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Psychological Work in a Women's Prison: A Window of Opportunity

Explore the range of counselling interventions in a women's prison, with case studies and findings on vulnerable clients. Learn about HIV throughcare, attachment theory, and effective counselling strategies.

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Psychological Work in a Women's Prison: A Window of Opportunity

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  1. A window of opportunity: psychological work in a women’s prison Dawn Whittaker Health Adviser, Women’s Health Clinic, HMP Holloway 11th September 2009

  2. Thanks • Teams, present and past • Elizabeth Howell, my clinical supervisor

  3. Outline • Work of WHC • Range of counselling interventions • Case study 1: HIV throughcare • Case study 2: brief one-to-one intervention • Case study 3: in-depth work informed by attachment theory

  4. Women’s Health Clinic • Sexual health clinic • Contraception • Cervical screening • Gynaecological assessments and referral • Breast examination and referrals • Facilitating HIV care • Facilitating Hep C treatment • Counselling and advice

  5. Vulnerable clients:findings Gabriel et al (2008) • Sample of 289 young women offenders (aged 17 to 21) at Holloway • 13.2% chlamydia prevalence • 80% no condom during LSI • 18% CSW • 53% previous STI • 63% previous pregnancy

  6. Further findings • 60% used crack cocaine • 42% injected heroin • 48% left school at 16 • 43% left school at 14 • 4% left school at 11

  7. Common presenting problems • New HIV diagnosis • Living with HIV (in prison and the community) • Hepatitis C • Risk-taking behaviour • Sex work • Sexual assault • Childhood sexual abuse • Sex trafficking

  8. Range of counselling interventions • Crisis intervention counselling • Contract-based time-limited counselling • On-going and intermittent supportive work • Advocacy and casework • Assessment and referral

  9. Key aspects of counselling • Sexual health is the primary focus • Type and level of counselling depends on patient need • Even information giving depends on use of counselling skills • Time frame that has to be worked within (Leach 2004, SSHA Manual)

  10. Window of opportunity

  11. Window of opportunity • Una McCluskey (2005) To be met as a person: the dynamics of attachment in professional encounters. Karnac. • Jeremy Holmes (2001) The search for the secure base: attachment theory and psychotherapy. Brunner-Routledge.

  12. HIV clients - audit data • Vulnerable clients, with complex medical, psychological, and social problems • 8/17 (48%) had a serious addiction • 7/17 (41%) had a severe and enduring mental health problem • 5/17 (29%) had a dual diagnosis • 7/17 (41%) were homeless (NFA) • 10/17 (59%) had immigration issues • 11/17 (65%) were irregular or non-attenders at their treatment centres

  13. HIV throughcare • A process from admission to release • Timely assessment • Identification and organisation of medical, psychological and social needs • Liaison, referral and advocacy • Counselling and advice • Pre-release planning

  14. Case Study 1 • HIV throughcare • Intermittent supportive work • Advocacy and casework • Assessment and referral

  15. Context for Case Study 2 • NICE guidelines (2007) - Identify high risk individuals - One-to-one structured discussion • Motivational interviewing - Clinical style for eliciting from patients their own good motivations for making behaviour changes in the interest of their health. - Guiding and listening. - Collaborative, evocative and honouring patient autonomy. (Rollnick, Miller and Butler 2008)

  16. Readiness for change • Importance (the why of change) • Confidence (the how of change) In brief conversations these two words are sufficient to access the motivational features, both restraining and encouraging change. (Miller and Rollnick 2002)

  17. Case study 2 • Brief one-to-one intervention • Risk reduction counselling

  18. Attachment theory • Three dimensions of insecure attachment laid down in infancy: Avoidant, Ambivalent and Disorganised • Template for how we negotiate relationships throughout life (Perry 2009) • Adult narratives reflect childhood attachment patterns (Holmes 2001)

  19. Case study 3 • In-depth work informed by attachment theory

  20. References Gabriel G, Burns T, Scott-Ram R, Adlington R, Bansi L. (2008) ‘Prevalence of Chlamydia trachomatis and associated risk factors in women inmates admitted to a youth offenders institute in the UK’ Int J STD AIDS;19(1):26-9. Holmes, Jeremy (2001) The search for the secure base: attachment theory and psychotherapy Brunner-Routledge Leach, George (2004) ‘Counselling’ The Manual for Sexual Health Advisers SSHA McCluskey, Una (2005) To be met as a person: the dynamics of attachment in professional encounters Karnac Miller, William and Rollnick, Stephen (2002) Motivational interviewing: preparing people for change Guildford Press Perry, Andrea (2009) ‘Insecure attachment and its consequences’ HCPJ, July 2009, 3-7. Rollnick, Stephen, Miller, William and Butler, Christopher (2008) Motivational Interviewing in Health Care Guildford Press

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