Presentation on theme: "Michele Gilluley Jillian McGinty"— Presentation transcript:
1Michele Gilluley Jillian McGinty The Assessment and Treatment of Substance Misuse in a Low Secure Psychiatric HospitalMichele GilluleyJillian McGinty
2The Ayr Clinic 34 Bed Low Secure In-Patient Facility 1 Female ward,1 Male ward,1 Rehabilitation wardPatient demographics: 17 to 65Major Mental Illness, Personality Disorders, Learning Disability, and Acquired Brain Injury.ReferralsPrisons, Courts, NHS (IPCU, HSU, MSU, LSU)Clinical Team: Forensic Psychiatrists and Psychologists, Nursing, Occupational Therapists and Health Care Workers.
3Comorbidity of substance misuse and mental health The prevalence of co-existing mental health and substance use problems ‘dual diagnosis’ may affect between 30 and 70% of those presenting to health and social care settings (Research Briefing 30 (2009) Social Care Institute for Excellence).There is growing awareness of the serious social, psychological and physical complications of the combined use of substances and mental health problems.Given the multiplicity of social, familial and economic problems associated with dual diagnosis, there is a distinctive role for multi-agency work.
4Prevalence – Ayr Clinic Dr Gary TannerPrevalence – Ayr ClinicPrimary DiagnosisPrevalence of Substance Misuse4
5Substance Misuse and Mental Health problems Dr Gary TannerSubstance Misuse and Mental Health problemsWhen compared with a mental health problem alone, people with dual diagnosis are more likely to haveFamily and relationship problemsHistory of childhood abuse (physical and sexual)More likely to fall through the net of careLess likely to be compliant with medication and other treatment(Department of Health 2009)Increased suicide riskMore severe mental health problemsHomelessness/unstable housingIncreased risk of being violentIncreased risk of victimisationPoorer general healthMore contact with criminal justice system5
6Assessment and Case Formulation All Patients in Ayr Clinic are subject to Care Programme Approach (CPA)6 monthly meetings attended by patient, clinical team, named persons, advocacy, and family/friendsCare and Treatment plan developedTreatment plan objectives set with cognisance to appropriate risks and a sequencing approach to addressing patient needs.
8What Works in Forensic settings? ‘What works’ = introduction of ‘manualised’, group-based offender programmes.‘One size fits all approach’Application of cognitive behavioural approaches to address particular problem behaviours e.g. sexual offending, domestic violence, anger, substance-misuse etc.
9What works in Forensic Mental Health? Smaller and heterogeneous populationsPatient’s have highly individual presentationsTheir needs must be considered alongside the risks they present.Patients often undertake numerous interventions (medical, social, psychological and occupational).Generally one-to-one delivery of complex, be-spoke, eclectic treatments are the most appropriate in settings of small populations.
10Assessment Comprehensive Case Formulation Full Structured Professional Judgement Risk AssessmentBattery of Baseline psychometric assessments depending on individual RNR
12Motivational Interviewing How we get patients to treatmentExplore ambivalence about drug use and possible treatment.Aim: increasing motivation to change behaviour.Provide non-judgemental feedback.Four general principles:expressing empathy,developing discrepancy,rolling with resistancesupporting self-efficacy.
13Therapies Cognitive Behaviour Therapy Dialectical Behaviour Therapy Critical Components: Functional Analysis & Skills TrainingIntegrated elements include (not limited to): psychoeducation, problem solving, anxiety management, coping skills, emotion regulation, insight work, skills training, self-esteem, relapse preventionDelivered by DBT TeamIncludes five essential functions:Improving patient motivation to changeEnhancing patient capabilitiesGeneralizing new behavioursStructuring the environmentEnhancing therapist capability and motivation
14Good Lives ModelGLM – is a strength based rehabilitative approach with dual focus on Risk Management & Psychological Well BeingUsed for Forensic PopulationModel considers the individuals risk to themselves and othersGLM – is about learning new skills and more life opportunities.
15Evaluation Pre & Post Treatment measures Single case study methodology Patient feedbackFeedback from clinical team
16Future Directions at the Ayr Clinic Across PiC there is a national and regional review of all available substance misuse programmes for Scotland, England and Wales intended during 2013
17Future Developments at Ayr Please Check Back With Us Soon
18ReferencesNational Education for Scotland; Scottish Government. A Guide to Delivering Evidence Based Psychological Therapies in Scotland – The MatrixMental Health (Care and Treatment) (Scotland) Act 2003Scottish Government Mental Health Division. Memorandum of Procedure for Restricted PatientsCase Formulation in Cognitive-Behaviour Therapy. The Treatment of Challenging and Complex Cases. s.1.: Routledge, 2006Yin.R.K.,(2003) Case Study Research, Design and Methods. Sage Publications. United States of AmericaResearch Briefing 30 (2009):The relationship between dual diagnosis: substance misuse and dealing with mental health issues. Crome, I., Chambers, P., Frisher ,M., Bloor, R,. & Roberts, D. Social Care Institute for Excellence).Department of Health (2009) Mental Health Policy Implementation Guide Dual Diagnosis Good Practice GuideAndrews, D. A., & Bonta, J. (2003). The psychology of criminal conduct (3rd ed.). Cincinnati, OH: Anderson Publishing.