The role and scope of forensic clinical psychology in secure unit provisions: A proposed service model for psychological therapies

Abstract

The purpose of this paper is to review the role and scope of forensic clinical psychology in forensic services and to develop a service model for psychological treatments in secure unit settings. The paper presents the findings of a one-year audit of the Southwark Forensic Psychology Service between April 2004 and March 2005, completed in order to determine the clinical activities provided by the service. It was found that 67% of working time was spent engaged in patient-related work (i.e., in direct or indirect patient contact), and an additional 11% in supervision of this work. The remainder of the time was spent in consultations and meetings, and in activities relating to recruitment, continuous professional development, research, teaching, and training. Only 19% of the patient-related work involved direct patient contact. Most of the indirect patient contact time related to attendance at management/ward rounds and care planning arrangement meetings, reading medical files, report writing, and conducting risk assessments. The audit findings have been used to produce a strength-based service model, which is based on current philosophy regarding the most effective way to integrate psychology into a multi-disciplinary team.

The recovery approach to care in psychiatric services: staff attitudes before and after training

“…Existing staff questionnaires were considered too lengthy and not suitable for the recovery approach being applied in forensic settings. The questionnaire was specifically developed for application in forensic services, but the content was guided by published work on the recovery approach, 4,7,11 where the focus is on teaching and training service users to be instrumental in their own care and recovery (i.e. learning to do things for themselves through collaboration with others, rather than being passive recipients of care), developing hope, and staff facilitating realistic choices and opportunities.…”

“…10,11 Training for staff in medium secure units within forensic services in Lambeth was devised in a number of stages, one of which was a 1-day training package on the forensic recovery approach to care. The aims of the training were to:…”

Sailing uncharted seas without a compass: A review of interventions in forensic mental health

“…Recent literature has described the application of recovery approach principles to a range of forensic domains and populations (Drennan & Alred, 2012;Gudjonsson, Webster, & Green, 2010;Gudjonsson & Young, 2007), and research evaluating forensic services against recovery-focused principles (Baker et al, 2012;Corlett & Miles, 2010) is beginning to emerge. Preliminary findings are that, despite its challenges, implementation of the recovery philosophy is possible in a forensic mental health context (Corlett & Miles, 2010) and can change how forensic mental health practitioners work with MDOs in fundamental ways (Drennan & Alred, 2012).…”

Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

“…Furthermore, it aims to provide a multi-disciplinary plan of care that works actively with the challenges of providing care and treatment to forensic mental health service users (such as poor motivation to change and/or engage, poor compliance with treatments, difficulties in generating integrated pathways across services and improving quality of life), aids transparency of intervention to need (so going some way to addressing the 'untrustworthiness' held by some forensic mental health service users to 'the system'; Austin et al, 2009) and aims to make best use of available resources. The development of models such as these continues to be advocated in the literature on forensic service evaluation (for example, Gudjonsson and Young, 2007;Young, Gudjonsson, NeedhamBennett and Chick, 2009). …”

“…Whilst these studies are not indicative of level of met or unmet need, they raise the notions of treatment intensity and frequency ('dosage'), service responsivity (how well specific service user needs are met) and how these relate to a timely care pathway. Furthermore, they raise the question of whether the readiness of service users for treatment has been assessed and what the services offer to help to motivate and engage groups of MDOs who frequently present with low motivation to change and low compliance with treatment (Gudjonsson and Young, 2007). Indeed, Wong, Gordon and Gu (2007) argue that the assessment Domains of Need 9 of treatment readiness amongst forensic clients is essential to reducing attrition in psychological treatment and thereby improving the outcomes of treatment and management strategies.…”