Women in prison have multiple needs. Many have histories of complex trauma, substance misuse, social deprivation, poor physical and mental health for which they have accessed limited support for in the community. Some women remanded to custody arrive pregnant and many are separated from their children. We are proud of the services we provide and have adapted to meet the needs of the women we care for. We work alongside multiple partner agencies, to assist the women in their recovery pathway within prison and back out into the community.
What does this service line offer?
Our specialist services include maternity and perinatal services that span prison and community care for women and their children. We are national forerunners in the provision of specialist prison perinatal mental health services. In addition to a comprehensive menu of trauma-informed mental health and physical care, we provide highly specialist ‘Offender Personality Disorder’ services in all of the women’s prisons in our service line. These include bespoke services to assist the women and the establishments reduce the use of self-harm through psychologically-informed models of support and intervention. We support and enable women with pre and post offence focused work in our acclaimed PIPEs (Psychological Informed Planned Environments) at HMP Send.
Our psychology therapies team are trained in multiple approaches, including:
- cognitive behavioural therapy,
- schema focused therapy,
- counselling,
- art therapy,
- mentalisation based therapy,
- dialectical behaviour therapy
- eye movement desensitization
- reprocessing therapy.
Our health promotion programme
Our health promotion programme acknowledges the significant health inequalities our population have experienced and adapts to needs of our population. Programmes include tackling obesity, cervical cancer, living through the menopause and provision of pre-conception education and advice. We listen to the feedback from our service users and partners and adapt the programmes we delivery to meet the need.
We have a transgender pathway for individuals with gender identity needs, and can provide an inreach or outreach service for patients to access local and national gender identity clinic services on an individual needs basis.
CNWL provides primary care, mental health and specialist services to men detained within prison. Men in prison have multiple needs. Many have histories of complex trauma, substance misuse, social deprivation, poor physical and mental health for which they have accessed limited support for in the community. Men are less likely to reach out for support. We are proud of the services we provide and have adapted to meet the needs of the men we care for and we work alongside multiple partner agencies, to assist the men in their recovery pathway within prison and back out into the community.
What does this service line offer?
In addition to a comprehensive menu of trauma-informed mental health and physical care, we provide highly specialist ‘Offender Personality Disorder’ services in all of the men’s prisons in our service line. These include bespoke services to assist the men and the establishments reduce the use of self-harm through psychologically informed models of support and intervention. We support and enable men with pre and post offence focused work, and at HMP High Down we are excited to be developing a new PIPE(s) (Psychological Informed Planned Environments) unit in partnership with HMPPS. Our psychology therapies team are trained in multiple approaches, including cognitive behavioural therapy, schema focused therapy, counselling, mentalisation based therapy, dialectical behaviour therapy and eye movement desensitization and reprocessing therapy.
Our health promotion programme
Our health promotion programme acknowledges the significant health inequalities our population have experienced and adapts to needs of our population. Programmes include tackling obesity and diabetes, prostate and bowel cancer awareness, living with long term conditions and general education and advice. We listen to the feedback from our service users and partners and adapt the programmes we delivery to meet the need.
We have a transgender pathway for individuals with gender identity needs, and can provide an inreach or outreach service for patients to access local and national gender identity clinic services on an individual needs basis.
HMP/HMYOI Feltham sit within our CYP (Children and Young People) services.
What does this service line offer
We provide a full range of healthcare assessments and interventions that span primary physical health, mental health and substance misuse services. We deliver an integrated model of trauma-informed healthcare which provides the best possible care for children, young people and young adults in the youth justice system. An integrated model means that our teams all work very closely together, thinking about CYP health needs in a holistic way, and ensuring that healthcare interventions form an integrated part of their overall care in custody. A trauma-informed approach ensures that we are attending to the developmental and psychological needs of the children, young people and young adults’ resident in our sites, as well as their wider healthcare needs to ensure that CYP are enabled to embrace opportunities of personal growth and future orientation.
A key part of our service delivery within youth custody is leading on SECURE STAIRS and in young adult services, REFRESHED; integrated frameworks for trauma-informed care. We work closely with our Youth Custody Service (YCS) operational colleagues to support not only the children, young people and young adults, but also the frontline staff through delivery of specialist training, development of multi-agency formulations and guided reflective practice.
We have leading experts within the field of CYP in custody, and provide specialist child, young person and young adult focussed healthcare that includes:
- creative therapies (art, drama and music),
- speech and language therapy
- family therapy
- Occupational Therapy
- nursing across all specialisms ie School, Learning disability, Physical and mental health
- clinical and forensic psychology
- child & adolescent psychiatry
- GPs, dentistry, optometry, physiotherapy, podiatry
- paramedics and emergency care
We offer a huge amount of health promotion and advice, as well as assessment and treatment, and work in collaboration with the children, young people and young adults, as well as their families, who we provide services for. Our services are led by experienced practitioners, and work in an individualised strength based approach, with early interventions to promote independence and optimum health outcomes. We work with a range of subcontracted, third sector and charitable organisations that add value to our offer and support us to meaningfully engage with the children and young people including in preparation for and during transition out of the setting. We work hard to ensure we receive regular service user and carer feedback, to continually review and develop effective services. We value the expertise of those with lived experience of the criminal justice and healthcare systems and are developing roles in our staffing models which ensure that this is embedded in all aspects of our service delivery.
We are expanding on using digital technology to enhance services, keeping confidentiality but to aid less disruption to individuals, and access local and national resources that may be beneficial whilst in custody, and aid preparation for release.
The OPD service line works both in custodial and community settings. We offer direct assessments and group and individual interventions, and indirect support through staff and network consultation, formulation, training and workforce development.
OPD services are commissioned as partner services. In prison settings, we partner with the prison provider (either HMPPS or Sodexo) and have both clinical (NHS) and operational (prison) staff working together to design, lead and run services. In the community we work in partnership with neighbouring NHS Trusts and with probation to provide services that work across London.
The OPD pathway is a specialist pathway designed to improve outcomes for individuals who have engaged in serious offending and who have pervasive psychological difficulties likely to meet the criteria for a diagnosis of personality disorder. This diagnosis can be quite contentious and we aim to work collaboratively with people referred into our services to identify their difficulties and focus on these rather than thinking only about diagnosis.
The populations we serve and the environments we work in can be quite complex and we therefore pride ourselves on developing and maintaining a skilled, compassionate and experienced workforce. We prioritise clinical supervision, good governance and professional development.
Currently our OPD services include:
EOS – a service for women who are stuck in the prison system and struggle to engage in normal regimes or other programmes within the prison. EOS is a psychology led service which provides in depth assessment, goal-setting and formulation with the women and then works with the teams around them to develop ways of better understanding and “mentalizing” their behaviours. This service draws heavily on ideas from MBT (Mentalization based treatment) and has been running at Bronzefield prison for the last five years.
OPTIONS – this service operates at HMP Downview, a women’s prison in Surrey. Options primarily provides individual and group interventions using DBT (dialectical behavioural therapy) an evidence based psychological therapy which teaches, practices and consolidates skills in emotional regulation, distress tolerance, mindfulness and interpersonal effectiveness. Options staff also work with prison staff to support greater understanding of behaviours through formulation and consultation.
PIPES – these are Psychologically Informed Planned Environments. We operate two PIPEs in a single unit at HMP Send, another prison for women in Surrey. We run a preparation PIPE and a progression PIPE, both residential services, meaning the women move to a specific area of the prison to reside whilst they are on the PIPE. The preparation PIPE works with women who need to engage in further specific programmes or treatment but who need some work to help get them ready for this. The progression PIPE works with women who have completed such interventions or treatment but need some further support to help them to consolidate changes they have made. The PIPEs are staffed by clinicians and specially trained prison officers who use relationships, key-working, activity and skills development to support these women to either be ready for, or to embed change.
Community services – we provide community services in probation and approved premises as part of the London Pathways Partnership (LPP). This is mostly focused around bringing psychological thinking through consultation, formulation and workforce development to the management of individuals who are under the Probation service and providing trauma informed interventions and support. Often their personality functioning and histories make their engagement and risk management more complex.
Primary Care MHTR – we are just beginning a new project providing the interventions required under mental health treatment requirements to women in London. Again this work is part of the LPP team and ensures we, and other Trusts, are working together to ensure women given an MHTR are able to access the right interventions.
In our community forensic service line, we cover a wide range of services from inpatient wards, rehabilitation services and community forensic teams. Our forensic services are for offenders with mental health conditions, whose healthcare cannot be managed within the referring service.
At Park Royal Hospital, we have a highly dedicated and experienced multidisciplinary team, which includes psychiatry, psychology, nursing and STAR workers providing low secure services on Tasman ward, and open rehabilitation services at Java House.
At the centre of service delivery is the patient’s capacity, within the constraints of their legal detention, to achieve optimum mental health, and living well. We foster hope, promote collaboration/co-production, and provide meaningful opportunities for personal development and social inclusion.
On completion of their assessment and/or treatment on Tasman Ward, service users will either:
- return to prison to continue their sentence
- move on their pathway to lower levels of security
- return to the least restrictive environment in the community.
The Kensington, Chelsea and Westminster Community Forensic Service based at Pall Mall Mental Health Centre, provides a fully integrated health and social care service of care coordination within the current Care Programme Approach framework (CPA), to those service users with a history of offending, or at risk of offending who are viewed as being a significant risk to others.
Our dedicated Community Forensic service provides support, treatment and monitoring for patients meeting our referral criteria, who are discharged back into the community, prior to their care transferring to local community teams. The core function of the team is to support patients intensively and to monitor their mental state, behaviour and the risks they may pose.