Programmes that are offered in prisons to address specific offending behaviours tend to have a “one size fits all” approach. If the individual has committed a sexual offence, he completes the prison service recommended sexual offending programme. If he has issues around violence or anger, he completes an accredited violence reduction programme. This suggests that the needs and difficulties of all offenders fit into these programmes neatly.
When working effectively with medium secure or low secure patients, greater consideration needs to be given to the specific difficulties that these patients have. Along with offending behaviours, there are a range of mental health difficulties which complicate the picture and present with another area of potential treatment along with the above-mentioned behaviours. The first step to ensuring an intervention is effective is thorough assessment of the patient.
As part of the development of an effective treatment plan, the sequencing of the treatment is of paramount importance. If a patient is acutely unwell, it will be important to wait until they are more stable to engage in treatment. This may mean waiting until the correct combination of medication is arrived at which allows them to be well enough to engage in the more psychologically focused treatments.
Whether the patient is in a medium secure or low secure unit, there is a typical sequence of treatment that is undertaken to be shown to be most effective. Initial treatment would aim to assess a patient’s motivation and insight into their difficulties. This tends to be low level and non-directive. It may just involve the patient sitting with their therapist and getting comfortable with the idea of having open conversations with them. If they are reluctant, techniques such as motivational interviewing may be helpful to aid with engagement. Motivational interviewing is a psychotherapeutic approach that attempts to move an individual away from a state of indecision or uncertainty and towards finding motivation to making positive decisions and accomplishing established goals.
Once presenting as motivated to engage in treatment, psychoeducation work to help the patient understand their illness and how it impacts on their day to day functioning would be beneficial. By having a greater understanding of their illness and how it affects them, they can become more aware of what a relapse may look like and engage in preventative strategies to stop further deterioration. Based on the formulation of the patient, it may be the case that the problematic behaviours discussed above, only occur in the context of a deteriorated mental state, so it may not be necessary to complete detailed offence focussed work; instead a focus on relapse prevention and the completion of a WRAP (Wellness Recovery Action Plan) may be sufficient, particularly if the patient will have a high degree of support once returned to the community.
If our formulation noted that the mental illness had no bearing on whether the patient engaged in problematic behaviours, then more typical offending behaviour treatment may be necessary. Some patients within these environments may have been transferred from prison when they became unwell, and there will be an expectation of completion of these types of programmes before the Ministry of Justice and/or the Parole Board are happy to support their return to the community.
What is becoming more apparent in the treatment of patients with both offending behaviours and mental illnesses, is the role that trauma can play in both of these areas. At Chadwick Lodge patients are now being offered the opportunity to address areas of trauma either as a stand-alone treatment, through schema therapy, Eye Movement Desensitized Repossessing (EMDR) or Dialectical Behaviour Therapy (DBT) Prolonged Exposure.
Throughout the process of treatment, whether in medium secure or low secure the key to its effectiveness is to consider it in the context of the patient’s formulation and making sure the treatment addresses the needs specific to the patient and their risk.
Chadwick Lodge & Eaglestone View provide specialist medium and low secure services for men and women who have been detained under the Mental Health Act 1983 (amended 2007).
Chadwick Lodge is renowned for successfully treating complex personality disordered patients and those with mental illness. In addition, we offer tailored care to those patients who present with a dual diagnosis of mental illness/personality disorder and mild learning disability. (We also specialise in remand patients, patients transferred from prison and those with a history of serious offending).
If you would like to know more about this service or make a referral, please call Sophia Jaques on 07387417022 or email Sophia.Jaques@Elysiumhealthcare.co.uk.