Pradeep Pasupuleti, Laura Stevenson and Emma Hargreaves Partnerships in care

1. Low secure service for Scottish womenThe Ayr ClinicClinical Forum: Women in Forensic Mental Health Setting07.02.2014 Pradeep Pasupuleti, Laura Stevenson and Emma HargreavesPartnerships in care

2. Today’s talk • Introduction • Service at the Ayr Clinic • Our Experience • Future plans The Ayr Clinic, Partnerships in Care

3. The Ayr Clinic • 2008 • 34 beds • 2 admission wards and 1 rehab ward • Low secure service The Ayr Clinic, Partnerships in Care

4. The Ayr Clinic, Partnerships in Care

5. Female service • Admission ward and mixed-sex rehab ward • MDT model • 2008-2013 • Total admissions - 95 • Total female admissions- 27 • Discharges- 14 • Longest admission- 4 years 7 months • Shortest- 1 month The Ayr Clinic, Partnerships in Care

6. The Ayr Clinic, Partnerships in Care Arran ward

7. Patient profile • Story of Miss S- 25 years old, inpatient since the age of 15, transferred from IPCU, prolific self harmer specifically inserter, vague psychotic symptoms • Story of Miss A- 21 years old, in care since the age of 9, prison transfer, serious offender, violence as primary defense, self harm behaviour, psychotic episode • Story of Ms M- 46 year old, schizophrenia, violence towards family members, transfer from a local open ward, unsuccessful community rehabilitation The Ayr Clinic, Partnerships in Care

8. Challenges- Patient related • Patient mix • Hybrid nature of needs • Complex personality disorder, Dual diagnosis, primary MI • Extreme levels of self harm • Problems in forming and maintaining relations The Ayr Clinic, Partnerships in Care

9. Challenges- security related • Forensic v low secure • Paradoxical effect • Enhanced relational security • Physical security • Risk management v recovery • A missing step into community The Ayr Clinic, Partnerships in Care

10. Challenges- Staff related • Recruitment • Staffing • Confidence and morale • Higher observations v Therapeutic relationships • Training • Sickness • Supervision The Ayr Clinic, Partnerships in Care

11. One size doesn’t fit all! • Patient-involved v Patient-centered model • Physical environment • Tailored procedural security • Zonal and modified zonal observations • Well supported relational security – fora, RP, supervision, training • Ward programme The Ayr Clinic, Partnerships in Care

12. An average day on ArranA semi-structured model • Morning briefing meeting • Rehabilitation v Recreation, striking a right balance • Low intensity/and open skills-based groups v Higher intensity groups and 1:1 work • Mindfulness, Relaxation, Social skills/communication group, Managing Emotions • DBT skills group and 1 to 1, Anger Management, Anxiety Management, Coping with mental illness, D&A programmes The Ayr Clinic, Partnerships in Care

13. The Ayr Clinic, Partnerships in Care Ward Bingo!

14. Feedback • Improved ward dynamics • ‘experience of safety’ by patients using EssenCES questionnaire (Essen Climate Evaluation Schema) • Improved attendance at patient fora • Reduction in the number of incidents • Reduction in observations The Ayr Clinic, Partnerships in Care

15. Pre Christmas celebrations

16. Relationships group The Ayr Clinic, Partnerships in Care

17. Future • Sustainability factor • Co-production models • My shared pathway • My risk management • Vocational education and training • Real work opportunities • Strong focus on physical health • Development of broad based Mentalisation Model The Ayr Clinic, Partnerships in Care