1. Issues in medium secure Female Forensic Mental Health Services in Scotland John Crichton

2. Policy Context Scottish Office (1998) Women offenders: A safer way: A review of community disposals and the use of custody for women offenders in Scotland. Edinburgh: Social Work Services Inspectorate Scottish Executive (2002) A better way. Report of the ministerial group on womens offending Edinburgh: Scottish Executive Scottish Executive (2006) Reducing Reoffending: National Strategy for the Management of Offenders Edinburgh: Scottish Executive Scottish Government (2008) Equally Well: report of the ministerial task force on health inequalities Edinburgh: Scottish Government Scottish Government (2009a) Equal Opportunities Committee Report; SP Paper 332 Edinburgh: Scottish Government Scottish Government (2009b) Safer Lives: Changed Lives A Shared Approach to Tackling Violence Against Women In Scotland Edinburgh: Scottish Government Scottish Prison Service (2010) SPS Strategy Framework for the Management of Women Offenders in Custody Edinburgh: Scottish Prison Service Commission on Women Offenders: Final Report April 2012

3. Pre -Orchard 1. Difficulty in finding in-patient places for female forensic patients. 2. Particular difficulty of finding secure beds for anyone not suitable for conditions of special security. 3. The need to manage deliberate self-harm and the sequelae of childhood sexual abuse. 4. The lack of resources to meet these treatment needs. 5. The difficulties of managing men and women in the same environment: the womens needs are not met and they are seen as disruptive of the overall service. 6. The importance of and the lack of suitable supported community placements.

4. FORENSIC MENTAL HEALTH SERVICES MANAGED CARE NETWORK REPORT OF THE SERVICES FOR WOMEN WORKING GROUP 2004 Dedicated multidisciplinary teams responsible for providing Forensic Psychiatry Services for Women should be established within local Forensic Services across Scotland. As a minimum there should be at least one such service within each of the 4 regional groupings. These should provide, direct secure and open inpatient care as well as community care. They should also be a source of support and expert advice to other local services. All of Scotland should be covered by such a service.

5. High secure care Until Secure Services for Women are available Scotland-wide, the Womens Service at the State Hospital should continue as a high quality service. It should not, in the meantime be run down. Where service improvements are required (for instance development of the rehabilitation service and standard of accommodation) these should be made. Only once there is clearly no need for the service, should it be closed.

6. Developments closure of high secure female services. Referral pathway now in place to Rampton Two Medium secure sites LD services Rowanbank Low secure patchy with use of private sector

7. Challenges Remand high secure patients Length of high secure referrals Prison transfer appeals Differences in models of care – seclusion SUS Adapting Orchard Clinic to single sex and pd Follow on care –two distinct groups of patient

8. Orchard Clinic admissions Low base rate fluctuation Last two years admissions at OC: –3 murders (4 filicide victims -3 kitchen knives - one other), –6 attempted murder (3 attempted filicide, one multiple –fire raising, 2 kitchen knives) –2 minor offences –1 civil transfer

9. Primary diagnosis Severe PD 1 Bipolar 1 Depression 1 Schizophrenia 9 – 3 clozapine

10. outcome 1 High secure 1 low secure locked 1 open rehab 3 community with forensic community team follow-up – Willow Project 6 inpatients remain

11. Current OC inpatient needs (1.2.2014) 8 total patients (inc 2 long term and 5 restricted) 3 low secure predischarge 2 low secure rehab

12. Patients declined severe PDs requiring single gender environments Admissions likely to require bespoke complex packages of care and supervision Likely to cause clinic wide disruption Almost all minor offenders with major mental illness

13. Risks Resistance to making do with inadequate gender specific services for women with severe PD and histories of abuse Complacency regarding risk of sexual assault Bed flow problems if lack of appropriate low secure rehabilitation and predischarge Boundaries Early discontinuation of criminal proceedings in certain minor cases

14. Questions?