Offender Personality Disorder Pathway Programme

Sarah Skett – NHS England Sarah.Skett@NHS.netJoint Commissioner OPD Programme

Ian Goode – NOMS Ian.Goode@NOMS.gsi.gov.ukJoint Commissioner OPD Programme

Commissioning in NOMS and NHS

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.”

Classification, assessment, prevalence, assessment and effect of PD. Tyrer et al . The Lancet. Vol 385, pp717-726. 2015

Personality disorder

• A pervasive disturbance in how an individual experiencesand thinks about the self, others, and the world, manifestedin maladaptive patterns of cognition, emotional experience,emotional expression, and behaviour.

• The maladaptive patterns are relatively inflexible and areassociated with significant problems in psychosocialfunctioning that are particularly evident in interpersonalrelationships.

• The disturbance is manifest across a range of personal andsocial situations (ie, is not limited to specific relationshipsor situations).

• The disturbance is relatively stable over time and is of longduration. Most commonly, personality disorder has its firstmanifestations in childhood and is clearly evident inadolescence.

Classification, assessment, prevalence, assessment and effect of PD. Tyrer et al . The Lancet. Vol 385, pp717-726. 2015

Equality

The entry criteria for services

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

20,000 men and women offendersDemand - ?

Estimate of need and demand

Men Women

Community sentence

8,000 3,000

Custodial sentence 8,000 700

Total 16,000 3,700

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

Public protectionPs

ycho

logi

cal h

ealth

im

prov

emen

t

Enabling Environments

Case identificationPathway planning

Community case management

PIPEs

PIPEs

Risk management

Funding (1)

2011-12OLD DSPD PROGRAME:

NHS - £54m (630m NOK)NOMS - £10m (120m NOK)TOTAL - £64m (750m NOK)

DELIVERING:170 Treatment Places in High and Medium Secure Hospitals156 Treatment Places in High Security Prisons12 Treatment Places in a Women’s Prison

Funding (2)

2015-16OPD programme – still £64m (750m 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

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

Holbeck House 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 Swinfen Hall, 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 Foston Hall,Derby,PD TrtCARE

EE

HMP Drake Hall,

Stafford,whole prison EE

HMP Eastwood Park, Bristol,

Prep PIPEPD Trt

EE

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

MSU Edenfield

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,

PIPEPD 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

Gaps

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

Pathway evaluation in London

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)

“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 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

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 GoodeNOMS and Joint

Head of OPDTeam

Laura d’CruzNOMS Senior

Co-CommissioningManager

London and national women’s

lead

Kirk TurnerNOMS Senior

Co-CommissioningManager

Therapeutic Environments

Nick JosephNOMS Senior

Co-CommissioningManager

South (incl. Wales)

Sarah BridglandNOMS OPD

ResearchManager

Patrick Wall and Debra

JeffreyWorkforce

Development & OPD

Engagement Manager

Neil PigginNOMS Regional

Co-Commissioning Manager

(North)

Rachel WilsonNOMS Regional

Co-Commissioning Manager

(Midlands and East)

Kathryn HarneyGreater Manchester West MH NHS FT

PD Research Advisor

Sarah Skett NHS and Joint Head

of OPD Team

ZoeThorntonNHS Specialised CommissioningSouth (Wessex)

Jennie SlaterTherapeutic Communities Development

Manager

Joint SROsSimon Boddis

(NOMS)Cathy Edwards(NHS England

Guy CrossDH

Personality Disorder policy

contact

As at 2-3-2015

Mick BurnsNHS Specialised

Commissioning North (South Yorkshire and Bassetlaw)

Terry KirkbyNHS Specialised Commissioning

Midlands and East (Leicestershire

and Lincolnshire) + Wales

Mary O’DonnellNHS Specialised Commissioning

London

Wayne Bartlett-Syree Programme

Director Specialised

Services