The Way Forward Forensic CAMHS

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The Way ForwardForensic CAMHS Prison Inreach

• Gary Risdale
• Prison CAMHS Manager
• Bristol Forensic CAMHS

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To provide a comprehensive mental health
assessment and treatment service to young people
in the secure settings, ensuring continuity of
care with the community whilst providing support,
training and consultation to other professionals
in the establishments.
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Population

• HMP YOI Ashfield
• Largest private
• juvenile prison
• in Europe
• 400 15-18 year old
• young males
• Take young people
• from over 120
• sentencing courts
• 41 over 100 miles
• from home
• 12 week average stay
• Turnover of 1600 p.a.

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Population (2)

• Mary Carpenter Unit HMP Eastwood Park
• 16 17-year-old girls
• Catchment same as Ashfield

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New Funding

• March 2007 commissioning document launched
• Development of Tier 3 CAMHS Services in Secure
  Settings
• Followed by new funding leading to expansion in
  service

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Prison CAMHS Team

• Consultant CA Psychiatrist (Tier3) 1
  session a week
• Consultant Forensic CA Psychiatrist (Tier 4)1
  session a week
• Consultant Psychologist
• 2 sessions a week
• Consultant Adult Forensic Psychiatrist
• 1 session a fortnight

• Band 8a Nurse
• 1 Band 7 Nurse
• 3 Band 6 Nurses
• 1 Prison Officer/HCA
• 1 OT
• 1 Admin
• Active partnership with prison primary care teams

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Mental Health Population

• ADHD
• Psychosis
• Depression
• PTSD
• 4 Most prevalent disorders in the prisons

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Mental Health Population Eastwood

• 2007
• 54 cases seen
• 2 Hospital Transfers
• 2008
• 2 Hospital transfers so far
• 2 Hospital referrals ongoing

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Mental Health Population Ashfield

• First referral meeting in Dec 2004
• 4 young people discussed
• Referral meeting
• 47 cases were discussed
• 20 new referrals were discussed
• 28 cases were on outreach/monitoring
• 25 of population monitored at any one time
• 2007
• 300 cases seen by CAMHS team
• 12 Hospital Transfers
• 2008
• 14 transfers to date
• 1 current transfer in progress

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Model of Care

• Based on Offender Mental Health Care Pathway
  (NIMHE 2005)
• Assessment Throughcare model
• Team can follow cases back into community
• With new staffing now moving to more
  therapies/treatment/interventions

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CPN Throughcare
Liaise hand over to local services progress in
prison
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Inreach - Hospital Partnership

• Bristol Forensic CAMHS Bluebird House
• Feltham Wells Unit
• Do we have partnerships in place with all young
  peoples secure settings?
• YOIs Male Female
• LASCHs
• STCs
• Immigration centres?

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Inreach Hospital Partnership Benefits

• Slimlined Referral Process
• Smoother/quicker transfer times
• Both out of custody
• And on return to custody
• Shared access to resources/training

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YOT CPNs

• 1st Point of Contact for majority of young
  offenders with mental health needs
• Workers often lone nurses isolated
• Support forums that are in place are run by the
  workers themselves in local areas with no
  strategic oversight or support

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YOT CPNs

• YOT mental health practitioners need access to
  peer support and development opportunities as
  well as the opportunity to share good practice.
  An existing group, the London CAMHS YOT workers
  forum, provides a useful starting point for these
  activities, but needs high level support (eg by
  CSIP and the London YJB), in order that it can
  hold regular, well attended meetings at a central
  venue and so that workers will be encouraged by
  managers to attend.
• Strengthening the forum will require
• -Written terms of reference, circulated to all
  YOT and CAMHS managers.
• -An annual calendar of meetings and events and a
  programme of speakers/external input.
• -A quarterly report/newsletter giving the
  outcomes of its meetings, sent both to the
  provider Trusts and to the YOT managers.
• CSIP in conjunction with the London CAMHS
  Partnership chairs should consider creating a
  regional specialist CAMHS group which focuses on
  adolescent forensic mental health and the young
  offender client group.
• London CAMHS YOT workers need a training
  programme that will help them share good
  practice, offer peer support and ensure they are
  offering the most effective packages to young
  people. This training should be based on a
  training needs analysis and a useful model would
  be facilitated action learning sets.
• London Youth Offending Teams Mental Health
  Mapping
• (The Health and Social Care Advisory Service
  June 2008)

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YOT CPNs Potential Benefits

• Development of strong pathways in and out of
  hospital
• Appropriate and timely referrals from local
  services avoiding custody
• Training and development of workforce more
  stability in provision

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• Halfway house in Bristol
• Opens 2009
• Supported by
• PCT agreed Prison CAMHS provide mental health
  support

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The Way forward?
NCG Units
STC MH Services
LASCH MH Services
Prison CAMHS Inreach Teams
Halfway Houses?
YOT CAMHS CPNs
Partnership