Presentation on theme: "CPN 4TH ANNUAL CONFERENCE"— Presentation transcript:
1 CPN 4TH ANNUAL CONFERENCE Celebrating Therapy in theCustodial SettingTherapeutic Communities,The Treatment Regime at HMP Grendon& Some Ethical ConsiderationsProfessor Michael BrookesDirector of Therapeutic Communities: HMP GrendonVisiting Professor: Birmingham City University
2 1939 East-Hubert ReportThis report recommended that a special institution be built with its conclusion being that “psychotherapy as an adjunct to an ordinary prison sentence appears to be effective in preventing or reducing the chance of future anti-social behaviour, provided the cases to which treatment is applied are carefully selected”
3 Rt Hon R.A. Butler, Home Secretary, on laying the foundation stone on 1 July 1960 said: “The regime must be flexible with the accent on treatment; and success will depend above all on an enlightened staff-inmate relationship, together with close co-operation at all levels between the different members of the staff”
4 HMP Grendon 240 bed Category B prison No Segregation Unit Opened in 1962Each of the six wings is an individual therapeutic communityFully accredited CSAP interventionWarren et al (2003) cite TCs as having the ‘most promising evidence’ in the treatment of severe personality disorder
5 Prisoner Characteristics (1) 90% serving life sentences (47% mandatory lifer, 21% discretionary lifer, 31% IPP, 1% Section 2).2% serving years, 2% serving years, 6% serving 10 years or more.21% aged 21-30, 31% aged 31-40, 37% 41-50, 11% over 50.High % personality disturbance (81% assessed as having at least 1 personality disorder)Significant levels of emotional distress (anxiety, depression, histories of abuse)
6 Prisoner Characteristics (2) The majority of residents at Grendon are serving sentences for murder, manslaughter or violence (including those with sexual elements)Many studies have drawn attention to the combination of both the extensive criminal history and disturbed personality profiles of Grendon prisonersGrendon receives more psychopaths than any other type of English prisonLarge proportion of the Grendon population (50% to 75%) identified as having Dangerous and Severe Personality Disorder characteristics
7 Referral Criteria Has more than 18 months to serve Has been off Category A status for the last 6 monthsMeets ‘drug free’ criteria (within 2 months)No diagnosis of major mental illnessComprehension of rules & signs compactAccepts responsibility for offenceMeets self harm criteria (within 2 months)
8 Responsivity Criteria Sufficiently motivatedNecessary insight & psychological mindednessIQ criteria (29 or over on the Raven’s Progressive Matrices or 80 and above on the WAIS/WASI)Psychopathy criteria: those scoring 25 or over on the PCL-R will be subject to further assessment prior to acceptance for treatment
9 Therapeutic Community Model LINKS BETWEEN DIFFERENT THERAPEUTIC ACTIVITIES THERAPEUTIC CULTURETHERAPY GROUPWORKEDUCATIONLEISURE ACTIVITIESCOMPLEMENTARY THERAPIESWING RELATIONSHIPSCOMMUNITY RESPONSIBILITYOFFENCE ACCOUNTINMATE FEEDBACKSTAFF FEEDBACKCOMMUNITY MEETINGCASE REVIEW
10 Principles of therapeutic communities (Rapoport, 1960; HMPS, 2007) DemocratisationPermissivenessCommunalismReality ConfrontationA living learning experienceCulture of enquiryConfidentiality/No secrets
11 Guiding Structures of Democratic TCs Therapeutic alliancesDebate, exploration andenquirySafety, boundaries and containmentInvolvement, participation and responsibilityDecision making and democratisation
13 Needs Addressed Within Grendon anti-social attitudes and feelings;distorted thinking used to justify/minimise offending;difficulty in recognising relevant risk factors and in generating appropriate strategies to cope with them;dependency on alcohol and drugs;adverse social and/or family histories and circumstances;deviant sexual or violent interests, especially arousal patterns and pre-occupations;poor social, interpersonal skills which are often offence-relevant.
14 Ethical Considerations Power relationships: staff vs resident decision-makingVoluntary engagement, addressing risk factors/treatment targets and process for withdrawing from therapyConfidentiality & disclosure of informationConditioning, compromise & integrityStaff support
15 Power relationships: staff vs resident decision-making To what extent can power in a Category B prison be truly devolved?Should staff vote in community meetings in the same way as residents?When should staff overrule votes taken by residents?What impact does the personality mix of residents have in the resident decision-making process?How does life ‘upstairs’ impact on life ‘downstairs’?
16 Voluntary engagement, addressing risk factors/treatment targets and process for withdrawing from therapyInformed consent? What about ISPs?Treatment within a TC: awareness of intensity of group based approach‘Opening up’ responsibilities: ‘capacity to cope’Impact of RTU & community/staff deselectionOutstanding risk factors and treatment needs/targets: divergent views
17 Confidentiality & disclosure of information Staff allegiances to different stakeholders(employing organisation, court requirement, professional body, client)Working in multi-disciplinary teams/multi-agency arrangements: information sharing/shared recordsNeed to protect the public - risk assessments, report writing, working notesNeed to ensure the safety of the individual (self-harm disclosure or if someone else at risk)Potential for staff compromise/collusion/splitting if told something‘in-confidence’Additional offencesSecurity of the establishment & SIRsEstablishing the right culture within each TC: ‘encouragement to do the right thing – share all relevant information’
18 Conditioning, compromise & integrity Closeness of working arrangementsSupportive therapeutic relationshipsImpact of hearing distressing materialMaintaining personal boundariesRole of the staff teamContaining own frustrations/expressed hostility of residentsAlways acting respectfully, competently, responsibly, decently & with integrity
19 Staff Support Mechanisms Pre-group/community meeting briefingPost group supervision/de-briefingPost community meeting de-briefingWeekly sensitivity meetingsIndividual supervision (contracted)Group supervisionInformal (and if necessary formal) individual/group peer and/or clinical team discussions (particularly if distressed)
20 Further ReadingBrookes, M. and Shuker, R (Eds.) Grendon 50th Anniversary Edition. The Howard Journal, 49, (5).Jones, D (Ed.) (2004). Working with dangerous people: The psychotherapy of violence. Oxford: Radcliffe Medical Press.Parker, M (Ed.) (2007). Dynamic security: The democratic therapeutic community in prison. London: Jessica KingsleyShuker, R. and Sullivan. E.L (Eds.) (2010), Grendon and the Emergence of Forensic Therapeutic Communities: Developments in Research and Practice, Chichester: Wiley-Blackwell.