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CNWL's Pipe Service at HMP Send takes centre stage

16 April 2018

The British and Irish Group for the Study of Personality Disorder (BIGSPD) 19th Annual Conference 2018 in Cardiff 20th to 22nd March

By Elaine Cameron Clinical Lead of CNWL’s HMP Send Preparation and Progression PIPE Service

I and a resident from our Progression PIPE (Psychologically Informed Planned Environment) service were invited as key note speakers on the Offender Personality Disorder Plenary at the end of the first day.

We were asked to talk through what a PIPE service is and use examples from our two PIPEs to bring the model to life.  

Our Progression Service was set up in 2011 and our new Preparation Service in July 2017, soon after we joined CNWL. Our PIPE has twice been awarded Enabling Environment status by the Royal College of Psychiatrists.

Both PIPEs are commissioned as part of the Women’s Offender Personality Disorder (OPD) Pathway.

The progression PIPE – Psychologically informed planned environment – has been running at Send for many years, CNWL took over last April and launched the preparation PIPE.

Progression PIPE is not a treatment but allows an environment for women in prison who have received treatment to consolidate gains made in a supportive relational environment with more intense support than general prison wings.

It provides enrichment opportunities, key worker relationships and small and large groups to help this consolidation and to support women in moving on from through the pathway.

This year’s conference started with a presentation about ACEs (adverse childhood experiences) by Janine Roderick from the Welsh Public Health Service. She spoke about the importance of identifying these in children and recognising how they can impact on someone’s lifelong mental and physical health, as well as their personality development. 

The theme of recognising and working with those early traumatic experiences for those who experience problematic personality traits permeated throughout the symposiums offered over the three days. There were many debates and suggestions made about how we work with ACEs, but it was a central theme running throughout.

The second theme was the importance of service user involvement and the conference reflected this, as through both the symposiums and plenaries there were many service users, who both presented and contributed to the discussion.  People shared their stories about their ACEs, about their diagnosis and their experience of it, their journey and what had worked for them.

Reflecting both themes, myself and a service user from our progression PIPE talked through the PIPE model and how it relates to the rest of the OPD pathway, both from my clinical experience as the Clinical Lead and her experience of being a resident.

The importance of a psychologically informed approach for all staff, the enabling environment and the relational model were highlighted. Our service user described how she had felt safe enough to try new things, get to know people and accept the support which was offered and how this had resulted in her slowly being able to place trust in staff and the other women around her.

Our service user is a life sentenced prisoner who has diagnoses of Personality Disorder and Autistic Spectrum Disorder. She shared how she first began to understand her diagnosis and personality traits through the support of staff and other residents with similar problems.

She identified how PIPE had empowered her to progress in her sentence and gain the confidence to stand in front of 350 people today to talk about what had helped her.

She remains a serving prisoner but was granted release on temporary licence (ROTL) for the day to present at the conference.

She was one of the first life sentence prisoners at HMP Send to gain her open conditions and remain in the prison to work on her resettlement.

She reflected that when she had joined our service she had felt angry and suspicious of others and had found it difficult to see anyone else’s perspective.

This often resulted in her isolating herself or experiencing confrontation with others. She highlighted the importance of the relational model and how the psychosocial approach had encouraged her to engage with others through ways that she had never tried before.

The response from the audience was very positive, demonstrated by those who came up to give their thoughts and thanks to us afterwards and throughout the conference, as well as a variety of positive twitter comments. All of which were greatly appreciated by our service user.

Among other symposiums, the conference offered opportunities to hear about MBT services working with homeless people (Dr Andrea Williams; Kate Sloan; Liz Jennings) , Nidotherapy (Peter  Tyrer) and how Slough is embracing the idea of making the whole town an enabling environment (Rex Haigh and Geoff Dennis).

The experience, knowledge and passion of those working within the field of Personality Disorder and how to continue to develop our services and research was central to the conference and what they offered.

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