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AWARD WINNERS 2011-12: Four Officers, an SO and a Senior Psychologist from HMP Gartree, receive their Award for their work on a specialist 12 bed unit for lifers with particularly challenging behaviours. The unit employs enhanced case management techniques, and specially developed systems of monitoring, compacts and behavioural contracts, to help prisoners improve their behaviours and return to normal location better prepared to progress through the lifer system. Each of the winners has played a significant role in the unit’s success since its launch in early 2010. (This Award is supported by Serco Civil Government).
[Stephanie Simpson gives her account of the work for which HMP Gartree won their Award]
When Life sentenced prisoners are not able to access mainstream offending behaviour courses, due to not meeting the criteria or by having complex needs, they are largely unable to demonstrate a reduction in their risk to the public and are therefore unable to progress, often languishing in prison long past their tariff date. While this may protect the public from harm, it can often result in a contravention of the prisoner’s human rights, and a high cost to the tax payer, ie £40,000 for each year an individual is housed in HMP Gartree.
In response to these issues, the staff team opened F wing in January 2010 and have developed a programme and regime in the small 12 bedded unit which has the ability to design individual plans to encourage residents towards progression. The average stay is 12 months and each individual will be aiming for a different target. Some may be ready to prepare and progress to Cat C, while others are only at the beginning of their journey and need to build their self confidence, group skills and relationships with staff before they can feel sufficiently able to engage in mainstream courses.. We also have individuals who, due to intellectual difficulties, or unusual offending behaviours, are only able to progress if they are offered individual sessions with a specially trained officer.
The diversity of skills offered by the F wing staff team means that a wide range of complex individuals can be catered for. Several have mental health issues, for example paranoid schizophrenia, ADHD, and PTSD. We have also accepted a number of prisoners direct from a secure psychiatric hospital setting whereby they are being returned to a prison environment after several years in treatment. Within the general prison population it is estimated that the presence of personality disorders is 63%, within the F wing residents this is considerably higher and the staff team have worked with several cases of Borderline, Paranoid, Avoidant, and Antisocial PD. Paranoia and avoidance often result in high levels of anxiety and suspicion so, while individuals may be assessed as suitable to engage in mainstream programmes, they resist as it would be too overwhelming for them. In addition, many of the complex cases are anti-authoritarian and institutionalised, which has often contributed to their reluctance to engage in mainstream treatment and courses and has resulted in them remaining in prison, often in segregation units, beyond their tariff date.
Although we have not had the time or opportunity to advertise F wing widely, we have produced posters and leaflets, which are distributed to the main wings and are available for sentence planning boards. We are also attempting to be included in the induction programme for new prisoners at HMP Gartee. Referrals for F wing come from a variety of sources, Offender Supervisors, Home Probation Officers, Mental Health team, LD nursing staff, main wing staff, Psychologists, and occasionally solicitors have advised their clients to apply. Engagement in the F wing regime is voluntary and motivation is vital. Although staff may identify that an individual would benefit from the unit, it is often frustrating to accept that the person may not be ready to engage and take a ‘leap of faith’.
For some, remaining in a situation that is familiar, even if it is uncomfortable, is more appealing than stepping into unknown territory in order to change. The invitation and assessment process is therefore gradual and is assigned to one officer in order that there is consistency. This begins with an informal conversation on the individual’s wing, followed by an initial interview on F wing and then a longer second-stage interview with two officers. The psychologist produces a background history on the individual and each member of staff then reads all of the interview and background information before voting on whether the individual is suitable. If found suitable, ie has sufficient and relevant issues to work on in the following 12 month period, then his name is added to the waiting list for a space. At each stage of the proceedings, the individual is kept informed of the situation, in order that they accept joint responsibility for taking a place on the unit.
The staff team includes a Senior Psychologist, Psychological Assistant, a Senior Officer and four basic grade officers. Although we work closely as a team and jointly decision make, each member has accepted responsibility for different tasks. Through my role as Head of Case Management at HMP Gartree, I recognised that there was a group of prisoners who were not progressing due to lack of opportunity. In addition the current lack of resources in the psychology department meant that they would not be assessed for individual work in the near future either. This coincided with the availability of the newly re-furbished F wing space, and presented a unique opportunity to develop a specialist unit to support the progression of complex individuals. I set up procedures for referrals, assessment and evaluation and ensured that these met professional standards. This involved devising structures and procedures for individual interventions by the officers as well as arranging training in cognitive behavioural techniques and personality disorders to equip them for the work. I also used my psychological knowledge to develop and introduce workbooks and individually based tasks for residents to complete. This is, in essence, a psychologically informed planned environment in which it was crucial that each member of the staff team was empowered to make suggestions for improving the unit and bring these to the team for a joint decision. I introduced compulsory counselling sessions for the staff due to the complex nature of the residents. This was in addition to the decision that the Senior Officer and I took to hold regular full staff meetings and weekly planning and debriefing meetings to ensure that the staff team felt empowered and supported. My ongoing role is to enable the staff to cope with the day-to-day management of the offending behaviour work that is conducted on an individual basis by providing clinical oversight, advice and supervision, occasionally providing individual sessions for the resident if there are specific needs, such as sexual abuse work. The Psychological Assistant has an essential role underpinning the entire process. Initially she was central to producing the hard copies of the paperwork needed to introduce the psychological regime. Subsequently, she takes a central role in quality checking the workbooks and giving feedback to the residents in order to provide the evidence of reduction in risk that will be required for report writing. This role is also important for ensuring that the paperwork, such as psychometric packs and medical consent forms, are completed thoroughly. Both the Psychologist and Assistant occasionally attend the weekly group meeting in support of the officers to ensure the level of psychological mindedness is maintained.
The five officer grades operate the discipline side of the prison regime as any other wing. As F wing is not, and cannot, be accredited due to the individualised nature of the product, we have not been recognised as a specialist unit and closed recruitment has not been permitted. However, we are fortunate that the majority of the unit staff have previously worked in the therapeutic community at HMP Gartree and have a good understanding of psychodynamic approaches and the importance of building a therapeutic alliance with residents. Although F wing is not a TC, this knowledge is important to the successful working of F wing, and newer staff have attended the intensive TC training provided by HMP Grendon, as well as the in-house workshops that the Psychologist arranges for all staff. The whole staff team have been on the nationally recognised KUF Personality Disorder Awareness training, and have also been trained in delivering individual sessions addressing offending behaviour. In addition, staff receive regular personal counselling which enables them to become self reflective of their own issues and this ensures that they build empathy for the demands being placed on the residents to explore and express themselves. The Psychologist offers supervision which allows the officers to discuss their cases and to consider practical ways to develop their residents. Each officer is assigned to specific residents and we operate a buddy system so each resident has a main and seconder officer to refer to for help, although general issues will be handled by any member of staff.
An essential aspect of the success F wing has been the willingness and ability of each staff member to work in a multi-disciplinary way and to embrace the help and advice from Probation, Substance Misuse team, Gym staff, Education Dept, Psychology, Psychiatry, and Healthcare when developing a formulation for each resident. It is often the case that the residents need to tackle their basic literacy skills, that they have mental health problems and need support to stabilise or reduce their medication, have had a history of substance abuse, or need help to focus on their physical and emotional wellbeing. These are all in addition to the need to evidence offending behaviour work and reduction in risk and requires the F wing staff team to be multi skilled and responsive to a variety of needs.
Increasingly, there are individuals with intellectual disability being referred to F wing and the officers are required to be creative and flexible in learning to adapt the material and workbooks to meet the needs of their particular residents. With the emphasis on individual attention, it is essential that the unit operates a self rostering system and that appointments with residents are pre-planned and pre-booked in the Detail book in order that the staff can adequately cover all of their residents as well as prison wing duties.
The ethos of the unit is that of a psychologically informed planned environment which means that the structure is psychologically based and evidenced. Progress is assessed on pre and post psychometric tests as well as clinical judgement and self report. All residents have the same interview and assessment process, they are provided with a 12 month structured plan containing written, verbal and activity tasks tailored to their individual needs, and they all have quarterly assessments which require self report, officer report and other residents to report on the progress being made across a number of areas by the individual. This information is discussed in a collaborative meeting involving the resident, the personal officer, a second officer and the Psychologist in order to give a wide range of opinion and feedback. In addition, all residents are required to go to work or Education daily and they attend a weekly hour long unit based group meeting to discuss wing issues and make group decisions about the wing, for example the cleaning budget has been divided between the residents in order that they learn to budget and this causes dissonance for the more institutionalised individuals. Residents are also expected to engage in a weekly teambuilding session which can range from sport to cookery to moral debates or dilemmas. The purpose of these sessions varies, at times it is to enable the men to learn to ‘play’, on other occasions it is to observe who would take the lead in a task and who might be overlooked, and the moral debates, for example who to save in a disaster, enables individuals to see other viewpoints and consider wider consequences of decisions than they may have previously. During their 12 month stay, each resident will chair a meeting and organise a teambuilding session in order to build their confidence or address other deficits. All residents are encouraged to sit in the wing office with the staff as this breaks down barriers and is a major challenge for the most anti-authority residents.
Staff are actively involved in wing activities such as cake baking, darts, pool, and board games, as well as taking part in group gym sessions. This is seen as essential for pro-social modelling and rapport building. It also enables staff to gather evidence of residents’ behaviour in off-guard moments.
F wing has now been operational for over two years and we have collected information throughout that time in order to be able to evidence the effectiveness of the regime regarding a reduction in risk. The pre and post psychometrics are being compiled into a database for analysis. In addition, each resident who leaves is asked to complete a statement to include comments on what they have learned from their experience on F wing, what aspect was particularly helpful, and what suggestions they have for improvements.. In addition, the staff team are meticulous about using the prison computer system to record extensive notes on behavioural observations regularly for each resident in order to build a comprehensive picture which will be used to produce a report, written by their personal officer which considers the areas of deficit and need previously, and the anecdotal evidence of change throughout the 12 month period. If substantial individual offending behaviour work has been completed on the unit, the Psychologist will also produce a risk assessment report which can be used to assess progress at the de-categorisation boards and Parole hearings.
In addition to the evidence for a reduction in risk of re-offending, we also have anecdotal evidence regarding the reduction in staff hours required to cope with previously prolific self harmers.
We continue to enable individuals to achieve targets towards progression which they were previously unable to attain, which in turn is cost effective in relation to the potential reduction of £40,000 per year that will be saved by the individual moving more rapidly through the system meaning he will now not stay as long in prison. F wing has been an innovative, unique, exciting, challenging, rewarding, and successful experiment which has only been possible with the support and co-operation of the management team at HMP Gartree.
[The following article appeared in issue 4 of the Butler Trust’s magazine, Inspire]
Philip Taylor, Peter Holdsworth, Trevor Lorking, Steve Lightbody, Mark Danvers and Stephanie Simpson of HMP Gartree, meanwhile, have won a Butler Trust award for their work on a specialist 12-bed unit for lifers with particularly challenging behaviours. The unit uses enhanced case management techniques to cater for the complex needs of prisoners experiencing difficulties with progressing through their life sentences, and helping them to improve their behaviour. The staff have had to develop their interpersonal skills to deal with the challenges of the role, and have demonstrated great commitment, motivation and enthusiasm in often very challenging circumstances.
For more information: contact HMP Gartree