savas dangerous offenders

Slide1: 

THE DANGEROUS andamp; SEVERE PERSONALITY DISORDER (DSPD) PROGRAMME November 2006 Savas HADJIPAVLOU (Programme Director)

Will aim to cover:: 

Will aim to cover: Programme objectives, criteria Current and future demand for places assessments and treatments Shape of the pilots, characteristics of offenders etc. Legislation Lessons for the future shape of services Conclusions

Slide3: 

Programme Objectives The Programme objectives are to enhance protection of the public and improve mental health outcomes by understanding better: How to identify, assess and treat those who are dangerous and severely personality disordered. The nature and challenges of treatments and service delivery involving multi-disciplinary teams working across agencies The extent to which treatment might reduce (or manage better) the risks of re-offending and how best to move on those offenders who have benefited from the programme, as well as those who have not. To strengthen the clinical, service delivery and policy evidence base in this area, informing the options for future services, and the costs and benefits

Who is the Programme for?: 

Who is the Programme for? An offender will be suitable for admission for treatment to a DSPD pilot unit if assessment indicates: they are more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it difficult or impossible to recover; a severe disorder of personality their offending is linked to personality disorder

How? : 

How? Joint programme of the Department of Health, Home Office and Prison Service Manifesto - to create 300 high-secure DSPD places in prison and hospital; also pilot work in medium secure and community settings Against a background Partnership between prisons and the NHS to deliver appropriate and effective health services to prisoners - mental health a big part of this agenda New legislation: the CJA 2003 provides new public protection sentences and proposed changes to MH law The formation of the National Offender Management Service (NOMS )

Current and future demand for DSPD: 

Current and future demand for DSPD Evidence: Prisoner cohort study 13-17% may be DSPD Existing people in high secure services ~2000-2500 Determinate sentences: very difficult group, but diminishing in size owing to impact of IPP sentences. DSPD had around 25 cases in the past year Estimate potential new cases a year: ~100-200 from lifer population ~125 from IPP sentences ~125 from EPP sentences (pointing to demand for MAPPA linked services)

Key issues: 

Key issues Typically not in hospital: most are in prison largely seen in the past as 'untreatable' there is a lack of specialist services in prisons, and limited PD capacity in hospitals Mental Health starting to be addressed in prison with NHS in-reach Limited consensus about the shape of assessments and treatments; research base weak Organisational capability and responsibility rests with many agencies

Overall shape of treatment: 

Overall shape of treatment Focussing on reduction in risk of serious offending evidence based and susceptible to evaluation Individual plans tailored to address those factors that predispose to offending behaviour patient/prisoner encouraged to play an active role in treatment planning and to share ownership of goals measures of change recorded using agreed minimum dataset

What is the assessment?: 

What is the assessment? Centered around structured clinical judgement informed by static and dynamic factors: Risk: Actuarial tools: violence - historical elements of VRS and HCR-20; sexual - Risk matrix 2000, Static 99 Dynamic tools: VRS, HCR-20, SARN Personality Disorder: - PCL-R/PCL-SV, IPDE Mental illness: SCID-1 Clinical presentation

Treatment approaches: 

Treatment approaches Cognitive Behaviour Therapy based: Focus on identifying and tackling criminogenic factors, and reducing risk through violence reduction programmes (VRP), CHROMIS ‘Good life model’ aimed at giving coping skills to avoid re-offending The units have put together programmes that combine these approaches in various ways Treatment is delivered in individual 1:1 sessions and also in groups Some Pharmacological interventions Developing motivation a key element in programmes

High secure units: 

High secure units

Planned pilot throughcare arrangements: 

Planned pilot throughcare arrangements 3 medium secure settings - East London andamp; City MHT, 3Ns Trust, Sth London and Maudsley - Dec 2004 3 hostels - Oxleas, South London, East London andamp; City MHT - Summer 2004 4 community teams - Oxleas, Sth London and Maudsley, East London andamp; City MHT, 3Ns Trust - April 2004 1 joint health probation supervision service, North West for up 30 MAPPA level 3+ Also looking at prison based through care arrangements (e.g. Grendon)

Admissions: 

Admissions

Admissions: 

Admissions

Admissions: 

Admissions

Legislation: 

Legislation There is no specific DSPD legislation. Services are provided within the framework of existing criminal or mental health legislation depending on the setting. The CJ Act 2003 provides for indeterminate sentencing for dangerous offenders, and for extended sentences for less serious offences . Proposed amendments to Mental Health legislation change 'treatability' to 'appropriate treatment available' The availability of DSPD resources and specialists would make treatment a viable option. DSPD offenders can access services provided in hospital via the hospital direction, already available under s45A of the 1983 MH Act. Those in prison are detained on the basis of their conviction and sentence. Treatment in prison is not compulsory.

Legislation: 

Legislation Do we need new legislation? IPPs deal substantially with the concern about those who previously received determinate sentences but were a continuing risk to the public But still have a substantial number of offenders of fixed sentence in custody who pose high risks At present the options are: to manage by transfer to hospital under the MH Act where that is possible. Not an easy route, clinically and in terms of management To manage in the community under the MAPPA. Needs strengthening with more effective supervision and aftercare models bringing together probation, health and social services Proposed violent offender orders would be helpful, complementing the sexual offender orders currently available

Shape of Services: 

Shape of Services Strengthen the knowledge base Evolving picture with the problems being tackled from a range of professional standpoints Comprehensive evaluation has been commissioned. Prof. Tom Burns, Oxford University leading. Difficult delivery environment: multi-agency; no single legal base; multi-professional

Shape of services: 

Shape of services These are pilot places never intended to be the full service. What has been learned? Too soon to come to a view about effectiveness Service delivery is complex and difficult The patient/offender group is probably too heterogeneous and difficult to manage solely in one setting (e.g. from 'learning disabled' to 'intelligent psychopaths') The conditions and risks are almost certainly life-long: we might hope to reduce risks so that some can be managed in less intrusive ways Risk reduction needs to be tested in different environments those released to community will continue to need supervision and aftercare

Shape of services: 

Shape of services What has been learned? Poorly coordinated approach across high/medium secure/community to very challenging individuals To deliver we need a system of managed care pathways, both in prisons and hospitals, covering high, medium security and the community Supported by effective case management arrangements that can plan the progress of individuals based on their assessed risk and progress against the 'whole system'. This means assessment early in the sentence

Shape of services: 

Shape of services Workforce Developing a competent and confident work force is key At what pace can we grow the Programme? Could more use be made of differently trained staff?

Conclusions: : 

Conclusions: Programme focusses on the most difficult group Consensus/agreement over risk tools(?) A thorough assessment of risk and treatment needs (even for those not subsequently admitted to DSPD services) Evidence of initial risk and current risk (if different) as well as advice about future management Evidence about how to package future services in custody and in the community that support individuals and manage risk