Offender Personality Disorder Pathway Programme Sarah Skett NHS

Offender Personality Disorder Pathway Programme Sarah Skett – NHS England Sarah. Skett@NHS. net Joint Commissioner OPD Programme Ian Goode – NOMS Ian. Goode@NOMS. gsi. gov. uk Joint Commissioner OPD Programme

Commissioning in NOMS and NHS Commissioner Determine need Specify ‘WHAT’ Procure Evaluate Provider Determines ‘HOW’ Delivers outputs and outcomes

Strategic Context

Strategic Context Inclusion for DSPD: Evaluating Assessment and treatment (IDEA) (March 2006 – August 2009) Tom Burns, Jenny Yiend, Tom Fahy, Seena Fazel, Ray Fitzpatrick, Julia Sinclair, Robert Rogers, Maria Vasquez Montes Multi-method Evaluation of the Management, Organisation and Staffing (MEMOS) in high security treatment services for people with Dangerous and Severe Personality Disorder (DSPD) (October 2010) Tim Weaver, Julie Trebilcock, Mary Leamy, Mohammed Al-Hairi, Mike Crawford & Peter Tyrer DSPD Strategy economic and financial modelling October 2010. TRIBAL consulting

Strategic context Response to the offender personality disorder consultation Oct 2011, , page 11: “The Government believes that the £ 69 m currently invested in DSPD services can be used more effectively to improve the management of offenders thereby reducing reoffending, risk of harm to the public, and providing more treatment places and high quality services. ”

Persistent What is Personality Disorder? Problematic Pervasive

Severe PD Moderate PD Mild PD Notable problems BUT Not associated with harm Marked problems. Harm but not endangering life Severe problems in all areas of life. High levels of harm to self and others. Endangering life Classification, assessment, prevalence, assessment and effect of PD. Tyrer et al. The Lancet. Vol 385, pp 717 -726. 2015

Personality disorder • A pervasive disturbance in how an individual experiences and thinks about the self, others, and the world, manifested in maladaptive patterns of cognition, emotional experience, emotional expression, and behaviour. • The maladaptive patterns are relatively inflexible and are associated with significant problems in psychosocial functioning that are particularly evident in interpersonal relationships. • The disturbance is manifest across a range of personal and social situations (ie, is not limited to specific relationships or situations). • The disturbance is relatively stable over time and is of long duration. Most commonly, personality disorder has its first manifestations in childhood and is clearly evident in adolescence. Classification, assessment, prevalence, assessment and effect of PD. Tyrer et al. The Lancet. Vol 385, pp 717 -726. 2015

Equality BME Disability Gender • Effect of Culture • Over representation in CJS • Under representation in services • Responsivity • Physical access to services • Cognitive capacity • Responsivity • Evidence of differences and similarities • Responsivity

The entry criteria for services Men • Assessed as presenting a high likelihood of violent or sexual offence repetition and high or very high risk of serious harm to others at some point during their current sentence • Likely to have a severe personality disorder • A clinically justifiable link between the personality disorder and the risk • Managed by NPS Women • Current offence of violence against the person, criminal damage, sexual and/or against children • Assessed as presenting a high risk of committing an offence from the above categories • Likely to have a severe form of personality disorder • A clinically justifiable link between the above

Estimate of need and demand • 7 or more checked items; – – – 1 or more conviction aged under 18 years Any breaches 3 or more different categories of conviction (as an adult) Any of the offences include violence/threat of violence/coercion Any of the offences include excessive violence/sadism Fails to recognise the impact of their offending on the victim/community/wider society Over-reliance on friends/family/others for financial support Has a manipulative/predatory lifestyle Evidence of reckless/risk taking behaviour Evidence of childhood behavioural problems Any Impulsivity Any Aggressive/controlling behaviour • AND / OR childhood difficulties, mental health problems, history of self harm or suicide, risk of serious harm to staff

Estimate of need and demand Men Women Community sentence Custodial sentence 8, 000 3, 000 8, 000 700 Total 16, 000 3, 700 20, 000 men and women offenders Demand - ?

Underpinning principles Shared responsibility Joint operations Service users have clarity of approach, role & responsibility Account is given to service user perceptions Community-tocommunity pathway Staff have clarity of approach, primary task & role; Case formulation Are well trained, supported & supervised; Psychologically informed Account is given to staff perceptions Long-term pathway commitment Managing breakdown& failure

Workforce development OPD treatment PIPEs Community case management Use resources efficiently Public protection Risk management Enabling Environments Offending behaviour programmes Psychological health improvement Case identification Pathway planning

Funding (1) 2011 -12 OLD DSPD PROGRAME: NHS NOMS TOTAL - £ 54 m (630 m NOK) £ 10 m (120 m NOK) £ 64 m (750 m NOK) DELIVERING: 170 Treatment Places in High and Medium Secure Hospitals 156 Treatment Places in High Security Prisons 12 Treatment Places in a Women’s Prison

Funding (2) 2015 -16 OPD programme – still £ 64 m (750 m NOK) DELIVERING: - - 105 Treatment Places in High and Medium Secure Hospitals 426 Treatment Places in Prisons 68 Treatment Places in 3 women’s prisons 700 Progression Places in 12 prisons and 7 Approved Premises Early identification, case formulation and consultation services provided by a partnership between a health provider and all probation areas Workforce Development programme 5 Year Programme Evaluation by Kings College London

Outcomes • A reduction in repeat serious sexual and/or violent offending (men); or A reduction in repeat offending of relevant offences for female offenders (women) • Improve psychological health, wellbeing, pro social behaviour and relational outcomes • Improve the competence, confidence and attitudes of staff working with complex offenders who are likely to have Personality Disorder • Increase the efficiency, cost effectiveness and quality of OPD Pathway Services

The services North Wales Midlands & East South London

Community outreach. Treatment MSU Oswin, Newcastle NORTH HMP Frankland, Durham. PD Trt PIPE HMP Garth, Preston. PD Trt Lancashire MBT Pilot site HMP Wymott, Preston. PIPE Holbeck House AP, Leeds. PIPE Liverpool MBT Pilot site Ashworth PD Trt Resettle, Liverpool. PD Trt Southview AP, York. PIPE Stafford House, AP Liverpool. PIPE The Retreat, York. PD Trt HMP Full Sutton, York. CSC support Leeds MBT Pilot site Bradshaw House, AP, Manchester. PIPE Community ID, case formulation, pathway planning and case management HMP Hull PIPE

MIDLANDS Notts MBT Pilot site Lincolnshire MBT Pilot site HMP Dovegate, Utoxeter DTC TC + Staffs and WM MBT Pilot site HMP Swinfen Hall, Lichfield, PD Trt PIPE HMP Long Lartin, Evesham Prep PIPE HMP Woodhill, Milton Keynes CSC support Rampton, Retford PD Trt TC+ HMP Whitemoor, March PD Trt HMP Wayland, Thetford. PD Trt PIPE Kirk Lodge AP, Leicester. PIPE HMP Gartree, Market Harborough DTC TC+ PIPE Community outreach. Treatment Community ID, case formulation, pathway planning and case management HMP Warren Hill, Ipswich. DTC PIPE

Community outreach. Treatment LONDON Community outreach PD Trt London NW MBT Pilot site HMP Pentonville, ESS MSU John Howard Centre HMP Belmarsh PD Trt Pathway planning Community Outreach Housing projects London SW MBT Pilot site London NE MBT Pilot site Community outreach PD Trt MSU River House London SE MBT Pilot site Community ID, case formulation, pathway planning and case management ALL AP will be Enabling Environments

SOUTH and WALES HMP Grendon, Aylesbury DTC TC + HMPYOI Ayelsbury, PD Trt Broadmoor, PD Trt Wales MBT Pilot site HMP Swaleside, Sheppey PD Trt Pre PIPE ESS Gloucestershire MBT Pilot site Pathfinder Bristol Pathway planning, PD Trt Devon MBT Pilot site Pathfinder, South, Pathway planning, PD Trt Community outreach. Treatment Community ID, case formulation, pathway planning and case management

HMP Low Newton, Durham PD Trt PIPE EE WOMEN’S PATHWAY MSU Edenfield Manchester WEMS HMP Styal, Cheshire EE Edith Rigby AP, Preston PIPE HMP Drake Hall, Stafford, whole prison EE Crowley House AP, Birmingham PIPE HMP Eastwood Park, Bristol, Prep PIPE PD Trt EE Intensive Integrated Risk Management Service, Yorks & Humber HMP Foston Hall, Derby, PD Trt CARE EE Mentoring & advocacy support in Birmingham MSU Arnold Lodge Leicester WEMS HMP New Hall, Wakefield, PD Trt CARE EE Mentoring & advocacy service for N. England & N. Wales Rampton, PD Trt HMP Bronzefield, Staines EE HMP Send, nr Guildford Prep PIPE DTC PIPE EE HMP Peterborough, EE HMP Holloway, London, DBT Service MSU The Orchard Southall WEMS Community ID, case formulation, pathway planning and case management Mentoring & advocacy support in London

NATIONAL – HIGH SECURE MSU, Oswin HMP Garth, Preston. PD Trt Ashworth PD Trt Arnold Lodge, MSU HMP Dovegate, Utoxeter, DTC TC+ HMP Long Lartin, Evesham Prep PIPE HMP Woodhill, Milton Keynes CSC support HMP Frankland, Durham. PD Trt PIPE HMP Gartree, Market Harborough, DTC TC+ PIPE HMP Grendon, Aylesbury, DTC TC+ HMP Full Sutton, York. CSC support HMP Hull, PIPE SO only Rampton, PD Trt, TC+ MSU John Howard Centre Broadmoor, PD Trt HMP Whitemoor, March PD Trt HMP Belmarsh, London PD Trt MSU, River House HMP Swaleside, Sheppey, PIPE PD Trt

Gaps High secure post pipe Community Forensic mental health services More PIPES in APs Sex Offenders pathway Cat C pre pipe Community CJS Treatment Pathway out of custody – Cat D LD pathway Supported housing

Research and Evaluation 1. To evaluate the effectiveness of the Pathway • How was the PD strategy delivered? • What difference did the PD strategy make? • Did the benefits justify the costs? In addition: 2. To evaluate the effectiveness of individual programmes, including pilots/field tests; 3. To evaluate the development of new tools (e. g. case formulation, training materials); 4. To develop knowledge in the field of forensic PD.

Research Programme (three levels) Pathway Effectiveness Service Impact Practice and Development National Evaluation OPD Treatment Pathway evaluation in London A case study investigation into the Chromis programme DTC PIPE An evaluation of risk reduction Following treatment using HCR 20 Impact Staff Training Module (KUF) Evaluation of the women’s PD Pathway in Lancashire

National Evaluation (male offenders) “The key principle for the national OPD Programme is that outcomes will be achieved and maintained by the offender accessing a Pathway of services, rather than accessing a single intervention or programme. ” • Kings College London (KCL) lead • Starts 1 st August 2014 for 4 years • Stage 1 (first 18 months) feasibility: develop Pathway theory, test data collection, analysis • Stage 1 focus on OPD Pathway in North of England

National Evaluation Process study – How was the PD strategy delivered? • Aim - to provide a robust theoretical understanding of how the pathway operates, how the Pathway has been delivered and explain the outcomes of the impact and economic evaluations in light of these expectations. Impact study – What difference did the PD strategy make? • Aim - to assess the effectiveness of the Offender Personality Disorder Pathway on reducing reoffending and improving psychological health; and guide commissioners, providers and policy makers on which aspects of the programme are most effective and how the programme can be refined. Economic evaluation – Did the benefits justify the costs? • Aim to provide evidence on the cost effectiveness of the Pathway, to support NHS England NOMS in its on-going strategic planning of the pathway

Offender PD Pathway Co-Commissioning Team Structure Joint SROs Simon Boddis (NOMS) Cathy Edwards (NHS England Kirk Turner NOMS Senior Co-Commissioning Manager London and national women’s lead Therapeutic Environments Patrick Wall and Debra Jeffrey Workforce Development & OPD Engagement Manager As at 2 -3 -2015 Nick Joseph NOMS Senior Co-Commissioning Manager South (incl. Wales) Guy Cross DH Personality Disorder policy contact NOMS OPD Research Manager Kathryn Harney Greater Manchester West MH NHS FT PD Research Advisor Mick Burns Terry Kirkby NHS Specialised Commissioning North Commissioning (South Yorkshire Midlands and East and Bassetlaw) (Leicestershire and Lincolnshire) + Wales Jennie Slater Therapeutic Communities Development Manager Sarah Bridgland Director Specialised Services Sarah Skett NHS and Joint Head of OPD Team Ian Goode NOMS and Joint Head of OPD Team Laura d’Cruz Wayne Bartlett-Syree Programme Neil Piggin NOMS Regional Co-Commissioning Manager (North) Rachel Wilson NOMS Regional Co-Commissioning Manager (Midlands and East) Zoe. Thornton NHS Specialised Commissioning South (Wessex) Mary O’Donnell NHS Specialised Commissioning London