Shaun Kenny, Adult Service Manager

1
Assessing The Feasibility Of Implementing The
GPCMHW Role In The Prison Environment

• Presented by
• Shaun Kenny, Adult Service Manager
• Melanie Jones, Project Lead and Graduate Primary
  Care Mental Health Worker

2
Acknowledgements

• Isabelle Gibbard, Counsellor, HMP Garth and
  Wymott
• Deborah Howe, Healthcare Manager, HMP Wymott
• Natalia Hunt, Mental Health Lead, HMP Garth
• Catherine Morton, PCGMHW, HMP Wymott
• Siobain Penpraze, Healthcare Manager, HMP Garth

3
Workshop Aims

• By the end of this session it is hoped that
• You will have an understanding of the feasibility
  of integrating the GPCMHW role into the prison
  environment.
• You will have an understanding of the challenges
  that the environment and prison population
  present to developing the GPCMHW role in prisons.

4
Policy Context

• NHS Plan (2000).
• Changing The Outlook (DoH, 2001).
• Shifting The Balance of Power (DoH, 2002).
• Nice Guidance for Anxiety Depression.
• Local Health Needs Assessment.

5
The Traditional Role of the Graduate Primary Care
Mental Health Worker

• Low intensity, brief CBT-based interventions.
• Regular telephone / face-to-face contact.
• Individual one-to-one work for common mental
  health problems based on problem-solving and
  other self-help methods.
• Group work for common mental health problems.
• Medication management.
• Liaison with the wider community.

6
Why Carry Out A Project?

• To assess the feasibility of integrating the
  GPCMHW role into the prison environment.
• To address the challenges that the environment
  and population present to developing the GPCMHW
  role successfully in prisons.

• Challenges to the role include
• Literacy difficulties
• Learning difficulties
• Language barriers
• Relevance of resources
• Emergency planning
• GPCMHW remit
• Capacity due to prisoner movements
• Supervision of GPCMHWs
• Peer support for prison GPCMHWs

7
Key Areas For ConsiderationLiteracy

• How Can Literacy Needs Be Met?
• Self-help materials need to be matched to the
  abilities of the prison population by identifying
  the varying levels of literacy across the general
  prison population.
• Alternative methods of delivery of self-help
  could be made available including CDs and
  cassettes.

8
Key Areas For ConsiderationLiteracy Difficulties

• Progress So Far
• Patients asked to complete a satisfaction
  questionnaire requesting feedback about the
  usefulness of self-help materials.
• So far, illiterate patients have not been
  identified.
• However, the Books on Prescription Scheme (BPS)
  includes books, CDs and cassettes which will
  enable illiterate patients, or those with low
  levels of literacy, to use audio self-help
  materials where possible.
• Written materials have been made available to
  match varying levels of literacy, from brief
  self-help materials such as Northumberland Trust
  guides to more demanding materials such as Chris
  Williams Overcoming Anxiety and Overcoming
  Depression.

9
Key Areas For ConsiderationLearning Difficulties

• How Can Learning Difficulty Needs Be Met?
• Resources can be adapted to ensure they are
  accessible to all (such as making adaptations
  suggested by The British Dyslexia Association).
• Progress So Far
• Reproduction of any written resources (such as
  handouts) to meet those recommendations made by
  the British Dyslexia Association, where possible.

10
Key Areas For ConsiderationLanguage Barriers

• How Can Language Barriers Be Overcome?
• Match self-help materials to the BME population
  in the prisons.
• Consider multi-lingual translation IT package
  vs. private company translation for requests.
• Self-help materials made available in other
  languages.
• Liaison with other PCTs with a high BME
  population to share resources.

11
Key Areas For ConsiderationLanguage Barriers

• Progress So Far
• 7 non-UK foreign nationals and 22 BME
  population, for example, at HMP Garth.
• Language Line provision from HMPS for verbal
  translation.
• Assistance will be provided by both the PCT and
  HMPS in the event that a request is received to
  translate self-help materials to other languages
  that are not already available.
• Computer translation packages are generally
  costly with a low level of accuracy. Therefore,
  purchase of such program rejected.
• Receipt of Northumberland PCT materials in
  languages including Chinese, Arabic, Bengali,
  Farsi, Punjabi, Hindi, Urdu, Gujarati, Cantonese,
  amongst other languages through partnership
  working with PCTS with high BME populations.

12
Key Areas For Consideration Relevance of
Resources

• How Can Resources Be Made Appropriate To The
  Environment?
• Resources referring to the external environment
  require adapting to the prison environment in
  order to ensure that suggestions for behavioural
  activation, for example, do not include methods
  solely available to those in the wider
  community.

13
Key Areas For Consideration Relevance of
Resources

• Progress So Far
• Resources have been adapted where possible to
  ensure they are not exclusive in any way.
• Worksheets are currently being produced to
  accompany all BPS books that require written
  input. This way self-help tasks can be completed
  without damage to BPS books.
• 1000 per prison was allocated for the BPS.
• HMP Garth caseload has established the
  suitability of self-help materials and influenced
  the choice of titles for the BPS.
• The permanent location of resources needs to be
  further explored re location. However,
  consultation with patients so far has found that
  patients would prefer to borrow titles from the
  Healthcare Centre, rather than request titles
  from the prison library.

14
Key Areas For ConsiderationEmergency Planning

• Key Concerns
• Riot, fire, lock-down procedure when patient in
  session.
• Procedure in event of risk of suicide /
  self-harm.
• Risk assessments.
• Personal protection.
• Progress So Far
• Formal procedures established for GPCMHWs to
  follow in an emergency such as riot, lock-down,
  fire or suicide / self-harm.
• Thorough risk assessments carried out using a
  variety of data collection methods before
  patients are offered an initial assessment.
• Attendance on personal protection session.

15
Key Areas For ConsiderationRemit of the Prison
GPCMHW

• Potential Duties Of The Prison GPCMHW
• Individual one-to-one work for common mental
  health problems (Remedial).
• Group work for common mental health problems
  (Remedial / Prevention).
• Healthy living classes with learning and
  education centre on topics such as drug and
  alcohol awareness (Prevention).
• Awareness raising events delivered via alternate
  methods such as theatre (Prevention).
• Staff awareness sessions including guest
  speakers, e.g. male rape and sexuality awareness
  (Prevention).
• Signposting through-care for those leaving prison
  (Remedial / Prevention).

16
Key Areas For ConsiderationAllocation and
Capacity

• Staff Allocation and Capacity for HMP Garth and
  Wymott
• 2 x WTE (1 full-time worker allocated per
  prison).
• HMP Garth Melanie Jones, Tues-Fri, Mondays on
  MSc Advanced Practice Interventions in Mental
  Health course at University of Manchester.
  Current caseload of 25 patients, based on 12
  patients seen per week over 3 days. 1 day at
  University, 1 day admin work, meetings, project
  work. Currently full to available capacity.
• HMP Wymott Catherine Morton, 0.5 WTE. Full-time
  worker splitting time between both prison and GP
  surgery. Current caseload of 8 patients seen
  over 2 days. 0.5 day spent per week on admin
  work, meetings, project work. Currently full to
  available capacity.
• HMP Wymott - Current vacancy for 0.5 WTE (shortly
  to be recruited).

17
Key Areas For ConsiderationAllocation and
Capacity

• Capacity
• 1 hour (assessments) and 45min / 1hr (subsequent
  appts).
• Full capacities so far suggests that the service
  will be in demand.
• Projected turnover 100 refs p.a. (1 in 8 of
  Garth, 1 in 12 of Wymott).
• Average caseload 35 40 patients (one-to-one
  work), based on 5 days.
• Unidentified time
• Clinical time limited due to prisoner movements.
  Risk ass., database, display work, replenishing
  resources, liaison with others and meetings
  identified as making most effective use of
  non-clinical time.

18
Key Areas For ConsiderationSupervision of Prison
GPCMHWs

• Supervision
• Clinical supervision proven vital and provided by
  prison Counsellor for both GPCMHWs.
• Case supervision provided so far by Mental Health
  Lead at HMP Garth, and likely to be also provided
  by PCT CBT therapists in the coming months.
• Peer supervision will be take place between the
  GPCMHWs at both prisons.
• Support also provided by Shaun Kenny and both
  Siobain Penpraze, Healthcare Manager (HMP Garth)
  and Deborah Howe, Healthcare Manager (HMP Wymott).

19
Key Areas For ConsiderationPrison GPCMHW Network

• Prison GPCMHW Network
• Aim to establish a network between all of the
  existing prison GPCMHWs in the country.
• Current provision located at HMP Haverigg, HMYOI
  Thorn Cross, HMP Risley and HMP Liverpool, as
  well as HMP Garth and HMP Wymott.
• Email support bulletin board established for
  prison GPCMHWs to share good practice and useful
  resources as well as supporting isolated workers.
• Attempt made to contact other prison GPCMHWs
  country-wide so far proven unsuccessful.

20
Service DevelopmentHelpline Services

• As a volunteer operator for the Lancashire Mental
  Health Helpline, I have enabled all HMP Garth
  prisoners access to the helpline during Helpline
  opening times when their wing telephone is
  available. All prisoners to receive leaflet for
  the service in April 2007.
• Established suicide and self-harm protocol for
  the Helpline staff to follow in an emergency,
  which has involved partnership working between
  Lancashire Care Trust, Central Lancashire PCT and
  HMPS.
• In my free time, I have provided helpline staff
  with training evenings to aid their understanding
  of prison environments.
• Helpline service likely to be rolled out to other
  prisons in the locality including HMP Wymott, HMP
  Preston, HMP Lancaster, HMP Kirkham and HMYOI
  Lancaster Farms.

21
Project Findings To Date Satisfaction
Questionnaires

• All 5 questions rated either poor, fair, good,
  very good or excellent
• Levels of courtesy and respect received 100
  Excellent.
• Length of time waited to be seen - 30 Excellent,
  70 V. Good.
• Range of treatments offered 60 Excellent, 40
  V. Good.
• Helpfulness of the treatment given 70
  Excellent, 30 V. Good.
• Overall satisfaction with service 100
  Excellent.
• Patients asked to state whether less able, about
  the same, or more able to deal with difficulties
  following treatment 100 stated more.
• Patients asked to comment upon helpful and
  unhelpful aspects. Most respondents stated that
  having someone to talk to has reduced their
  isolation. Others commented positively upon CBT
  models of working. Patients have not, so far,
  commented upon anything unhelpful (all findings
  based on 10 returned questionnaires at HMP Garth).

22
Project Findings To Date Self-Help Materials
Clinical Outcomes

• Comments refer to texts including Chris Williams
  Overcoming workbooks, Northumberland Trust
  Guides, Trevor Powell's Mental Heath Handbook,
  CCI Worksheets and Constable Robinsons
  Overcoming Series (all findings based on 10
  returned questionnaires, and 10 discharges
  following treatment at HMP Garth).
• Both questions rated either poor, fair, good,
  very good or excellent
• Overall layout (pictures, text) 40 Excellent,
  60 V. Good.
• Overall content 60 Excellent, 40 V. Good.
• Easy to read Yes / No 100 Yes.
• Right Length Yes / No 100 Yes.
• 90 patients discharged following treatment
  demonstrated improvement in their HADS
  depression score and 100 patients in their HADS
  anxiety score.

23
Conclusions

• Project work so far has identified specific
  challenges facing the implementation of the
  GPCMHW role in prisons and ways to overcome
  barriers.
• Project work has established the development of
  the role in prison is feasible and, so far,
  proving effective when challenges overcome.
• Likely to be a strong emphasis on health
  promotion in the prison environment with the
  opportunity to complete preventative work as well
  as remedial.
• Project work is not only maximising the impact of
  the role in prisons but also ensuring that
  GPCMHWs are protected and safely implemented
  into this complex environment using extensive
  risk assessment.

24
Report Deadlines

• Interim Report Presented w / c 4th December
  2006.
• Final Report Likely to be completed late Spring
  2007.

25
Questions Answers

• Any questions?
• Thank You

26
References

• Department of Health (2000) The NHS Plan A Plan
  for Investment A Plan for Reform. London
  Department of Health.
• Department of Health (2001) Changing The Outlook
  A Strategy for Developing And Modernising Mental
  Health Services In Prisons. London Department of
  Health.
• Department of Health (2002) Shifting the Balance
  of Power The Next Steps. London Department of
  Health.
• National Institute for Clinical Excellence (2004)
  Anxiety Management of anxiety (panic disorder,
  with or without agoraphobia, and generalised
  anxiety disorder) in adults in primary, secondary
  and community care. Clinical Guideline no. 22.
  London NICE.
• National Institute for Clinical Excellence (2004)
  Depression management of depression in primary
  and secondary care. Clinical Guideline no. 23.
  London NICE.