Saturday 2 October 2010

Probation and Psychology

I was really irritated by this piece in the Guardian from 22nd September about an initiative between Islington and Camden Mental Health Trust and the London Probation Trust. The project involves high risk personality disordered offenders and in particular their high recall rates to prison. Winifred Bolton, the lead clinical psychologist, helped set the project up. She explained that the idea was for "psychologists to train frontline probation staff to improve their skills and to work more effectively with offenders who have a personality disorder so they can better refer their difficult cases to the mental health services rather than be relieved of them."

She goes on:-

"Probation staff, who don't necessarily speak the language of mental health, have experienced difficulties in making timely referrals to mental health services. NHS and third sector staff often have concerns about risk when they work with offenders," says Bolton. "By bringing together expertise from both sides, we are able to bridge these gaps. It means that the psychologists get to understand the needs of probation staff in managing high-risk offenders in the community. It also gives probation officers a better understanding of personality disorder and ways to address offenders' individual psychological needs."


"A small number of cases do involve some direct working, for example, to provide a specialist psychological assessment."

I simply do not recognise the world being described in this article. In my experience community adult clinical psychology provision is virtually non-existent within the NHS. I sincerely hope the London Probation Trust hasn't paid for this 'initiative' as it should be provided by the NHS anyway. Incredibly an offender is far more likely to be seen by a psychologist when in prison than when out in the community. Over the last few years the Prison Service has funded a massive increase in psychology departments, but even then there can be long delays before many prisoners can be seen. Then there is the small problem of getting a diagnosis, possibly before clients get to prison. In my experience your one and only chance is at PSR stage and then you have to convince the Legal Adviser to authorise the significant expense of a psychology report. Psychiatric reports are often much cheaper. 

If probation officers are not felt able to recognise those people who might be personality disordered, then their training has been sadly lacking. What a probation officer needs are indeed the services of a clinical psychologist for diagnosis, assessment and access to psychotherapy for their client. But apart from possibly Camden, where is that routinely available in the community for probation clients? It is precisely for this reason that I have argued for psychologists to be employed directly by the probation service. As for "A small number of cases do involve some direct working...." What?! There's a significant number - we don't need an initiative, we just need a service from the NHS thank you! 

2 comments:

  1. 80% of the prison population assessed as having some sort of personality disorder.
    I recently had the pleasure of spending 3 days training at a secure mental health unit where a lot of prisoners end up.
    My closing question asked where we seek support for those with PDs in the community who don't need secure in-patient treatment. The answer? We don't. There is NOWHERE, not one project, available for the treatment or support of PD's in the entire huge county I work in.
    And we all know how useless CMHTs are. I have people who are told they have "personality disorder" without even being told which type, what that means and what they're supposed to do about it!

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  2. I'm not sure 80% have a personality disorder - I think more likely a mental health problem, be that learning disability, mental illness, psychological disorder or PD.

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