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The Forensic Network www.forensicnetwork.scot.nhs.uk 1 A Study of Major Change: Legislation, Education & Practice.

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Presentation on theme: "The Forensic Network www.forensicnetwork.scot.nhs.uk 1 A Study of Major Change: Legislation, Education & Practice."— Presentation transcript:

1 The Forensic Network 1 A Study of Major Change: Legislation, Education & Practice

2 The Forensic Network 2 Lindsay Thomson, MD, Medical Director, The State Hospital/Forensic Network/ Edinburgh University (Chair) Andreana Adamson, BSc (Econ) MBA, Chief Executive, The State Hospital/Forensic Network Ed Finlayson, CQSW, DipSW, Head of Social Work, South Lanarkshire Council/The State Hospital

3 The Forensic Network 3 Legislation Practice Education A study of major change

4 The Forensic Network 4 Legislation Mental Health (Care and Treatment) (Scotland) Act 2003 “The best mental health legislation in the world?” Holyrood Magazine (7/5/07)

5 The Forensic Network 5 Background 20 years out of date? Significant changes in mental health policy and service delivery Human Rights Millan Committee MH Act Reference Group – Working Together Legislation

6 The Forensic Network 6 MHA 2003 Royal Assent 25 April 2003 Preparing for Implementation Programme Act Implemented 5 th October parts with over 300 sections Code of Practice, 3 Volumes Legislation

7 The Forensic Network 7 The Act Mental Health (Care and Treatment) (Scotland) Act 2003 Legislation

8 The Forensic Network 8 Principles Take Account of Patients Wishes Maximise Participation Provide Maximum Benefit Non Discriminatory Practice Take Account of Views of Named Person Carers Needs Appropriate Services Minimum Restriction Child’s Welfare is Paramount Duty to Maintain Parental Relationships Social Inclusion Legislation

9 The Forensic Network 9 Protection / Rights Advocacy Duty to Inform Patient of Advocacy Services Duty to Take Steps to Arrange Advocacy Services Legislation

10 The Forensic Network 10 Protection / Rights Named Person Nominated by a patient in accordance with the provisions of the Act to act in their best interests. The named person is entitled to receive certain information about the patient and to act on behalf of the patient in certain circumstances and at certain times Legislation

11 The Forensic Network 11 Protection / Rights Advance Statement A written, witnessed document made when the patient is well, setting out how he or she would prefer to be treated (or not treated) if they were to become ill in the future Legislation

12 The Forensic Network 12 Protection / Rights Mental Welfare Commission Monitor operation of act and promote best practice Patient visits; investigations; interviews and medical examinations; inspect records Publish information and guidance; give advice or bring matters to the attention of others including services and government. Legislation

13 The Forensic Network 13 Protection / Rights Mental Health Tribunal Scotland New independent body to make decisions in relation to applications, reviews and appeals Legal Members, Medical Members and General Members Right of appeal against compulsory measures Right of appeal against excessive security Legislation

14 The Forensic Network 14 Definition of Mental Disorder Mental Illness Learning Disability Personality Disorder Exclude if only by reason of: Sexual orientation; sexual deviancy; transexualism; transvestism; dependence on or use of alcohol or drugs; behaviour that causes harassment, alarm or distress; acting as no prudent person would do Legislation

15 The Forensic Network 15 Definition of Treatment Nursing Care Psychological Interventions Habilitation Rehabilitation Legislation

16 The Forensic Network 16 Grounds for Compulsion Mental Disorder Treatment is Available Significant Risk to Health, Welfare or Safety (Significantly Impaired Decision Making)* Compulsion is Necessary * Only applies in Civil Procedures Legislation

17 The Forensic Network 17 Menu of Compulsory Powers Detention in Hospital Compulsory Treatment Attendance at Services Access for Service Providers Place of Residence Notification or Approval of Change of Address Legislation

18 The Forensic Network 18 Requirements for Compulsory Powers Psychiatric Reports Mental Health Officer Reports Designated Responsible Medical Officer and Mental Health Officer for all cases. Legislation

19 The Forensic Network 19 Mental Health Officer Registered Social Worker Training in Mental Disorder and Mental Health Law Appointed by the Local Government Legislation

20 The Forensic Network 20 Care Plan Objectives of Treatment Details of Community Care Services Details of any other Treatment or Services Legislation

21 The Forensic Network 21 Issues Number of Interim Orders and Tribunals Provision of Information to Named Person Managing Views of Victims Legislation

22 The Forensic Network 22 Outcomes Fewer Emergency Orders Fewer episodes of compulsion Increasing use of community measures Successful appeals against security Legislation

23 The Forensic Network 23 Use of Mental Health Legislation MH(S)A 1984MH(C&T)(S)A /4/05-4/10/055/10/05-1/4/06 Emergency (62%  ) Short term (10%  ) Long term Hospital 469 Community 59 Legislation

24 The Forensic Network 24 Mental Health Tribunal - good for patients? “Patients feel they are being listened to by the panel members – that has to be a good thing” Carolyn Little, Chair National Schizophrenia Fellowship Legislation

25 The Forensic Network 25 A Study of Major Change: Legislation, Education & Practice Questions? Legislation

26 The Forensic Network 26 Practice MEL 1999 (5) Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland provides the basis for Forensic Mental Health Services in Scotland. Policy

27 The Forensic Network 27 Practice Mentally disordered offenders should be cared for: with regard to quality of care and proper attention to the needs of individuals as far as possible in the community rather than in institutional settings under conditions of no greater security than is justified by the degree of danger they present to themselves or to others in such a way as to maximise rehabilitation and their chances of sustaining an independent life as near as possible to their own homes or families if they have them Guiding Principles of MEL 1999 (5)

28 The Forensic Network 28 Scottish Ministers call for new approach to FMHS “.. to bring a pan-Scotland dimension to the planning process for services.. to support the development of local services.. and to secure protocols to ease the management of patients through the system” Mary Mulligan, MSP Deputy Health Minister, 2002 Practice

29 The Forensic Network 29 Context Population: 5 million Forensic inpatient population 500 Under developed services in 15 health authorities Forensic Services within NHS –1 small independent provider (24 beds) Practice

30 The Forensic Network 30 Media Practice

31 The Forensic Network 31 “Review the process for determining the right care for mentally disordered offenders” “Consider wider issues surrounding patient pathways.. Including information systems, education and training and strategic planning” Scottish Executive Health Department, March 2003 Objectives Practice

32 The Forensic Network 32 Forensic beds High 240 Low Currently Planned Low Practice 500 Beds Approximate figures Med 50 Low High 140 Med 150 Low

33 The Forensic Network 33 “A key measure of success will be a smaller State Hospital … services can and should be provided in other secure and community settings” Malcolm Chisholm, MSP Health Minister, 2003 Practice

34 The Forensic Network 34 Network Board Multi Agency –Health, Scottish Executive, Social Work, Police, Prison, Local Government Housing, Carer agencies Regional Representation –North, South and East, West, Northern Ireland –Each circa 1.5m population Practice

35 The Forensic Network 35 Principles Practice Pan Scotland approach Strategic Planning Performance Management Frameworks Information Systems Education and Training

36 The Forensic Network 36 National High secure Regional Structure Practice Local Low Secure Medium Secure

37 The Forensic Network 37 Local Services – Low Secure Regional – Medium Secure National High secure Community Services Regional Structure Practice

38 The Forensic Network 38 Appeals against excessive security 66 applications 34 heard 24 upheld 8 declined 17 cancelled/withdrawn Practice

39 The Forensic Network 39 “The Forensic Network is an excellent example of how we can bring together national, regional and local perspective on the planning and delivery of services” Hugh Henry, MSP Justice Minister, 2005 Practice

40 The Forensic Network 40 Strategic Planning Definitions of Levels of Security –Obvious starting position –Matrix of security –Tool for audit of existing and planned services –Recommended development of Secure Care Standards Practice

41 The Forensic Network 41 Secure Care Standards –Eleven standards –Three generic standards across all security levels (1 assessment & care planning; 2 delivery of generic and specialist treatments, interventions and support for recovery; 3 teams, skills, staffing) –Remaining eight specific to security level (maintenance of detention; suspension of detention; management of violence; excluded items; communication and technology; movement of personnel and contingencies) Practice Strategic Planning

42 The Forensic Network 42 Services for Women –Small patient-specific group –No need for high secure beds –Favour community based specialist services –Small number of medium secure beds Practice Strategic Planning

43 The Forensic Network 43 Services for Learning Disabilities –Small population –Robust community based services –Regional multi-agency risk management groups –12 high secure beds –Separate services for LD, small regional units Practice Strategic Planning

44 The Forensic Network 44 Personality Disorders –Significant population in NHS and Prisons –“PD should not be a diagnosis of exclusion from forensic mental health services in Scotland” –No change to current clinical in-patient practice –Pilot work with criminal justice and prisons Practice Strategic Planning

45 The Forensic Network Policy and Guidance –Including conflict resolution and patient flows Care Programme Approach Risk Management Clinical Governance School of Forensic Mental Health Launch October 2007 Practice Policy

46 The Forensic Network 46 A Study of Major Change: Legislation, Education & Practice Practice Questions?

47 The Forensic Network 47 Education SoFMH School of Forensic Mental Health School of Forensic Mental Health: Teaching, Training & Research

48 The Forensic Network 48 The Three Graces Education SoFMH School of Forensic Mental Health

49 The Forensic Network 49 Venus de Milo Education SoFMH School of Forensic Mental Health

50 The Forensic Network 50 Knowledge and Understanding of the MH(C&T)(S)A 2003 within Trainee Psychiatrists Response Rate93% (n=48) Mean Total Score 22/61 (range 6-51) -FY2 19 -SHO 29 -SpR 38 -Principles: mean 2/10 (40% - 0) -Detention Criteria2/5 Education SoFMH School of Forensic Mental Health

51 The Forensic Network 51 Survey of Services for People with “Forensic” Personality Disorder 7 implicitly exclude people with a primary PD Dx from admission 7 assess people with a primary diagnosis of PD 8 use multidisciplinary and 10 comprehensive methods of assessment 4 use structured clinical tools for the assessment of PD 6 services did not accept people with a primary diagnosis of PD for specific intervention, treatment or management, 4 services did not accept people with a secondary dx No reliable figures Training requirements were identified in particular for developing case formulations and employing evidence based Education SoFMH School of Forensic Mental Health

52 The Forensic Network 52 Education SoFMH School of Forensic Mental Health Rationale “The Network provides the opportunity for participating stakeholders to consider …. education and training... and the commissioning of research to establish an evidence base for service development” Scottish Executive Health Department March 2003

53 The Forensic Network 53 Education SoFMH School of Forensic Mental Health Network Working Group Multi-agency expert group Objectives –Review provision of forensic education and identify gaps –Review recent research –Develop proposals and models for school of forensic education and research (if required) –Consider advantages and disadvantages –Consider resource and funding issues

54 The Forensic Network 54 Education SoFMH School of Forensic Mental Health Identifying needs Two scoping exercises (including independent) Both highlight clear gaps Complex nature of needs (risk, law, complex system & clients) No postgraduate provision No forum for multidisciplinary training although clinicians work on multidisciplinary basis Limited forensic mental health training in non health agencies Research efforts are small and uncoordinated

55 The Forensic Network 55 Education SoFMH School of Forensic Mental Health Meeting the needs Develop a Forensic School Coordinating body (consortium) Provider and Commissioner Build on existing resources Programme development Training trainers Teaching materials

56 The Forensic Network 56 Education SoFMH School of Forensic Mental Health Option Appraisal IDo nothing IIRefer to a Coordinating Body IIIEstablish a Virtual School IVEstablish a Physical School

57 The Forensic Network 57 Education SoFMH School of Forensic Mental Health Business Case Appraisal of options Advantages/disadvantages Costs Risk assessment Establish and weight benefits criteria

58 The Forensic Network 58 Education SoFMH School of Forensic Mental Health Option Appraisal Score IDo nothing 2.54 IIRefer to a Coordinating Body 7.52 IIIEstablish a Virtual School16.03 IVEstablish a Physical School14.38 Affordability

59 The Forensic Network 59 Education SoFMH School of Forensic Mental Health Principles Practical Utility Inclusive Feasible Financially viable

60 The Forensic Network 60 Education SoFMH School of Forensic Mental Health Delivery (1) All of Scotland Links with educational institutions Board – stakeholders Administrative base Use of existing materials Development of new materials NHS & educational interface

61 The Forensic Network 61 Education SoFMH School of Forensic Mental Health Delivery (2) Multidisciplinary courses in forensic studies Modular basis with clear assessment of competences Access to modules, diploma or MSc Part-time Distance learning Multi-agency Specific training

62 The Forensic Network 62 Education SoFMH School of Forensic Mental Health Sample Modules Law and Mentally Disordered Offenders Mental Disorder and Crime Risk Assessment and Management Treatment of Mentally Disordered Offenders Services for Mentally Disordered Offenders

63 The Forensic Network 63 Education SoFMH School of Forensic Mental Health Support for the school Government Policy NHS Education Scotland Scottish Executive Health Department Forensic Network Associates Higher Education Institutions Further Education Institutions

64 The Forensic Network 64 Education SoFMH School of Forensic Mental Health New to Forensic Commissioned by NHS Education Scotland Designed for clinical and non clinical staff 6 month self directed learning programme Students supported by mentors Twelve chapters with case scenarios Delivery by network of trainers within services

65 The Forensic Network 65 Chapter 1 - Aims and Teaching Methods Chapter 2 -Understanding Mental Disorder Chapter 3 -Definitions, Principles and Policy for Mentally Disordered Offenders Chapter 4 -Civil Mental Health Legislation Chapter 5 -Forensic Mental Health Services Chapter 6 -Attitudes to Mentally Disordered Offenders and ways of dealing with personal emotions and boundaries Chapter 7 -Forensic Mental Health Services and the Criminal Justice System: Understanding the relationship Chapter 8 -Psychiatric Defences and Legislation for Mentally Disordered Offenders Chapter 9 -Assessment, Treatment and Management of Mentally Disordered Offenders Chapter 10 -Multidisciplinary Working, Communication and Managing Difference Chapter 11-Safety of Staff, Patients and Public including Risk Assessment and Management Chapter 12 -Taking Account of the Views of Users and Carers Education SoFMH School of Forensic Mental Health Content (1)

66 The Forensic Network 66 Content (2) Differential objectives A problem based learning approach Participants supported by experienced mentors Use of a reflective diary Case studies designed to challenge thinking Links to other learning materials throughout the programme Education SoFMH School of Forensic Mental Health

67 The Forensic Network 67 Education SoFMH School of Forensic Mental Health

68 The Forensic Network 68 Education SoFMH School of Forensic Mental Health Current Work Police Probation Training Strategic Change Grant Network of Trainers Risk Management Agenda Psychological Therapies Training

69 The Forensic Network 69 Education SoFMH School of Forensic Mental Health

70 The Forensic Network 70 Education SoFMH School of Forensic Mental Health Come and see for yourself …… IAFMHS 2009 Conference, Edinburgh PracticeLegislation

71 The Forensic Network 71 A Study of Major Change: Legislation, Education & Practice


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