|Contact||Lorraine Parker, High Intensity Psychological Therapist|
|Address||1st Floor, Gwendolen House, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4QF|
The Open Mind service provides evidence based psychological therapies for common mental health problems to offenders subject to community supervision in Leicester.
The service is available to people with a post custody licence, community order and suspended sentence order on Leicester City Probation Service premises.
- Open Mind Information Leaflet
- Open Mind Case Narratives and Feedback
- Open Mind Presentation for Offender Managers
- Open Mind Outcomes
Research has established that mental health issues are disproportionately greater in the offender community than in the population as a whole. One study (Soloman, Silvestri 2008), found that up to 42% of an Offender Manager’s caseload had mental health difficulties, and there was a significant association with problems around mental health, accommodation and employment, and a risk of reoffending. As a whole, this client group are likely to have little contact with GP services, with a resulting low referral rate to psychological therapy.
Our short-term aim is therefore to provide an integrated health and Criminal Justice service. We tested the business case to inform commissioning, by examining outcomes from 100 referrals in 12 months. The challenge was to provide psychological therapies within an integrated pathway that included other relevant disciplines, such as Offender Managers, Health Trainers and created an environment that was ‘safe and familiar’ to the offender group.
The change introduced and how this was done
A model of co-location was agreed, which meant that an area had to be provided within the probation premises to house a small therapy team. A structure of reporting had to be also put in place between health and criminal justice. Information sharing agreements had to be agreed. Health staff needed to be trained and authorisation given to access criminal justice information and data.
Throughout the process, systems were put in place for meetings between the Offender Manager, IAPT therapist, and service users to enable information sharing, transparency and to allow a therapeutic relationship to develop, thus breaking down barriers to accessing services.
The service involved the provision of 1.2WTE CBT therapist, Integrative Therapist – 1 session each week.
Staff needed to have experience of providing evidence-based therapy in accordance with NICE guidelines and of working with a complex client group.
Of 104 referrals from Nov 2012 – July 2013, 13% were identified as not suitable. 41% did not attend their first appointment. This DNA rate needs to be compared with the equivalent service in general practice. 46% of the referrals entered treatment.
Anecdotal evidence from Offender Managers, and self-reports from service users, imply that results are better than the figures suggest. Further analysis indicates that those who engaged did very well. The pilot scheme increased access to psychological therapies, and some offenders were able to commit to therapy and engage in the process.
If extended, the scheme is likely to contribute to reducing the level of re-offending, and offer the possibility of recovery to a client group who would, in all likelihood, not have had access to psychological therapies.
The main challenge was trying to balance the IAPT model of treating only mild, moderate, and moderate-severe depression and anxiety, with the therapeutic needs of such a complex client group, often requiring Step 4 expertise.
The project leads are part of the National IAPT Steering Group for Offenders, which aims to spread best practice by setting standards for working with offenders nationwide.
Key learning points
Whilst it might appear to be a significant investment to set up, the resulting reduction in health and social care utilisation from successful treatment, presents future cost savings. The uptake of the service has gradually increased as the role, remit and efficacy of the IAPT workforce in the Probation Service has become embedded in the Offender Manager Practice.
Factors which have had an impact on attendance rates include: the number of appointments the offender has to attend such as work programmes, meetings with the Offender Manager, housing issues, benefits, etc.
Training was necessary for Offender Managers to identify mental health problems and to engage offenders in discussions about their mental health/wellbeing. These discussions would include giving information about what help was available.