MANAGING PERSONALITY DISORDERED SEXUAL OFFENDERS IN THE COMMUNITY A model for providing clinical input to support criminal justice agencies Dr Rajan Darjee Consultant Forensic Psychiatrist Dr Katharine Russell Consultant Forensic Clinical Psychologist The Orchard Clinic, Royal Edinburgh Hospital

Referral Criteria So how do agencies know who to refer? What are our criteria? There are no explicit criteria and we have no referral form that needs to be filled out. We ask staff to phone or email and engage in a brief discussion about the main issues. We then tell them whether we think we can help. We have used broad descriptions such as WEIRD, UNUSUAL, COMPLEX, CONCERNING. Although we know that we mainly deal in PD we don’t ask for a diagnosis of PD in order that we see the offender – that is one of the things we hope to help people identify and understand. We focus on the problematic behaviour or the problems staff are having. Lack of explicit criteria Focusing on evidence of problematic behaviour WEIRD, UNUSUAL, COMPLEX, CONCERNING Not concerned about previous diagnosis or lack of such, or previous convictions We have had referrals for people with HI and Psychosis – we don’t need someone to have a PD diagnosis to be referred – if that was the case we would have no referrals – the point is we are helping people to identify and work with this

Clinical input Full clinical assessment Attend MAPPA meetings Available for telephone consultation and advice Regular meetings with police sex offender management units and criminal justice social work sex offender service Detailed case discussion meetings with case manager Full clinical assessment

Issues we have been asked to address What is the risk of serious harm? Who does he pose a risk to? Is it safe for him to have contact with children? Is it safe for him to work with women? Can he do offence focussed work? Does he need treatment from mental health services? What are the signs that he is moving towards offending? Are these restrictions necessary? What response has he made to treatment? Does he need further treatment? What was his motivation for offending? What should be the focus of supervision sessions? Should a disclosure be made to employers? Is this behaviour concerning? How should staff interact with him? Will this treatment make him more risky?

Case discussions Documents provided in advance or at meeting Attended by anyone involved with case Discuss case in detail Use structured professional judgment framework Provide formulation, scenarios and management advice Consider suitability for full assessment

Assessment Initial referral and case discussion Information gathering Interviews Ratings of psychopathy and personality disorder Risk assessment instruments Formulation including risk scenarios Management recommendations Feedback to referrer

Communication with referrer Written report Make sure report layout is structured Use understandable language Explain clinical terms (e.g. psychopathy, personality disorder, paraphilia) Don’t have long sections explaining methodology etc. (use appendix if necessary) Verbal feedback & discussion Discuss report and implications with referrer Attend case conferences, e.g. Risk Management Case Conferences (RMCCs), Multi-Agency Public Protection Arrangement (MAPPA) meetings Available for follow-up queries or advice at any point in the future

Outcome of assessment Risk management Managing relationships What should and shouldn't be monitored Tailored restrictions Appropriate victim safety measures Disclosure Managing relationships Understanding interpersonal functioning Interactions with staff Team dynamics Sex offender treatment Suitability for programmes Preparatory work Method of treatment delivery Impact on others in group Mental health input Referral for psychological treatment Support from forensic mental health Assessment and treatment for cormorbid mental illness

Serious Offender Liaison Service Consultant Psychologist Consultant Psychiatrist Psychology Assistant Senior Social Worker Secretary

Personality disordered offenders Sexual harm Domestic abuse Stalking Arson Other serious violence

Consultant Forensic Clinical Psychologist Dr Katharine Russell Consultant Forensic Psychiatrist Dr Rajan Darjee