Dr Manjit Gahir Consultant Forensic Psychiatrist Jason Lowe Advanced Healthcare Practitioner

Transcription

1 The National High Secure Deaf Service/ Prison In-reach Programme The 2nd Health and Justice Conference Achieving Health Equality in Secure Care and Custody Dr Manjit Gahir Consultant Forensic Psychiatrist Jason Lowe Advanced Healthcare Practitioner 1

2 History Deaf patients in Rampton since 1960 s Employed deaf worker in 1982 Previously had interpreters on ad hoc basis Deaf and hearing patients used to be mixed Lots of violence communication frustration Brought all deaf patients together in 2002 Moved to 10 bedded deaf only unit in 2006 New ward in

3 Patients 8 profoundly deaf men (+ 1 waiting) All committed serious violent/sexual offences (homicide, rape, arson, child sexual offences) All mentally disordered (psychotic illness, learning disability, personality disorder) Most have multiple pathology Majority use sign language but some lip reading 3

4 Staff Majority staff are hearing 2 deaf staff All must learn BSL (but varying ability) Clinical team has psychiatrist, staff doctor, psychologists, social worker, OT, art therapist, speech and language therapist, teacher, communication support worker, administrator Pool of 7 interpreters 4

5 Therapies Provide adapted therapies in BSL Mainly individual work Clinical assessments (but problem with lack of validated psychology questionnaires) Individual work includes developing timelines, introduction to psychological treatments, anger management, VOTP, SOTP Need for sex education and general literacy 5

6 Difficulties Communication is fundamental Some patients have minimal language skills Mental disorder can affect engagement Treatment programmes not validated for deaf Very lengthy duration of treatment Staff burn out and move on (loss of BSL skills on ward) 6

7 What makes us different? Most services are hearing Services don t identify correct disorders Incorrect or no treatment being given Stays in hospital are longer Failure detecting suicide risk Increased risk of harm to others 7

8 Obstacles to treatment Lack of linguistic knowledge Lack of knowledge of cultural norms Assumptions about the Deaf Attitudes can be paternalistic Institutionalised audism like racism 8

9 Deaf patients attitudes Mistrust of hearing professionals Hearing people are viewed as oppressor Sign language Detention Family contact Normal paranoia 9

10 Environmental Factors Must have mental health trained SLI Deaf support workers if appropriate Environment e.g. lighting, distractions Time (very important) Background information Lack of corroborative history Misinterpretation of body language 10

11 Deaf prison in-reach programme 11

12 OVERVIEW The main drive for services for Deaf prisoners is the need to provide the equitable access to services as hearing prisoners. The National High Secure Deaf Service (NHSDS) at Rampton Hospital in 2011 developed an In-Reach service aimed at addressing the shortfalls in the provision of therapeutic interventions for deaf prisoners within the UK. 12

13 Why In-reach? Legal obligations & Government policy DDA 1995 & Equality Act 2010: Equitable access to services Towards Equity & Access (DoH, 2005): - Mental Health Trusts involved in prison in-reach should seek to identify deaf prisoners with mental health problems and seek specialist advice on their management -Specialist in-reach to be considered, perhaps with one Prison Service designated to have a distinct role in managing deaf prisoners - Specialist services more likely to recognise clinical needs 13

14 Why In-reach - Continued? Prior to the involvement of the NHSDS deaf prisoners were unable to meet the requirements of the Parole Board and therefore could not be recommended for Parole, often extending their time in prison 14

15 Why not standard treatment? Just translate? No standard assessments BSL a (very) different language No written form Cultural differences Individual differences Communication Learning ability Clinical & offending need Identity D/d 15

16 Difficulties when Working clinically with Deaf Offenders Often Limited vocabulary. Limited ability to use tense or time referents and difficulty in conveying a linear narrative of a story. Confused and incorrect syntax (sign order). Struggle with abstract thinking and time concepts. Poor Chronological memory. 16

17 Working clinically with the Deaf Low Functioning Deaf Glickman 2009 Communication Living Skills Secondary impairments Social Emotional & Behavioural Vocational Educational 17

18 Client group Assessed 9 deaf men in total 5 deaf men receive regular input 2 determinate sentences 3 IPP (all over tariff) No previous engagement in therapy in prison All repeat offenders Schizophrenia (x2) Delusional disorder (x1) Dissocial personality disorder (x4) 18

19 Treatments provided Medication for psychotic illness as appropriate Adapted anger management programme Individual formulation driven interventions around Sexual Offending Programmes delivered at Rampton Hospital UK adapted for use with Deaf people 19

20 Anger Management Programme CBT based Anger Management Programme Individualised programme aimed at clients level of ability and understanding Manualised Programme is adapted with an emphasis on role play scenarios and pictorial aids. Utilise programme curriculum but with an open timeframe for delivery Consistent approach Work with registered British Sign Language Interpreters 20

21 The last 3 years Obtained funding to continue until 2015 Involved with 5 deaf male prisoners Multi-disciplinary assessments Regular multi-agency meetings at prison Delivery of therapeutic interventions Feedback to prison/parole board Presentation to National Probation conference Publication of service description 21

22 Future Aims Raise awareness the service further to HMPS, Probation and the Criminal Justice Courts Build upon our service provision Increase Deaf awareness training to HMPS Achieve designation of a cluster of prisons within our region to provide a service to Deaf prisoners To assist and offer consultation to HMPS in the management of Deaf offenders 22

23 Conclusion Highly specialist deaf service Need to employ more deaf staff Very successful prison in-reach service Try to encourage prisons to refer Currently provide assessments all over UK Need to secure funding post-april

24 Thank you. QUESTIONS? Contact: