Low secure service for Scottish women
The Ayr Clinic
Clinical Forum: Women in Forensic Mental Health Setting
07.02.2014
Pradeep Pasupuleti, Laura Stevenson and Emma Hargreaves
Partnerships in care
Today’s talk
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Introduction
Service at the Ayr Clinic
Our Experience
Future plans
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The Ayr Clinic, Partnerships in Care
The Ayr Clinic
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2008
34 beds
2 admission wards and 1 rehab ward
Low secure service
The Ayr Clinic, Partnerships in Care
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The Ayr Clinic, Partnerships in Care
Female service
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Admission ward and mixed-sex rehab ward
MDT model
2008-2013
Total admissions - 95
Total female admissions- 27
Discharges- 14
Longest admission- 4 years 7 months
Shortest- 1 month
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The Ayr Clinic, Partnerships in Care
Arran ward
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The Ayr Clinic, Partnerships in Care
Patient profile
• Story of Miss S- 25 years old, inpatient since the age of 15,
transferred from IPCU, prolific self harmer specifically inserter,
vague psychotic symptoms
• Story of Miss A- 21 years old, in care since the age of 9, prison
transfer, serious offender, violence as primary defense, self
harm behaviour, psychotic episode
• Story of Ms M- 46 year old, schizophrenia, violence towards
family members, transfer from a local open ward, unsuccessful
community rehabilitation
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The Ayr Clinic, Partnerships in Care
Challenges- Patient related
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Patient mix
Hybrid nature of needs
Complex personality disorder, Dual diagnosis, primary MI
Extreme levels of self harm
Problems in forming and maintaining relations
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The Ayr Clinic, Partnerships in Care
Challenges- security related
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Forensic v low secure
Paradoxical effect
Enhanced relational security
Physical security
Risk management v recovery
A missing step into community
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The Ayr Clinic, Partnerships in Care
Challenges- Staff related
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Recruitment
Staffing
Confidence and morale
Higher observations v Therapeutic relationships
Training
Sickness
Supervision
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The Ayr Clinic, Partnerships in Care
One size doesn’t fit all!
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Patient-involved v Patient-centered model
Physical environment
Tailored procedural security
Zonal and modified zonal observations
Well supported relational security – fora, RP, supervision,
training
• Ward programme
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The Ayr Clinic, Partnerships in Care
An average day on Arran
A semi-structured model
• Morning briefing meeting
• Rehabilitation v Recreation, striking a right balance
• Low intensity/and open skills-based groups v Higher intensity
groups and 1:1 work
• Mindfulness, Relaxation, Social skills/communication group,
Managing Emotions
• DBT skills group and 1 to 1, Anger Management, Anxiety
Management, Coping with mental illness, D&A programmes
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The Ayr Clinic, Partnerships in Care
Ward Bingo!
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The Ayr Clinic, Partnerships in Care
Feedback
• Improved ward dynamics
• ‘experience of safety’ by patients using EssenCES
questionnaire (Essen Climate Evaluation Schema)
• Improved attendance at patient fora
• Reduction in the number of incidents
• Reduction in observations
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The Ayr Clinic, Partnerships in Care
Pre Christmas celebrations
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Relationships group
Underlying patient conflicts / dynamics
Unrecognised ward tensions & incidents
Explicit discussion in an informal group setting
Enables clarification and experience of more functional relating
Enables nursing staff involvement & experience of working
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The Ayr Clinic, Partnerships in Care
Future
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Sustainability factor
Co-production models
My shared pathway
My risk management
Vocational education and training
Real work opportunities
Strong focus on physical health
Development of broad based Mentalisation Model
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The Ayr Clinic, Partnerships in Care
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