The Resettle Project Beyond The Therapy Room. Dr Vikki Baker & Dr Sarah Davidson 21 st January 2017

Transcription

1 The Resettle Project Beyond The Therapy Room Dr Vikki Baker & Dr Sarah Davidson 21 st January 2017

2 Aims For Today Who We Are - Why Beyond The Therapy Room? History of the service & OPD Pathway The Resettle Model key principles A relational approach to working with trauma Some challenges

3 Resettle (Intensive Intervention & Risk Management Service) Part of the joint health/criminal justice offender personality disorder pathway For men coming out of prison with complex difficulties linked to their personality functioning Who are at high risk of re-offending Attend as a condition of post custody release licence (18 month minimum) Balancing intensive risk management alongside high levels of therapeutic support

4 Resettle: A Brief History National pilot, originally part of DSPD provision Recognition that this client group become stuck in prison/high secure hospitals Need to test and manage risk in the community Recognition of social and psychological origins of offending (manifestation of trauma, distress, absence of hope)

5

6 Factors Associated With Re- Offending (MOJ) Substance use Impulsivity / low self control Attitudes that support crime Social networks that support crime (anti-social peers) Lack of / poor family and intimate relationships Lack of employment Suitable accommodation Absence of hope NB all of these are exacerbated within a prison environment

7 Links Between Offending and Social Adversity Compared to the general population, prisoners are: 13 times more likely to have been in care as a child 10 times more likely to have been a regular truant from school 13 times more likely to be unemployed 2.5 times more likely to have a family member who has been convicted of a criminal offence 6 times more likely to have been a young father

8 Why An Offender Personality Disorder (PD) Pathway? Recognition that around 60% of male prison population would meet the criteria for PD Prevalence in general population is between 5 and 10% Most have multiple psychological and social difficulties and needs PD diagnosis neither helpful nor valid (disproportionately associated with risk and challenging behaviour) Need for individualised, multi modal understandings and interventions, focussing on strengths and interests as well as offending

9 Some Positives About The Offender PD Pathway De-emphasis on diagnosis Focus on environmental interventions Recognition of need for innovation and partnership working Focus on psychologically informed services and staff Recognition of the importance of optimistic, boundaried relationships Importance of staff supervision and training to support this Continuity and coherent services from community to community Focus on wellbeing and social integration as well as offending behaviour

10 What Personality Disorder Means To Participants

11 Resettle (IIRMS) High intensity: 4 days per week Non residential Psychology led service departure from medical model Multi agency, multi disciplinary team 3 stage model: prison in reach, attendance at project, move on Attachment based enabling environment. group and individual interventions delivered within a therapeutic milieu. Over arching model is sociotherapy

12 Key Principles Clear and high expectations of behaviour whilst also recognising and working with difficult behaviours Focus on engagement fostering and maintaining a therapeutic alliance Robust and transparent risk management alongside support and therapeutic input Difficulties are noticed and explored and additional support/monitoring given as needed 12

13 The Resettle Model 24 hour crisis line Targeted interventions (group and individual) Guided by CAT informed biopsychosocial formulations- developed with the team and the individual; led by team clinical psychologist Focus on social integration and high levels of support Education, employment, benefits, housing, substance misuse and other agencies Underpinned by therapeutic community principles and focus on community activity 13

14 A relational approach Not personalising attacks Awareness of relational script being repeated Maintain compassion Aware of need for power, control Sensitivity Maintenance of boundaries in relation to risk

15 Traumatising I act out my story on the minds and bodies of my victims victims Abusing/humiliating Abused/humiliated perpetrators

16 Containing

17 Supporting The Team Encourage curiosity No certainty, alternative hypotheses What is behind the behaviour? Resist the temptation to engage in the dance Notice strong pulls maintaining the seesaw Support Clinical/Group supervision

18 Some challenges Unrealistic expectations from staff and stakeholders too high or too low Client expectations mistrusting, idealising, rejecting Ambivalence about seeking and receiving help Substance misuse Desire for a quick fix (staff and participants) Trauma Managing anxiety about risk (both service user s and others ) Maintaining hope during any period of recall 18

19 Why is desistance from crime hard?...i am finding out a great deal about myself. I am making new relationships and living in a world totally unknown to me. I love it yet there are times when I hate it. I am torn between two worlds alienated from the old one and a stranger in this new one ( Jimmy Boyle, 1985: The Pain of Confinement, prison diaries)

20 Finally... Any questions...? Thank you for listening