The Way Forward Forensic CAMHS & Prison Inreach

1. The Way ForwardForensic CAMHS & Prison Inreach Gary Risdale Prison CAMHS Manager Bristol Forensic CAMHS

2. “To provide a comprehensive mental health assessment and treatment service to young people in the secure settings, ensuring continuity of care with the community whilst providing support, training and consultation to other professionals in the establishments.”

3. Population • HMP & YOI Ashfield • Largest private juvenile prison in Europe • 400 15-18 year old young males • Take young people from over 120 sentencing courts • 41% over 100 miles from home • 12 week average stay • Turnover of 1600 p.a.

4. Population (2) • Mary Carpenter Unit HMP Eastwood Park • 16 17-year-old girls • Catchment same as Ashfield

5. New Funding • March 2007 commissioning document launched • Development of Tier 3 CAMHS Services in Secure Settings • Followed by new funding leading to expansion in service

6. Band 8a Nurse 1 Band 7 Nurse 3 Band 6 Nurses 1 Prison Officer/HCA 1 OT 1 Admin Active partnership with prison primary care teams Prison CAMHS Team • Consultant C&A Psychiatrist (Tier3) 1 session a week • Consultant Forensic C&A Psychiatrist (Tier 4)1 session a week • Consultant Psychologist 2 sessions a week • Consultant Adult Forensic Psychiatrist 1 session a fortnight

7. Mental Health Population • ADHD • Psychosis • Depression • PTSD • 4 Most prevalent disorders in the prisons

8. Mental Health Population Eastwood 2007 • 54 cases seen • 2 Hospital Transfers 2008 • 2 Hospital transfers so far • 2 Hospital referrals ongoing

9. Mental Health Population Ashfield • First referral meeting in Dec 2004 4 young people discussed • Referral meeting • 47 cases were discussed • 20 new referrals were discussed • 28 cases were on outreach/monitoring • 25% of population monitored at any one time 2007 • 300 cases seen by CAMHS team • 12 Hospital Transfers 2008 • 14 transfers to date • 1 current transfer in progress

10. Model of Care • Based on Offender Mental Health Care Pathway (NIMHE 2005) • Assessment & Throughcare model • Team can follow cases back into community • With new staffing now moving to more therapies/treatment/interventions

11. Already known to local mental health services New identified mental health need Pre-release Pre-release Unplanned release Prison transfer Unplanned release Liaise with YOT Health Worker Liaise with YOT Health Worker Inform local services Liaise & hand over to local services progress in prison Planned transfer Unplanned transfer Arrange local services CPA CPA Coordinate with services in receiving prison Contact receiving prison on day of transfer Local team come into prison Young Person Released Attend transfer & joint reception screening. Full handover Follow up CPA visit Young Person Released Joint visits if CPA deems appropriate Follow up CPA visit CPN Throughcare Liaise & hand over to local services progress in prison

12. Inreach - Hospital Partnership • Bristol Forensic CAMHS & Bluebird House • Feltham & Wells Unit • Do we have partnerships in place with all young peoples secure settings? • YOI’s – Male & Female • LASCH’s • STC’s • Immigration centres?

13. Inreach Hospital Partnership Benefits • Slimlined Referral Process • Smoother/quicker transfer times Both out of custody And on return to custody • Shared access to resources/training

14. YOT CPN’s • 1st Point of Contact for majority of young offenders with mental health needs • Workers often lone nurses: isolated • Support forums that are in place are run by the workers themselves in local areas with no strategic oversight or support

15. YOT CPN’s • YOT mental health practitioners need access to peer support and development opportunities as well as the opportunity to share good practice. An existing group, the London CAMHS YOT workers forum, provides a useful starting point for these activities, but needs high level support (eg by CSIP and the London YJB), in order that it can hold regular, well attended meetings at a central venue and so that workers will be encouraged by managers to attend. • Strengthening the forum will require: -Written terms of reference, circulated to all YOT and CAMHS managers. -An annual calendar of meetings and events and a programme of speakers/external input. -A quarterly report/newsletter giving the outcomes of its meetings, sent both to the provider Trusts and to the YOT managers. • CSIP in conjunction with the London CAMHS Partnership chairs should consider creating a regional specialist CAMHS group which focuses on adolescent forensic mental health and the young offender client group. • London CAMHS YOT workers need a training programme that will help them share good practice, offer peer support and ensure they are offering the most effective packages to young people. This training should be based on a training needs analysis and a useful model would be facilitated action learning sets. London Youth Offending Teams Mental Health Mapping (The Health and Social Care Advisory Service June 2008)

16. YOT CPN’s Potential Benefits • Development of strong pathways in and out of hospital • Appropriate and timely referrals from local services – avoiding custody • Training and development of workforce – more stability in provision

17. Halfway house in Bristol • Opens 2009 • Supported by • PCT agreed Prison CAMHS provide mental health support

18. The Way forward? NCG Units Prison CAMHS Inreach Teams STC MH Services LASCH MH Services Halfway Houses? YOT CAMHS CPN’s Partnership