1. How can a library work with clinical staff in a high secure hospital? Catherine McCafferty Knowledge & Library Services Manager

2. The setting Ashworth Hospital, Liverpool 250 patients live in 18 wards Referrals courts, prisons, other secure or mental health settings Severe mental illness, personality disorder or neuro-cognitive difficulties

5. As a librarian in this setting…. Manage a small public library for patients Work with clinical staff Develop safe practices Collaborate with local authority Support library staff with delivery

9. What could library use tell clinicians at Ashworth? About general interests of patients Indicate an interest in private study Show a continued interest from pre- admission Demonstrate an interest in the world outside Indicate ‘attitude’

10. Day in the life of a patient

11. Psychiatrist Rehabilitation Staff Psychotherapist Occupational Therapist Nurses Social Worker Library? Security Liaison

12. Where does the care team get information? Previous health and care records Offence history and accounts Prison Service reports Social work records and reports Psychological tests Nursing reports Reports from workshops and education Telephone conversations Random drug testing

13. How does the Care Team use information? Information gathering Record keeping Using information INFORMATION STAGE Psychological testing Information sharing Use of information Making Sense Validation SENSE MAKING Truthfulness Synthesise/Layers Report writing Corroboration Personalities in team Team dynamics THE MDT TASK Complexity of task Decision making Team working Treatment Personality assessment CLINICAL TASK Diagnosis Risk Assessment Assessment

14. Role of the psychotherapist gathering information that would inform the relevant psychological tests needed making sense of that information by listening to other professionals reports of activities and events in order to corroborate and validate regularly attend meetings and contribute to the MDT task contributing the psychological perspective to the clinical task working towards the overall aim of ASSESSMENT

15. How I added new information to this process Attended care teams over 8 months Presented library loans for individuals Gave broad context for material Recorded responses from care team members

16. ‘Gives an interesting insight’ PSYCHIATRIST Healthy Interest:.....in discussions the material caused no issues of concern ‘Doesn’t surprise me – he’s interested in history’ SOCIAL WORKER ‘All very normal – good for him’ PSYCHIATRIST ‘I’m glad he’s being flexible in his selections’ OCCUPATIONAL THERAPIST ‘Nothing to worry about in that lot’ PSYCHIATRIST

17. ‘Are we worried?’ PSYCHIATRIST, ‘There is a theme’ Unhealthy Interest:....in discussions the material did cause some concern ‘Was he a member of a gang?’ PSYCHIATRIST ‘This could be an indication of his illness’ PSYCHOTHERAPIST ‘I have seen that film it is horrifically violent’ NURSE MANAGER

18. ‘What a contradiction’’ PSYCHIATRIST Neither healthy nor unhealthy...comments were very general ‘Nothing too exciting’ PSYCHIATRIST ‘He’s in the music group’ SOCIAL WORKER ‘You’d expect it to be all immature stuff’ PSYCHIATRIST

19. Other...a consideration of other factors ‘Different to what he’s asking his partner for’ SECURITY LIAISON ‘Who chooses the books for the library?...Is it appropriate to have books on gangs?’ PSYCHIATRIST ‘Do we check the content of these titles regarding present patient population...’ PSYCHOTHERAPIST That’s his kind of title...Ask him about the movie – why did he choose it?’ PSYCHIATRIST

20. Themes from MDT interviews - 1 Insight into patients interests ‘..if prior to that people had asked me what do they read what do they watch, I wouldn’t be able to say.’ PSYCHIATRIST Clinical relevancy Indicator of mental state ‘What they are reading could be a marker – the Bible is a very clear one for some people – if they get the Bible out then they’re deteriorating’ SOCIAL WORKER Indicator of risk ‘....not diagnosis possibly risk – if a person with index offences and then they are continuing an interest in these activities that would be helpful I think. CHECK ’PSYCHIATRIST Trigger signals

21. Themes from MDT interviews - 2 Development of the work Around stock selection ; reporting systems & timing of the information provision Practical insights Around patients organisational skills; literacy ability

22. Next steps....... How to continue with the information provision? Support for stock selection? How can the care team interpret the meaning?