personality disorder, hazardous drinking and drug dependence); Bradley Report 2009 PrisonersGeneral population Schizophrenia and delusional disorder 8%0.5% Personality disorder66%5.3% Neurotic disorder (e.g. depression) 45%13.8% Drug dependency45%5.2% Alcohol dependency30%11.5% SourceSingleton et al (1998)150 Singleton et al (2001)151

7. Mental Health Act 1983 (Amended 2007) Section 135 (from private place) and 136 (from public) Section 2 2 medics and a AMHP, lasts 28 days, can only leave hospital if RC says, can be forcibly treated. The aim is assessment. Section 3 2 medics and a AMHP, lasts 6 months, can only leave hospital if RC says, can be forcibly treated. The aim is treatment. Needs to be well know to mental health services. Section 17 Leave granted by the RC Section 17a (CTO) Can be returned to hospital (72 hours) for treatment if stop in community

8. Mental Health Act 1983 (Amended 2007) cont: Section 37 (Hospital Order At sentence to go to secure hospital rather than prison. Continue until well enough to leave. Section 47/49 (Sentenced Prisoner) Secretary of State for Justice oks transfer from prison to Hospital for treatment. When better return to Prison, if sentence complete Notional 37. Section 48/49 (Remand Prisoner) Secretary of State for Justice oks transfer from prison to Hospital for treatment. When better return to Prison, Can convert through court to section 37. Section 41 (Restriction) No time limit, secretary of state has to ok leave and discharge, can have restriction post discharge.

9. Important meetings Section 117 (after care) Imposes a duty on health and social services to provide aftercare services to patients who have been detained under the Mental Health Act (3,37,47 &48). meet needs that they have because of mental illness, and reduce the chances of having to go back into hospital Paid for by CCG (GP group) and Local Authority (where resident; can cause problems). Care Programme Approach Meeting. A meeting to devise and review a care plan. Ensures care co-ordination Mental Health Tribunal Judge, Psychiatrist and Lay Member Can release from Hospital (if 41 recommend to Secretary of State) Make general recommendations

10. Mental Health Services Secure Hospitals; High-Broadmoor, MSU/RSU- Fromeside, Low-Wickham. CARS, Mental Health In reach, Forensic Psychology, Community Forensic Mental Health Teams Non-forensic; Open Acute, Rehabilitation, PICU PCLS, LIFT Psychology, Intensive Teams, Recovery Teams, Drug and Alcohol Services, ADHD Service, EI, Pathfinder (will accept referrals from anyone)

11. Offender Personality Disorder (OPD)Pathway Project Personality pathology increases the likelihood of serious re-offending (Craissati, Webb and Keen, 2008), these individuals have faster reconvictions and more serious offences (Coid et al., 2007, cited in Minoudis et al 2011). OPD A Health Practitioner (normally Psychologist) has input into every probation office in England and Wales Male: high risk+ of harm during sentence, NPS and suspected personality traits. Female: medium+ risk of violence, sexual offending or damage to property (NPS/CRC) and suspected personality disorder

12. Offender Personality Disorder (OPD)Pathway Project Screening Training Consultancy Formulation- helping to develop a shared understanding of the individual Joint working MBT ( Tamworth, Exeter, Torbay, Gloucester, Bristol, Leeds, Lincoln, Liverpool, Llanelli, Nottingham, Preston and four locations in London (Baker Street, Lewisham, Stratford and London Bridge) Other specialist interventions available in different areas

13. Case Study 1 (James)

14. Case Study 2 (Peter)

15. Continuum Exercise and Discussion Continuum exercise and discussion

16. Thank you for your participation Dan Wakefield 03000 492 326 Daniel.wakefield@probation.gsi.gov.uk Andy Newman 03000 492 694 andrewnewman@nhs.net General contact 03000 491 880