1. Michele Gilluley Jillian McGinty
The Assessment and Treatment of Substance Misuse in a Low Secure Psychiatric Hospital
Michele Gilluley
Jillian McGinty

2. The Ayr Clinic 34 Bed Low Secure In-Patient Facility
1 Female ward,1 Male ward,1 Rehabilitation ward
Patient demographics: 17 to 65
Major Mental Illness, Personality Disorders, Learning Disability, and Acquired Brain Injury.
Referrals
Prisons, Courts, NHS (IPCU, HSU, MSU, LSU)
Clinical Team: Forensic Psychiatrists and Psychologists, Nursing, Occupational Therapists and Health Care Workers.

3. Comorbidity 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.

4. Prevalence – Ayr Clinic
Dr Gary Tanner
Prevalence – Ayr Clinic
Primary Diagnosis
Prevalence of Substance Misuse 4

5. Substance Misuse and Mental Health problems
Dr Gary Tanner
Substance Misuse and Mental Health problems
When compared with a mental health problem alone, people with dual diagnosis are more likely to have
Family and relationship problems
History of childhood abuse (physical and sexual)
More likely to fall through the net of care
Less likely to be compliant with medication and other treatment
(Department of Health 2009)
Increased suicide risk
More severe mental health problems
Homelessness/unstable housing
Increased risk of being violent
Increased risk of victimisation
Poorer general health
More contact with criminal justice system 5

6. Assessment 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/friends
Care and Treatment plan developed
Treatment plan objectives set with cognisance to appropriate risks and a sequencing approach to addressing patient needs.

7. Dual Diagnosis/Sequencing of interventionsOR

8. What 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.

9. What works in Forensic Mental Health?
Smaller and heterogeneous populations
Patient’s have highly individual presentations
Their 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.

10. Assessment Comprehensive Case Formulation
Full Structured Professional Judgement Risk Assessment
Battery of Baseline psychometric assessments depending on individual RNR

11. Key Ingredients of Treatment
Person-centred care
Therapeutic Relationship
Therapeutic Milieu
Motivational Interviewing
Treatment Approaches:
Cognitive Behaviour Therapy
Cognitive Therapy
Good Lives Model
Dialectical Behaviour Therapy

12. Motivational Interviewing
How we get patients to treatment
Explore 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 resistance
supporting self-efficacy.

13. Therapies Cognitive Behaviour Therapy Dialectical Behaviour Therapy
Critical Components: Functional Analysis & Skills Training
Integrated elements include (not limited to): psychoeducation, problem solving, anxiety management, coping skills, emotion regulation, insight work, skills training, self-esteem, relapse prevention
Delivered by DBT Team
Includes five essential functions:
Improving patient motivation to change
Enhancing patient capabilities
Generalizing new behaviours
Structuring the environment
Enhancing therapist capability and motivation

14. Good Lives Model
GLM – is a strength based rehabilitative approach with dual focus on Risk Management & Psychological Well Being
Used for Forensic Population
Model considers the individuals risk to themselves and others
GLM – is about learning new skills and more life opportunities.

15. Evaluation Pre & Post Treatment measures Single case study methodology
Patient feedback
Feedback from clinical team

16. Future 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

17. Future Developments at Ayr
Please Check Back With Us Soon

18. References
National Education for Scotland; Scottish Government. A Guide to Delivering Evidence Based Psychological Therapies in Scotland – The Matrix
Mental Health (Care and Treatment) (Scotland) Act 2003
Scottish Government Mental Health Division. Memorandum of Procedure for Restricted Patients
Case Formulation in Cognitive-Behaviour Therapy. The Treatment of Challenging and Complex Cases. s.1.: Routledge, 2006
Yin.R.K.,(2003) Case Study Research, Design and Methods. Sage Publications. United States of America
Research 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 Guide
Andrews, D. A., & Bonta, J. (2003). The psychology of criminal conduct (3rd ed.). Cincinnati, OH: Anderson Publishing.