Prison Mental Health service
The Prison Mental Health service is an integrated mental health team that provides mental health interventions for primary and secondary care mental health. We currently have three prisons within the Devon cluster:
- HMP Exeter (Remand Prison, Cat B)
- HMP Channings Wood (Cat C)
- HMP Dartmoor (Cat C)
Across the Devon cluster we have: clinical leads/managers, mental health nurses, ADHD specialist, LD specialist, ASC specialist, older adult’s specialist, clinical psychologists, counselling psychologists, assistant psychologists, healthcare assistant/support workers and admin.
We aim to achieve the following:
- To provide a community primary and secondary mental health service to all Devon prisons using a stepped care model equivalent to that provided in the community.
- To co-ordinate the care and negotiate appropriate access to services for prisoners with learning disabilities.
- To accept referrals, and provide an assessment and treatment service based on a multidisciplinary community mental health service approach.
- To manage and co-ordinate the assessment and treatment of seriously mentally ill prisoners needing transfer to hospital.
- To arrange, manage, and facilitate the seamless transfer of patients into community services on release from prison.
- To be available during office hours for advice, support, consultation, and supervision.
- To contribute to the risk assessment and management process, including for Assessment and Care in Custody Team (ACCT), internal risk management procedures and Multi Agency Public Protection Arrangements (MAPPA).
- To assist the prisons with a package of mental health training, support, and supervision.
Our approach is based on the stepped care model as recommended by the National Institute for Health and Care Excellence (2011).
At step one of the approach, the patients have typically been identified with requiring a brief intervention with a support worker. This could be work surrounding sleep hygiene, anxiety and/or low mood. All of these patients will have an individualised care plan and a risk assessment. At step one, they are usually offered guided self-help information leaflets and therapeutic work for up to four sessions (These can be either weekly or fortnightly). Devon Partnership NHS Trust offer a range of self-help guides including: prisoner depression and low mood, prisoner anxiety, prisoner posttraumatic stress, self-harm, social anxiety, obsessions and compulsions, hearing voices and disturbing beliefs, health anxiety, eating disorders, controlling anger and bereavement.
At step two of the approach, the patients have been identified as requiring psychological support in managing anxiety and/or depression. They may also have additional needs such as a trauma history or challenging behaviours that would benefit from group intervention. All of these patients will have a generalised care plan and risk assessment according to the group material. Across the cluster we offer: Anxiety Management Group, Mood Management Group, Dialectical Behavioural Therapy (DBT) Group, Acceptance and Commitment Therapy (ACT) Group for trauma, and Mentalization-Based Therapy (MBT) Group.
At step three of the approach, the patients have been identified as having an increased level of anxiety and/or depression which will require 1:1 psychological support delivered by assistant psychologists. This will be delivered typically under the CBT model and will consist of between 6-12 sessions. All patients will have an individual psychological intervention care plan, risk assessment and CBT formulation. Whilst we recommend and use CBT in all of our 1:1 sessions, we also acknowledge the importance of being person-centred and adapting treatment plans to the client and their needs. This means that we highlight the importance of working using integrative models at times, if it would benefit the client. For instance, we use CBT thought and behaviour challenging techniques in some sessions, but we may also use distress tolerance techniques to help a particular individual modify their thoughts and behaviours.
At step four of the approach, the patients have a working or confirmed diagnosis of an enduring mental illness or learning disability. They may be taking antipsychotic medication including, a depot. These patients will be reviewed by a consultant psychiatrist and a care coordinator. They will be under the care programme approach (CPA) caseload, mirroring the care provided in the community. All patients will have a CPA care plan, a level 3 risk assessment and a formulation. Some of these patients may also be working at a step two or three level of care for group or 1:1 psychological intervention with an assistant psychologist. They may also be working with the clinical psychologist for specific 1:1 intervention.
At step five of the stepped care approach in prison, the patient will have a severe and enduring mental health diagnosis and may require transfer to a hospital under mental health detention. These patients will be assigned to a CPA caseload and have psychiatry input (and psychology input if required).