Leeds Personality Disorder Services – WINNERS PD/COMPLEX NEEDS #MHAWARDS18

The Leeds & York Partnership Foundation Trust (LYPFT) Personality Disorder Service is comprised of: The Leeds Personality Disorder Managed Clinical Network (PDMCN). A local based service offering specialist care coordination and group work interventions to men and women living in Leeds.; The Pathway Development Service (PDS). A regional service offering advice, signposting and case review for men and women belonging to the region who are residing in (or at risk of escalating into) secure hospital beds or where a pathway back to the community from any inpatient setting has not been identified/progressed. ; Yorkshire Humberside Personality Disorder Partnership (YHPDP). A regional service working in partnership with the National Probation Service to enhance the criminal justice management of male and female offenders with personality disorder.

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: Yes

Evaluation

  • Peer: No
  • Academic: No
  • PP Collaborative: Yes

Find out more

 

 

 

Overview

The Leeds & York Partnership Foundation Trust (LYPFT) Personality Disorder Service is comprised of: The Leeds Personality Disorder Managed Clinical Network (PDMCN). A local based service offering specialist care coordination and group work interventions to men and women living in Leeds.; The Pathway Development Service (PDS). A regional service offering advice, signposting and case review for men and women belonging to the region who are residing in (or at risk of escalating into) secure hospital beds or where a pathway back to the community from any inpatient setting has not been identified/progressed. ; Yorkshire Humberside Personality Disorder Partnership (YHPDP). A regional service working in partnership with the National Probation Service to enhance the criminal justice management of male and female offenders with personality disorder.

Our Personality Disorder Services work in collaboration and partnership with other organisations to enable movement and provide therapeutic opportunities for people who are frequently perceived to behave in a way which is destructive to relational and therapeutic bonds. We are interested in maintaining people as safely as possible in the community and close to their homes. We are interested in making sure that opportunities are unobstructed and that services remain hopeful about pathways which don’t progress as they had planned. We are interested in creating systems which are thoughtful and which manage risk as collaboratively with service users as possible. We are less focussed on ‘treatment’ and more concerned with creating opportunities at every level to think about and understand minds, repair ruptures and to learn. We are ambitious and we want to evolve with the full involvement of all our stakeholders to make sure that we stay relevant and provide a meaningful service to a client group who traditionally are excluded, marginalised, stigmatised and traumatised. To do this we work both locally and across the region to understand individuals through psychologically informed formulations and to use these formulations as a basis for: 

    • 1. Providing a series of direct interventions for men and women with a personality disorder presentation within Yorkshire & Humberside. These direct interventions sit at the centre of a network of other, more systemic based interventions and aim to involve the service users as much as possible in their own formulation and therapeutic journey. They include: • Specialist care coordination for men and women who present with a high level of distress and risk of harm to themselves in the community in Leeds
    • • Dialectical Behaviour Therapy Informed Skills Groups. A structured group work programme focussing on developing skills to manage emotional distress, interpersonal difficulties and self-harming/suicidal behaviours 
    • • The ‘Journey Programme’. Journey is an occupational therapy group work programme designed for people with personality disorder and is based on the understanding that what people do (occupation) and don’t do in their daily lives has a direct impact upon their health and wellbeing
    • • Intensive Interventions for Risk Management with high risk men (Discovery Service) and women (Compass Service) with offending histories. These are focussed on managing transitions (e.g. out of prison) and on providing both psychological and occupationally based therapeutic opportunities

• Mentalisation Based Therapy (MBT) groups for men diagnosed with Anti-Social Personality Disorder 2. Reviewing the cases of men and women detained in hospital across Yorkshire & Humberside whose pathways are identified by NHS England and CCG case managers as being ‘stuck’. We offer recommendations to clinical teams about how these pathways may be progressed

3. Working in partnership with probation services across Yorkshire & Humberside to enhance the criminal justice management of high risk offenders by providing consultation/co-working of complex cases. This work supports the implementation of the national Offender Personality Disorder pathway. 

5. Supporting specialist living environments, including two Psychologically Informed Planned Environments (PIPEs) which look to provide a robust psychologically informed relational environment for men with personality disorder leaving prison 

6. Working together with third sector partners to provide a specialist Tier 4 inpatient Personality Disorder service in order to develop a more cohesive pathway for women with personality disorder who require secure/inpatient care and treatment

7. Supporting carers of service users with a personality disorder presentation by facilitating co-produced carers groups within Leeds

8. Supporting workforce development across Yorkshire & Humberside, and in relation to Offender Personality Disorder services then also across the North, via the Knowledge & Understanding Framework (KUF) personality disorder workforce development programme

9. Intensive support for Offender Managers (OMs) in the Humberside region around their case management of individuals detained under Indeterminate Public Protection (IPP) sentences. Pathways for this group are highly problematic. 

Our service is celebrating 15 years of service delivery this Autumn through a national conference. The PDMCN being the most established component (15 years), followed by the PDS (10 years) and latterly YHPDP (5 years). Our services are psychologically informed with systemic working delivering in partnership with service users and other providers being key aspects across all of our service provision (referenced further in later sections of this submission). 

We hold the position that the ‘problem’ for many of our service users with regards to moving forward in their lives is not located with them but rather with the wider ‘system’ itself. The service is therefore committed, as indicated in the range of ‘interventions’ outlined above, to making a difference through both direct intervention with service users and systemic working. How we evidence making a positive difference to individual service users will be referenced in the ‘outcomes’ section of this document. 

 

What makes your service stand out from others

We believe that Leeds Personality Disorder services is different in a number of ways: 1. Firstly, we believe that at the forefront of our clinical model is an understanding of the importance of the emotional labour which is required in the work that we do. We understand that services get drawn into unhelpful practices which obstruct pathways when the emotional impact of the work is ignored. Below are some examples of how we work to both notice the impact of the work on our practice and ensure the emotional well-being of staff: a. Clinical case discussion in YHPDP is structured to ensure that observers can notice what are often unconscious reactions to the work. It is expected that all staff take part in the clinical case review meaning that the organisation communicates an implicit understanding that unhelpful practices can emerge regardless of seniority or role. Our clinical case discussion allows for full multi agency and partnership involvement given that roles (as presenter, consultant or observer) are allocated. Our expectation is that all stakeholders should be free to participate and bring knowledge into the discussion.

The 2017 staff survey generally reflected a team positive about their place of work, feeling effective in what they do and well supported in their role. For example as a ‘flavour’ from the 2017 survey staff in Leeds Personality Disorder services reported: 92% feel trusted to do their job; 100% feel their manager values my work; 88% feel that they make a difference to service users; 89% feel that their manager takes a positive interest in their well being; 100% feel they are supported by work colleagues; 84% felt their appraisal provided clear objectives for their work.

Secondly, Leeds Personality Disorder services are committed to expanding the definition of what constitutes bold and effective ways of working. Too frequently, personality disorder services are concerned solely with the treatment of individual intra psychic pathology and not enough with other equally valid outcomes and psychosocial phenomena.  For example, a. We provide consultation to other agencies. This consultation is grounded in the understanding that the aims and tasks of other organisations may be more relevant to the social circumstances of the individual but that relational difficulties make the work impossible.

We provide psychoeducational groups for carers/family members residing in Leeds who support an individual with personality disorder/difficulties.  The groups provide information about the difficulties associated with a diagnosis of ‘personality disorder’, how these difficulties might develop, the impact of these difficulties on carers and family members, and how carers might respond and cope differently, including considering their own wellbeing. Groups are co-facilitated by a carer and a PDCN staff member.  Feedback from carers has been highly positive and has led to the development of an additional bi-monthly peer support group, run in partnership with Carers Leeds. 

Colleagues from the service have won the poster competition at the British and Irish Group for the Study of Personality Disorders (BIGSPD) for the last three years. The work captured in these posters has been about a broad range of practice innovations (e.g. psychological informed warning letters for probation) and socially/occupationally focussed interventions (e.g. cross stitch). 3. Thirdly, and finally, Leeds Personality Disorder services are focussed on ensuring that, through collaboration and partnership, new knowledge about what works with the client group can emerge. We believe that what works with our clients is not yet properly known or understood and we are committed to enabling a culture of enquiry which supports innovation and evolution. a. Involvement strategies across all services include the importance of ensuring that outcomes are co-produced wherever possible to ensure that they are meaningful. 

Service user satisfaction feedback is routinely gathered as part of the PDCN annual review process.  Current and recently discharged service users are asked to complete a brief questionnaire about their experiences.  Service users are also invited to attend a Service User Involvement Group to provide feedback and to work together with staff to improve services. 

PDCN group programmes are co-facilitated with experts-by-experience

The PDS routinely gather feedback from key stakeholders, including service users, hospital staff and NHSE/CCG Case Managers. This feedback is used to guide service improvement and development. 

Service users are actively involved in the co-delivery of our PIPE projects and a recent ‘open day’ at one site featured entirely co-produced presentations and workshops 

We have an active research strategy group which is committed to contributing to the body of national knowledge about what works with the client group. 

We hold regular stakeholder events for our partners and ensure that the partnership arrangements are represented at every level (e.g. senior management meetings and governance) 

 

Staffing

Developing and maintaining a highly motivated and effective work force is in our view a key objective for all members of the service but a primary task for the leadership team. Achieving this aim is multi-factorial but we would point to the significance of our established:

    • Values informed recruitment 
    • o Investment in staff development and support
    • oContaining and reflective structures across the service

All staff within the service are employed via recruitment panels consisting of staff and service users and once employed staff all staff have individual CPD plans developed and monitored through the appraisal process and access to relevant short and long course training opportunities, aligned to service level training plans. For example currently the service is supporting staff to complete x1 PhD and x1 PhD application, x3 advanced Therapy qualifications and a number of additional degree/masters level personality disorder qualifications. Engagement with high quality and regular supervision is considered to be essential for staff well-being and effective service delivery. This is demonstrated by all staff within the service having both management and individual clinical supervision on a monthly basis.

Additional group clinical supervision is provided to support management of group work processes in the DBT and Journey group work programme teams. All clinical supervisors and supervisees have completed clinical supervision training, updated within the past 6 months as a service level quality improvement objective, with the quality of supervision being reviewed through individual and service level feedback questionnaires (relevant action plans then being developed and monitored through clinical governance). All staff attend, as a mandatory requirement, monthly team development days (TDDs) to support team reflection on relevant areas of practice development.

The focus for TDDs are developed in consultation with the staff team and facilitated by senior clinicians within the service with additional input from external facilitators as required. Each service area additionally has a weekly ‘clinical review’ forum with mandatory attendance across the MDT where cases are formulated and treatment plans developed/reviewed. As a psychologically led service reflective practice is embedded at all levels of the service. There is a transparent approach to workload allocation with a clear commitment to ensuring that staff caseloads do not exceed those agreed within the team and with commissioners. There are annual team ‘away days’ facilitated for each team across the service with a shared focus of team building and service development.       

The ‘evidence’ of the structures impacting positively on the staff well being, and crucially therefore on their psychological capacity to continue to work effectively despite the challenging nature of the work, is demonstrated through the positive response to the Trust’s annual survey from staff within the service (see previous section) and in our HR related performance. The service routinely has less than 5% vacancy factor across the service (currently with one vacancy only), low staff turnover and low levels of sickness absence (typically 1-2%). Our belief is that the high level of service user satisfaction is directly related to high level of staff satisfaction within the workplace. A clear and sustained commitment from the leadership within the service to working to this principle is evidenced through the structures outlined above and is prioritised as a standing item for review on the service’s bi-monthly senior management forum.  

Who is in your team?

Consultant Clinical Psychologist – 3 1.6

Principal Psychologist – 3 2.8

Nurse Consultant – 1 1.0

Operational Manager – 1 1.0

Senior Psychologists/Psychotherapists – 14 12.1

Clinical Team Manager – 1 0.9

Senior Probation Officer – 2 2.0

Housing & Resettlement Manager – 1 0.6

Psychologist/Psychotherapist – 2 2.0

Occupational Therapist Specialist – 1 1.0

Occupational Therapist – 5 5.0

Care co-ordinator – 4 4.0

Caseworker – 4 3.6

Housing & Resettlement caseworker – 5 4.4

Probation Officer – 3 2.5

Administration Team Leader – 1 1.0

Service User Involvement (paid) – 4 2.0

Higher Assistant Psychologist – 2 2.0

Assistant Psychologist – 5 5.0

Health Care Assistant – 1 1.0

Administrators – 4 2.0

Working together

Leeds Personality Disorder Services work with a range of key partners and stakeholders. These primarily include: • The National Probation Service; Community Links (3rd sector housing provider); Together Women Project ;  Leeds Survivor Led Crisis Service; Leeds CAMHS; Turning Point; Institute of Mental Health; Service User Training; NHSE and local commissioners across the region.

We consider partnership working to be essential in providing a suitably complex service for our service user group and systemic work is embedded across all aspects of our service. Indeed supporting pathway planning is the primary task for the PDS. The PDMCN was originally designed using a ‘Managed Clinical Network’ model, with multi agency and multi-disciplinary arrangements being central to the design of the operational model. We are motivated to engage with the psychological and social circumstances of our clients and as such we look to ensure that our work encompasses the widest possible social agenda and involves multiple stakeholders and partners. In addition, our clients are frequently transitioning between services. We know that these transitions are often ill planned or fraught given the level of anxiety they tend to trigger. We are also, therefore, motivated to work closely with other agencies to manage gaps and transitions and ensure that learning about the individual is captured. We strive to be brave and to ensure that we, and those we are collaborating with, manage what often appear to be increases in risk thoughtfully and effectively. As a consequence, we are keen to ensure that partner agencies are involved at every level of our business. Below are just some examples of how we work closely with partners and involve all stakeholders to support service provision across the wider system:

The PDMCN CAMHS transition protocol. We have an established protocol with local CAMHS services which ‘operationalises’ the early identification of young people ‘transitioning’ into adult services who may benefit from our service. Collaborative formulation and joint working prior to the young person’s 18th birthday is a key component of this protocol and to the development of an adapted/individualised package of support 

The PDS led specialist personality disorder inpatient services review. This project, commissioned by NHS England, focuses on the population of Yorkshire and Humber who are currently using, or may be requiring specialist medium or low secure personality disorder services. The review is tasking with: o Reviewing best practice and the evidence base for the population

Engaging with service users, staff and commissioners in developing a vision for future service provision

Reviewing current in-patient services and provision across the whole pathway 

Supporting commissioners to develop a three to five year strategic implementation plan • The Knowledge and Understanding Framework (KUF) personality disorder training programme. The service co-ordinates delivery of personality disorder training from awareness level to Masters level across the Northern region and will deliver over 40 cohorts of training to multi-disciplinary staff across health, criminal justice and 3rd sector agencies. Supporting workforce development across the whole system is a key aspect of this programme 

Our Humberside based project which is tasked with supporting the case management of high risk individuals who are detained under Indeterminate Public Protection (IPP) sentences is working actively with prison based psychologists and the parole board to ensure that goals are shared and transitions are as smooth and as actively supported as possible for this client group. ‘Progression panels’ are routinely held in this locality through the project ensuring a forum for multi-agency involvement and shared decision making for a client group whose pathways are highly problematic. 

 

Do you use co-production approaches? 

Leeds Personality Disorder Services have a long history of service user involvement. We provide a range of opportunities for all current and previous service users to become involved with service development, delivery and improvement. There are established involvement strategic documents co-developed with service users in operation across our services and embedded within clinical governance. We have consciously striven to implement a ‘ladder of involvement’ continuum methodology, providing engagement opportunities from services user’s experience of directing their own care to paid involvement at a senior governance level. Examples of this are provided below:

In the PDMCN & PDS a co-developed and co-facilitated involvement event, entitled ‘Re-imagining Service User Involvement’ attended by over 40 service users has led to the development of an Involvement Steering Group and a refreshed Service User Involvement Group. The group produces a quarterly newsletter, ‘Validate’, and are involved with developing and analysing the data from the annual Service User Satisfaction Survey. The survey examines service users’ feedback on various areas of the service, such as service experience of staff support for and understanding of clients, the impact on service user’s lives and general feedback on the services individuals received. The survey leads to an annual action plan, reporting to the Clinical Governance forum

We have a contract with Leeds Survivor Led Crisis Service to provide a service user involvement worker, social media engagement worker and a senior manager into the service to support involvement activity from care planning to Clinical Governance level. This pilot arrangement, commenced in April 2018, is bespoke to the service and we anticipate that the model of paid involvement across different levels of the ‘organisation’ may provide a model for involvement activity within our Trust and potentially beyond • The service has well established two volunteer Service User Consultants (SUC) who co-produced the group programme and now provide peer support within the Journey Occupational Therapy day service and an employed SUC providing peer support into the DBT service • The model for KUF training delivery is one of co-facilitation by individually contracted expert by experience and expert by occupation trainers, with the contract also being co-managed between the Leeds Personality Disorder Service Manager and an expert by experience lead. This embedded model of co-production supports the delivery and development of programme content being continually informed by service user experience and recognises the unique contribution to learning that experts by experience provide

The service provides a minimum of three carers groups within Leeds each financial year. This innovative programme has been developed in partnership with carers services in Leeds and carers themselves, with the groups being co-facilitated by staff and carer volunteers

PIPE delivery is informed by active service user participation through community meetings and a recent ‘open day’ for one of the PIPEs was entirely co-designed and co-delivered. 

We recently involved a service user with an offending history in the co-delivery of training and then in recruitment. The process for agreeing within the health Trust that someone with an offending history could be involved in this work was challenging. Actively pursuing a process whereby all involvement activity is grounded in a live (and co-produced) assessment of risk has been very important. 

 

Do you share your work with others? 

Leeds Personality Disorder services are committed to sharing but also learning from others. We are keen to publish our learning whenever possible but also to engage with stakeholders to showcase our work and explore challenges together. As a leading personality disorder service we routinely engage in and contribute to local, regional and national forums which reflect the comprehensive scope of our service provision. Some examples of how we have shared our work and sought to learn from others are: 

The BIGSPD conference is an event which Leeds Personality Disorder services regularly has a presence at. We have presented at this conference for the last 5 years. At the most recent event (in March this year) Leeds Personality Disorder services presented: o A symposium on transition showcasing how we work with multiple agencies to support movement and pathways through services 

Two workshops on our direct work with high risk individuals with personality disorder. These included early outcomes from our Intensive Intervention Risk Management services and a workshop on the application of CAT principles to the work.

A workshop on ‘narratives on success’ when working with women offenders 

A co-produced presentation on ‘Innovation and involvement in times of austerity’: service user involvement in DBT  • YHPDP have held two learning events for criminal justice and health stakeholders in the region.  These learning events combine a series of key note speeches with workshops. The workshops all explore different areas of work which have posed challenges for us and which have enabled us to learn as a consequence. Our goal is to share our learning in the hope that it will help others with similar challenges as well as to provide a space for further discussion and exploration of the issue

We will be facilitating a national conference in October 2018 reflecting on our experiences of service delivery over the past 15 years and considering ‘what next’ for personality disorder services. In attendance will be local, national and international speakers, such as Professor John Livesley, reflecting the profile and credibility of the service

Publications this year include: o Radcliffe, McMullen & Ramsden (2017) Developing Offender Manager Competencies in Completing Case Formulation.  Probation Journal, 65 (1),  pp 27-38 

Ramsden, J (in press) “Are you Calling me a Liar: Clinical Interviewing for Trust rather than Knowledge with high risk men with anti-social personality disorder” International Journal of Forensic Mental Health

Harvey, D.W & Sefton, W. (2018). Developing psychologically informed warning letters in probation for high-risk clients with personality difficulties. Probation Journal, 2018, Vol. 65 (2) 170–183

Harvey, D.W. & Ramsden, J. (2017) Contracting between professionals who work with offenders with Personality Disorder. Probation Journal, Vol 64, Issue 1, pp. 20 – 32.

 

Outcomes and evaluation 

Below is a summary of some of the key the outcome measures for Leeds Personality Disorder Services. Results are reviewed with service users as appropriate, within clinical governance forums and reported/monitored through commissioner meetings and annual review documents. 

Service

Clinician Reported Outcome Measure (CROM)

Patient Reported Outcome Measure (PROM)

Patient Report Experience 

Measure (PREM)

Other outcome measure used systematically for all service users

PD Network

CORE 34

WHOQOL (BREF) 

Borderline Evaluation of Severity over Time (BEST©) 

Occupational Self-Assessment (OSA)

Service user questionnaire 

Service User Satisfaction Questionnaire

Your View

Intensive Intervention and Risk Management Services (PD Services) Scores from NPS OASYs (National Probation Service Offender Assessment System): • Criminogenic Needs Score

General reoffending Predictor (OGP) 

OASys Violence Predictor (OVP)

Social functioning questionnaire

CORE-10 

Working Alliance Inventory – Short (Offender) Version Occupational  Self-Assessment (OSA)

Supervisor questionnaire (from Offender Manager) 

Exit Questionnaire with client 

(where possible) and 

Probation Officer  

*PROMS = patient-reported outcome measures; CROMS = clinician-reported outcome measures; PREMS = patient-reported experience measures 

 

Has your service been evaluated (by peer or academic review)? 

Leeds Personality Disorder services has not been subject to a CQC inspection or a recent peer/academic review following an initial NHS England led PDMCN pilot review. The Yorkshire/Humberside Personality Disorder Partnership is soon however to be a pilot site for new quality reporting which will, ultimately, include peer and commissioner reviews.

 

Development and sustainability 

We work to ensure sustainability through a clearly defined culture which is value driven and operationally clear. This is to ensure that a strong value led culture should ‘live on’ even when key individuals leave. YHPDP, for example, has a clear set of value statements and examples of how those actions should be ‘lived’. The team was fully involved in the process of developing those value statements and plans are underway for a ‘case study’ type evaluation to investigate the impact of those statements on practice. 

We work hard to record what we do, how we’re thinking and what’s important to us in operational policies, annual reports, governance documents and published papers. Again this is to primarily ensure that the service has ‘a memory’ and key principles are sustained both at points of ‘stress’ and change.

 We actively work to recruit staff who will continue to contribute to the existing culture and work to its core principles and look to retain staff through investing in followership; collaboratively working with staff to review and critique our processes and our approach. We have a strong record on staff development and low staff turnover. Feedback from our staff in the most recent staff survey (2017) provided clear evidence of staff feeling supported by the management team to provide high quality clinical care. 

The service has strong and well established relationships with a range of commissioners and we are consistently requested to contribute to collaborative work with commissioners regarding our own service performance through quarterly contract review meetings and the development of wider service provision. Examples of this are the service being requested to lead on a regional review of inpatient personality disorder services by NHS England and be a national pilot site for the development of personality disorder quality standards for NHS England and HMPPS co-commissioners. We believe that a constructive relationship with commissioners has inherent value in the continued positive development of services for personality disorder but is also integral to the longer term sustainability of our individual service.  

 

What aspects of your service would you share with people who want to learn from you? 

Since Leeds Personality Disorder Services began in 2004 there have been many and varied challenges, some forecast and some unexpected. We are not, however, aiming to be a service which doesn’t experience challenges but to be a service which develops and evolves from what we learn when there are pressures, problems and ineffective ways of working. Learning as we grow and evolve is central to the work of Leeds PD Services.  Being a learning organisation is enshrined as an approach and we are not afraid to notice and acknowledge when we have made mistakes or worked ineffectively. We are also keen to ensure that our learning helps others. 

Things we would want to share include • The importance of paying close attention to the health of partnerships. Work in partnership is deeply challenging and we have learned that this tends to be due to the obscured authority which is an inherent aspect of partnership work. Negotiating authority and having a narrative about these challenges has enabled us to work restoratively with the difficulties. 

Involving service users meaningfully and effectively is challenging. Our learning would be the importance of clear strategies and of explicit commitments to exploring the potential for involvement in all aspects of the work. We have noticed the anxiety in organisations when it comes to involving people (especially if they have offending histories) and we would share the importance of a clear, comprehensive (collaborative where possible) risk assessment. 

Evidencing the difference we make when the work is often indirect and about a way of being rather than doing is challenging. We would share the importance of thinking differently about outcomes and co-producing them wherever possible.   

Changes to our Intensive Intervention Risk Management service operations. These changes reflect our learning that work with high risk offenders is difficult to achieve in groups. The client group tend to find groups very challenging and when the work is community based and voluntary, it is hard to keep a group sustained. The changes we have made reflect a move more towards individually based work. 

A paper we published last year details the journey we have taken in developing and delivering an Intensive Intervention Risk Management service to women offenders. This paper outlines key challenges which were experienced by the team developing this service and discusses how we have responded to these challenges and learned from them. (Ramsden, J; Hirons, A, Maltman, L & Mullen, T (2016) Finding Our way: Early Learning from the Compass Project, an Intensive Intervention Risk Management service for women. The Journal of Forensic Psychiatry and Psychology. Vol 28 (2)) The focus for us is to maintain a framework which allows us to notice and to think about things that go wrong or things that are difficult. This framework consists primarily of a strong sense of our primary task and clarity about our values and our model.  

 

 

Access

Referrals processes are different across different service areas. In the PDCN, referrals can come from varied sources including self referral. The PDS accepts referrals from case managers. YHPDP clients are not referred, as such, but are screened in and are, therefore, in scope for the service. Prioritisation for direct work in YHPDP is determined by the matrix (below). 

The work of YHPDP is actively promoted within probation and we have employed probation officers who are able to carry the message about the work and seek referrals from their teams. 

1 POINT 2 POINTS 3 POINTS

Risk 

OASys OVP1 raw and banded score Medium:

30 to 59% High:

60 to 79% Very high:

80% and over

OASys ROSHMediumHighVery high

Current risk escalation2NoPossible/partialYes

TOTAL RISK

/9

Extent of needs (nature of needs assumed to be appropriate given he has met referral criteria)

Professional support network Clearly present Possible/partial Not present 

Prosocial protective personal support network4 Clearly present Possible/partial Not present 

Needs  met by current provision5 Yes Possible/partial No 

TOTAL NEEDS

/ 9

Responsivity of system6

Time already on waiting list < 3 months3 – 6 months6 months

Time remaining on license/sentence  24 months18-24 months< 18 months

Relationship between client & OM Broke down/ poor7ModerateVery good

Capacity of service in relevant locality PoorModerateVery good

TOTAL RESPONSIVITY

/12

PRIORITY SCORE  

/30 

Additional considerations8

Low OPD priority Medium OPD priority High OPD priority

0-10 10-20 20-30

    • Howard & Dixon (2012) found that the OVP on OASys improved predictive validity for non-sexual recidivism compared to more general predictors of non-sexual recidivism such as ORGS and RM2000 v scale. As the OVP is part of OASys it is embedded in NPS practice and there is no need for additional assessments to be completed, such as HCR-20. The OVP may not fully capture risk for IPP and life sentenced service users so risk of harm should also be considered alongside. The bandings represent banded the predicted two-year probabilities of proven reoffending as per Howard (2011). 
    • 2. This should be based on the opinion of the Offender Manager, in conjunction with Discovery. Factors indicating an escalation in risk may include an increase in substance misuse, disengagement with professional and/or personal support, presence of adverse events such as relationship difficulties, bereavement, loss of job, loss of accommodation, financial difficulties  etc.  
    • 3. Is a professional support network available? Are other agencies / 3rd party agencies working with them? 
    • 4. If their support network is limited to people who have a positive attitude towards crime or antisocial behaviour, protective support is ‘not present’. 
    • 5. If yes – does this support appear to be sufficient to manage risks of violent offending? Is it protective enough? How long is this support for?
    • 6. Consent and some motivation, however ambivalent, is assumed by all men given the three way meeting process.
    • 7. Consider referral to community specification 
    • 8. For example, if this is a re-referral, is there new learning to assist with how we can work with him? 

Advancing mental health equalities

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

We believe that people from black, Asian and minority ethnic groups are underrepresented on our caseload. We have a quality improvement plan (QIP) to address this and are actively tracking our referrals so that we can get more accurate data. Once we have this data we can look to ensure that we are better able to address the inequalities.  

 

What is your service doing to address and advance equality?

There are a number of ways in which we have worked flexibly to ensure access for people who are at risk of experiencing inequalities. These include: • Individual work with a group member who was experiencing difficulties in hearing whilst in the group.; A policy for working with transgender women and ensuring they have access to our service; Extending the length of time that a man recently diagnosed with cancer could access the group he was in to account for time lost due to hospital admissions and appointments; We regularly travel to different localities to meet people for assessments who struggle to travel for mental health reasons

 

Assessing needs and providing car

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

In YHPDP, assessment of need is carried out through individual engagement. We work actively to reduce assessments which, for our client group, are often repeated and contested and obstruct (rather than enhance) access to services. 

We work from file reviews to ensure that referrals are appropriate and meet the person only when we are certain that they would benefit from our service. We would then define need collaboratively through the engagement process. 

In the PDCN the assessment phase leads to a co-produced formulation from which there are recommendations for treatment.

 

How do you meet the needs of people using the service and how could you improve on this?

The needs of people using our service tend to be met through having a wide variety of options available and a large, flexible workforce. NICE guidance is adhered to and we work actively to address transitions. We are concerned with multi agency systems around people and ensuring that these work collaboratively to understand and manage risk. 

We could improve this work through more partnerships to ensure an even wider social agenda for our clients. Access to a wider range of therapeutic options (e.g. gardening, yoga) would be beneficial. 

 

 

FURTHER INFORMATION

https://www.leedsandyorkpft.nhs.uk/our-services/personality-disorder-managed-clinical-network/

https://www.leedsandyorkpft.nhs.uk/our-services/pathway-development-service/

Hours the service operates: Monday-Friday 9am-5pm

Population details

Men and women of working age living in Leeds and the surrounding Yorkshire/Humberside localities. We look to work with men and women who present with serious and intractable emotional and relational difficulties regardless of socio economic status. We work with men and women who primarily present as service users within the health service and/or as offenders within the criminal justice system.

Size of population and localities covered:

  • Our services work with different populations: • Leeds managed clinical network: men and women resident in Leeds.
  • • Pathway Development Service: Men and women with GP addresses in the Yorkshire/Humberside region who are often out of area in hospital and identified by case managers as having problematic pathways.
  • • Yorkshire/Humberside Personality Disorder Partnership: Men and women case managed by probation in the Yorkshire/Humberside region. 

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England):  NHS England, Leeds CCG & HMPPS (Prison & Probation Service)

Provided by (e.g. name of NHS trust): Leeds & York Partnership Foundation NHS Trust (LYPFT)

Share this page: