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Midlands Partnership NHS Foundation Trust (MPFT) is involved in working with National Probation Service partners to deliver a range of services as part of the Offender Personality Disorder Pathway. This national initiative was launched following the 2011 consultation led by the Department of Health and the Ministry of Justice which resulted in the re-investment of resources following the re-configuration of the Dangerous and Severe Personality Disorder programme.
The Offender Personality Disorder Pathway is designed to address the needs of both male and female offenders. Male offenders supported by OPD services are likely to have a severe personality disorder and will have been assessed as presenting a high likelihood of further violent or sexual offences and a high or very high risk of serious harm to others. Female offenders who may be appropriate for referral to OPD services are those with a current offence of violence and who have been assessed as presenting a high risk of committing another serious offence.
Core aspects of the OPD services are the formulation of clinically justifiable links between the traits associated with personality difficulties and the identified risk and the formulation of appropriate treatment and management plans informed by this understanding.
There are a number of aspects to the Offender Personality Disorder Pathway and MPFT is involved in delivering the following:
- Offender Personality Disorder (OPD) Community Specification Service
- Intensive Intervention and Risk Management Service (IIRMS)
- Psychologically Informed Planned Environments (PIPE)
- Metallisation Based Treatment (MBT) Service
- M-TREM Treatment Service
Midlands Partnership NHS Foundation Trust is delivering four OPD Community Specification services in partnership with Probation Service colleagues. These cover the areas of South Staffordshire, West Mercia, Leicestershire and Derbyshire.
The services are delivered by teams of Applied Psychologists and Specialist Probation Officers who work closely with local Probation Officers to support the identification of offenders with personality disorder through caseload screening methods; deliver case consultations and develop case formulations, including recommendations for treatment interventions and risk management in relation to offenders. The OPD teams also deliver training for probation staff in relation to the needs of this group of offenders and are involved in initiatives to support staff health and well-being.
Intensive Intervention and Risk Management Services work with individuals leaving prison or forensic mental health care to support successful transitions to community living. MPFT is involved in delivering services in Derbyshire and Leicestershire and as part of the regional Reach-Out Partnership in the West Midlands.
The services provide a range of support depending on service users’ needs. This can include psychological support to improve mental health and psychological well-being; risk assessment and risk management; social and living skills to help make and maintain good relationships; substance misuse support; housing advice and signposting to other services and advocacy.
The Mentalisation Based Treatment service in South Staffordshire is one of 11 pilot sites in a national project to implement and evaluate the efficacy of this treatment approach for male offenders with a diagnosis of Anti-Social Personality Disorder (ASPD) who are living in the community and subject to supervision by probation services. The MBT- ASPD project, coordinated by the Tavistock and Portman NHS Foundation Trust, commenced in May 2014.
MBT-ASPD participants attend a weekly group therapy session and in addition receive monthly individual therapy sessions with an allocated therapist. A dedicated clinical team of 3 therapists work one day a week to deliver the service with additional support provided by an Assistant Psychologist and a Consultant Forensic Psychiatrist. All members of the team have attended training in MBT-ASPD delivered by the Anna Freud Centre.
MPFT is currently supporting the delivery of two Psychologically Informed Planned Environments. The first PIPE is located at Crowley House, Approved Premises for women in Birmingham, which takes women on community sentences or on licence upon release from custody. The second PIPE is at Kirk Lodge Approved Premises Leicester for men in Leicester, which on license or bail or who present with a high or very high risk of harm.
PIPE’s are specifically designed environments, operating in Prisons and Probation Approved Premises, where staff members have additional training to help them develop an increased psychosocial understanding of their work with a particular focus on the environment in which they operate, actively recognising the importance and quality of relationships and interactions. The approach supports staff to create an enhanced, safe and supportive environment. PIPE’s aim to maximise learning opportunities within 'ordinary' living experiences and to approach these in a psychologically informed way, paying attention to interpersonal difficulties, for example, issues that might be linked to personality disorder.
PIPE’s are delivered by a psychologist, supported by a part-time assistant psychologist, working alongside probation staff working in the Approved Premises. Key elements of the model include: supporting 'Enabling Environment' accreditation; provision of staff training and development; coordination and provision of structured sessions for residents, including socially creative sessions, Key Worker sessions; and implementation of high quality clinical supervision.
M-TREM is an education and discussion group for men who have a history of trauma experiences and who are supervised by the National Probation Service. The group runs for 18 weeks and is led by NHS staff.
The group aims to provide a safe space for men to explore their trauma experiences and develop an understanding of the connection between these experiences and their current difficulties with a view to developing skills and strategies to manage these in a prosocial way.
The group programme considers the influence of male gender roles and stereotypes and how these are related to the experience of trauma; the relationship between feelings, thoughts, behaviour and trauma experiences and the ways in which distress may manifest itself; the pros and cons of different coping styles; individuals' strengths and strategies to build upon these strengths.