11 March, 2015

Sarah SkettJoint Lead, OPD Programme, NHS EnglandSarah.Skett@NHS.net

Ian GoodeJoint Lead, OPD Programme, NOMSIan.Goode@NOMS.gsi.gov.uk

Evening Seminar

Offender Personality Disorder

Pathway Programme

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

Strategic context

Response to the offender

personality disorder consultation Oct

2011,, page 11:

“The Government believes

that the £69m currently

invested in DSPD services

can be used more effectively

to improve the management of

offenders thereby reducing re-

offending, risk of harm to the

public, and providing more

treatment places and high

quality services.”

What is Personality Disorder?

Persistent

PervasiveProblematic

Equality

BME

• Effect of Culture

• Over representation in CJS

• Under representation in services

• Responsivity

Disability

• Physical access to services

• Cognitive capacity

• Responsivity

Gender

• 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- men / custody

No. of males in custody June 2012

Offenders who pass harm

screen (and included in

analysis)

Offenders who pass harm screen

and satisfy at least one of the

five other screening criteria

no. % no. %

Sentence Length <12 months determinate

5,924 1,13719%

678 11%

12+ months determinate

42,414 7,33917%

4,057 10%

IPP 5,813 1,837 32% 1,199 21%

Life 7,204 1,072 15% 728 10%

Recall 5,071 1,809 36% 1,345 27%

Total 66,426 13,194 20% 8,007 12%

Estimate of need and demand – men / community

No. of males in the

community June 2012

Offenders who pass harm

screen (and included in

analysis)

Offenders who pass harm screen and

satisfy at least one of the five

other screening criteria

no. % no. %

Sentence Type Licence 44,551 5,052 11% 2,678 6%

CO / SSO 72,622 8,307 11% 4,871 7%

Punitive only orders 24,667 627 3% 246 1%

Total 141,840 13,986 10% 7,795 5%

No. of females in

custody June 2012

Offenders who pass harm

screen (and included in

analysis)

Offenders who pass harm screen and

satisfy at least one of the five other screening

criteria

no. % no. %

Sentence Length <12 months determinate

622 15325%

7448%

12+ months determinate

1,989 65533%

30146%

IPP 125 98 78% 78 80%

Life 252 249 99% 137 55%

Recall 206 88 43% 65 74%

Total 3,194 1,243 39% 655 53%

Estimate of need and demand – women / custody

No. of females in

the community June 2012

Offenders who pass harm

screen (and included in

analysis)

Offenders who pass harm screen and

satisfy at least one of the five

other screening criteria

no. % no. %

Sentence Type Licence 3,037 943 31% 436 14%

CO / SSO 13,698 5,113 37% 2,276 17%

Punitive only orders

3,263 73923%

371%

Total 19,998 6,795 34% 2,749 14%

Estimate of need and demand – women / community

Need – 20,000 men and women offenders

Demand - ?

Estimate of need and demand – conclusions

Underpinning principles

Shared responsibility

Joint operations

Community-to-community

pathway

Staff have clarity of approach,

primary task & role;

Are well trained, supported & supervised;

Account is given to staff perceptions

Service users have clarity of

approach, role & responsibility

Account is given to service

user perceptions

Case formulation

Psychologically informed

Long-term pathway commitment

Managing breakdown& failure

Workforce development

Use resources efficiently

Pu

blic p

rotectio

nPs

ych

olo

gica

l hea

lth

im

pro

vem

en

t

Enabling Environments

Case identificationPathway planning

Community case management

PIPEs

PIPEs

OP

D t

reat

men

tO

ffend

ing

beh

aviou

r p

rogram

me

s

Risk management

Key MilestonesTo Jointly Commission with NOMS and the NHS

• New community based PD services in all probation areas

• Up to 6 new PD treatment services for men in prisons - (total of 300 places)

• Up to 13 new PD progression services in prisons and in approved premises (800 places)

• PD treatment services for women in prison - up to four services (total of 80 places)

• PD workforce development in prisons and probation

• Appropriate information technology

• A number of support services linked to the programme, such as: a) field test in a prison working with violent and disruptive prisoners, b) PD support for Close Supervision Centres c) Therapeutic Communities for prisoners with LD

d) PD treatment services in the community

• PD programme evaluation

The services

North

London

Midlands & EastWales

South

MSU Oswin,

Newcastle

Community outreach.Treatment

HMP Frankland, Durham.

PD TrtPIPE

HMP Full Sutton, York.CSC support

HMP Garth,

Preston.PD Trt

Resettle, Liverpool.

PD Trt

Community ID, case formulation, pathway planning and case management

HMP HullPIPE

HMP Wymott, Preston.

PIPE

HolbeckHouse AP,

Leeds.PIPE

Bradshaw House, AP,

Manchester.PIPE

The Retreat, York.

PD Trt

Stafford House, AP Liverpool.

PIPE

AshworthPD Trt

NORTH

LeedsMBT Pilot site

LiverpoolMBT Pilot site

LancashireMBT Pilot site

Southview AP, York.PIPE

Community outreach.Treatment

Rampton, RetfordPD Trt

TC+

HMP Whitemoor,

MarchPD Trt

HMP Dovegate, Utoxeter

DTCTC +

HMP Warren

Hill, Ipswich.

DTCPIPE

Community ID, case formulation, pathway planning and case management

HMP Wayland, Thetford.

PD TrtPIPEKirk Lodge AP,

Leicester.PIPE

HMP Gartree, Market

Harborough DTCTC+PIPE

MIDLANDS

HMP SwinfenHall, Lichfield,

PD TrtPIPE

LincolnshireMBT Pilot site

Staffs and WMMBT Pilot site

NottsMBT Pilot site

HMP Long Lartin, Evesham

Prep PIPE

HMP Woodhill,

Milton KeynesCSC support

MSUJohn

Howard Centre

Community outreach.Treatment

HMP BelmarshPD Trt

Pathway planning

Community ID, case formulation, pathway planning and case management ALL AP will be Enabling Environments

Community outreach

PD Trt

LONDON

MSURiver House

HMP Pentonville,

ESS

Community Outreach Housing projects

London NWMBT Pilot site

London NEMBT Pilot site

London SEMBT Pilot site

London SWMBT Pilot site

Community outreach

PD Trt

Community outreach.Treatment

HMP Grendon,Aylesbury

DTCTC +

Pathfinder Bristol

Pathway planning,

PD Trt

Community ID, case formulation, pathway planning and case management

HMP Swaleside, Sheppey

PD TrtPre PIPE

PIPEESS

HMPYOI Ayelsbury,

PD Trt

Pathfinder, South,

Pathway planning,

PD Trt

Broadmoor,PD Trt

SOUTH and WALES

WalesMBT Pilot site

DevonMBT Pilot site

GloucestershireMBT Pilot site

HMP Send, nr GuildfordPrep PIPE

DTCPIPEEE

HMP Holloway,

London, DBT Service

HMP FostonHall,

Derby,PD TrtCARE

EE

HMP Drake Hall,Stafford,

whole prison EE

HMP Eastwood

Park, Bristol,Prep PIPE

PD TrtEE

HMP Styal, Cheshire

EE

HMP New Hall,

Wakefield,PD TrtCARE

EE

Rampton,PD Trt

WOMEN’S PATHWAY

Community ID, case formulation, pathway planning and case management

MSUArnold Lodge

LeicesterWEMS

MSUThe Orchard

SouthallWEMS

MSUEdenfield

ManchesterWEMS

HMP Peterborough,

EE

Mentoring & advocacy

service for N. England & N.

Wales

Mentoring &

advocacy support in

London

Mentoring & advocacy support in

Birmingham

Edith Rigby AP, Preston

PIPE

Crowley House AP,

BirminghamPIPE

HMP Bronzefield,

StainesEE

HMP Low Newton, DurhamPD TrtPIPEEE

Intensive Integrated

Risk Management Service, Yorks

& Humber

HMP Frankland, Durham.

PD TrtPIPE

HMP Full Sutton, York.

CSC support

HMP Garth,

Preston.PD Trt

AshworthPD Trt

NATIONAL – HIGH SECURE

Broadmoor,PD Trt

HMP Belmarsh,

LondonPD Trt

MSUJohn Howard

Centre

MSU,River House

HMP Grendon,Aylesbury,

DTCTC+

HMP Swaleside,Sheppey,

PIPE

PD Trt

HMP Whitemoor,

MarchPD Trt

Rampton,PD Trt,

TC+

HMP Gartree,Market

Harborough,DTCTC+PIPE

HMP Dovegate,Utoxeter,

DTCTC+

Arnold Lodge, MSU

MSU,Oswin

HMP Hull,PIPE

SO only

HMP Woodhill,

Milton KeynesCSC support

HMP Long Lartin,

EveshamPrep PIPE

What are the gaps?

Gaps

Sex Offenders pathway

Community CJS Treatment

High secure

post pipe

Cat C pre pipe

Community Forensic

mental health services

Pathway out of

custody –Cat D

LD pathway

Supported housing

More PIPES in

APs

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 and Evaluation

National Evaluation

OPD Treatment

IONNA

A case study investigation into the Chromis programme

PIPE

Impact Staff Training Module (KUF)

Evaluation of the women’s PDPathway in Lancashire

DTC

An evaluation of risk reduction Following treatment using

HCR20

Pathway Effectiveness

ServiceImpact

Practice and Development

Research Programme (three levels)

National Evaluation (male offenders)

• Kings College London (KCL) lead

• Starts 1st 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

“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.”

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 and NOMS in its on-going strategic planning of the

pathway

Offender PD Pathway Co-Commissioning Team Structure

Ian Goode

NOMS and Joint

Head of OPD

Team

Laura d’CruzNOMS Senior

Co-Commissioning

Manager

London and

national women’s

lead

Kirk TurnerNOMS Senior

Co-Commissioning

Manager

Therapeutic

Environments

Nick JosephNOMS Senior

Co-Commissioning

Manager

South (incl. Wales)

Sarah BridglandNOMS

OPD

Research

Manager

Patrick Wall

(covering for Debra

Jeffrey – on

Maternity leave)

Workforce

Development

& OPD

Engagement

Manager

Neil PigginNOMS Regional

Co-Commissioning

Manager

(North)

Rachel WilsonNOMS Regional

Co-Commissioning

Manager

(Midlands

and East)

Kathryn Harney

Greater Manchester

West MH NHS FT

PD Research

Advisor

Sarah Skett

NHS and

Joint Head

of OPD Team

ZoeThornton

NHS Specialised

Commissioning

South (Wessex)

Jennie Slater

Therapeutic

Communities

Development

Manager

Joint SROs

Simon Boddis

(NOMS)

tbc

(NHS England

Guy Cross

DH

Personality

Disorder policy

contact

As at 2-3-2015

Mick Burns

NHS Specialised

Commissioning North

(South Yorkshire

and Bassetlaw)

Terry Kirkby

NHS Specialised

Commissioning

Midlands and East

(Leicestershire

and Lincolnshire)

+ Wales

Mary O’Donnell

NHS Specialised

Commissioning

London

Jeremy Glyde

Programme

Director

Specialised

Services

Questions ?