Stuart John Chuan Butler Trust Workshop 1 October 2013

1. Psychologically- Informed case management Stuart John Chuan Butler Trust Workshop 1 October 2013

2. Overview • Model of consultation, training and joint direct working • Applications of the model to support mental health needs of offenders • How/Why it works

3. Focus on the practitioner • Consultee-centred • Build capabilities in the practitioner (consultee) • Remedy (1) knowledge (2) skills (3) confidence (4) objectivity in consultee • Practitioner applies learning to current and future clients • Specialist tends not to meet client • Scope for joint working • Client-centred direct service • Focus on clients problems/functioning • Specialist directly assesses and diagnoses clients to make recommendations to practitioners • Refer to..........

4. Diagnosis vs formulation

5. PICM (psychologically-informed case management) • what to do - having a plan • why do it in this way - a planned approach based on a psychological understanding of the individual • how to do it - providing the practical knowledge and skills to translate this into practice. • Joint working and liaison with other statutory and non-statutory services may be provided to strengthen case management

6. Consult to the system WITH 8 NEEDS DO WE NEED 8 WORKERS?

7. Impact Offender Personality Disorder Project Summer 2009

8. Sensitive to perceived rejection Poor impulse control Rapid mood changes Stormy relationships Reckless Prison recalls • Historically, large shortfall in local services aimed at offenders with personality disorder living in the community. • Probation, as a result, left in relative isolation to manage this complex and challenging client group. • Little mental health training RECALL?

9. Offender AP OM Where to intervene Do we intervene here? Or perhaps direct our efforts here And here

10. Average PPU recalls

11. Comparison to London trend * N=10 ^N=6 (therefore comparison cannot be made)

12. Reasons for recall

13. “itgives you more confidence, it relieves stress, and I think it makes you less likely to go off sick, because you are actually dealing with the stuff here and you feel capable whereas when you’re floundering in the dark it’s really scary … he is able to see things that I can’t see and tell me how to work specifically with that from a different perspective”. “When I was asked this before and I didn’t really understand it. I was like “well I can’t deal with those offenders cause they annoy me, they wind me up, they make me angry and I want to say something back to them.” Whereas now my experience is different cause I don’t take it personally. I can take a step back which stops me from getting so stressed out, it’s quite a big change for me”. Training needs analysisPPU and the two APs 45 min semi-structured interviews (1-year follow-up) “they are able to see things that I can’t see and tell me how to work specifically with that from a different perspective”

14. Impact - some lessons • Target intervention at staff – economical and sustainability • Provide a helping intervention • It’s better to identify and intervene early rather than crisis manage • ‘Treatment’ for PD is not the only option – think creatively to meet offender needs using community resources • Aim for organisational culture and system change

15. Islington 18-24 Transitions Gangs & Serious Youth Violence Winter 2012

16. The team approach Multi-agency team based in probation Supporting 18-24 year old age group and their families Risk of involvement in serious youth violence Reduce reoffending and gang violence Exit gangs and offending lifestyles

17. NHS Forensic psychologist 0.5 wte Nurse 0.05 wte psychologist (supervisor) IYPDAS Substance misuse worker CSPU Team Manager Islington 18-24 Gangs Transitions Team Police BIU Analyst Support CSPU Administrative support officer CSPU Transitional Key Workers x2 LPT Probation officer

18. Added value • Main activities • In-house MH Proactive screening/triage ax • Training - eg., Motivational interviewing; Contingency Management; Personality Disorder • Case formulation and plans for complex cases • Timely advice/consultation (eg., on engagement strategies) • Integration with partners eg., YOS/CAMHS lead for transitions planning • Joint case management

19. MH Screening • GAD-7, PHQ-9, SAPAS, MVQ • 22 screened, including those not completed questionnaires • GAD7 score ≥10 = 3 (moderate or worse anxiety) • GAD7 score 5-9 = 1 (mild range) • PHQ-9 score ≥ 10 = 3 (moderate or worse depression severity) • PHQ-9 score 5-9 = 0 (mild range) • SAPAS ≥3 = 8 (risk of ‘emerging’ PD) • MVQ - Tendency for the young people to normalise use of violence (individual use and/or in media)

20. Early days data • 26 YP tracked for 9 months pre and 9 months post the start of intervention: • 17 (65%) people offended prior to the intervention compared to 13 (50%) people offending post intervention. • The reoffending rate in 9mths pre intervention was 1.84 offences compared to 1.03 offences post intervention • The average offence gravity of offences committed in the 9mths prior to intervention start was 3.19 compared to an average gravity of 3.00 post intervention start.

21. Winter 2013

22. Family Early years help & CiN teams Family 'Troubled families' - ASB, Edge of Care Teams Primary care GPs, IAPT, SPoC MH ax team Crisis teams, crisis houses, Acute inpatient wards, A&E Crisis services

26. PICM Summary • Consulting to the system makes more coherent & efficient use of existing resources and workforce • Service users needs can be met earlier in pathway • Practitioners are better informed about what to do • Iatrogenic effects are minimised • Service users are better understood and engaged - more stable, better managed Stuart.johnchuan@candi.nhs.uk