1. 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

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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

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

11. 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

12. 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

13. 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

14. 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