The proportion of older adults in forensic secure services is rising. Research indicates that a quarter of patients have cognitive impairment and often a range of physical and other mental health conditions and / or personality disorder.
Older forensic patients have complex needs and require specialist treatment which is unable to be provided in secure hospitals
At St Peter's Hospital in South Wales we are able to safely transfer men and women detained under the Mental Health Act in secure settings, to be cared for in a specialist hospital setting.
We are able to offer longer term rehabilitation for those individuals who may require lengthier support or whose condition is likely to deteriorate further
Our multidisciplinary team
To ensure continuity of care and to minimise distress we are proud that we have built up an extensive in-house multidisciplinary team which includes:
Consultant Psychiatrists
Clinical Psychologists
RMN & RGN Nursing Staff
Occupational Therapists
Physiotherapists
Dietitians
Speech & Language Therapists
Social Workers
Our team formulation approach, led by the Psychology department ensures that the nursing and support staff gain a better understating of the individual's difficulties and develop a shared and consistent approach. Results demonstrate that this approach has a positive impact on reducing incidents.
We are able to support those who display behaviours of concern caused primarily by symptoms of organic mental disorder, such as dementias or other neurodegenerative conditions including Huntington’s Disease and Parkinson’s Disease
We also support patients with behaviours resulting from impairment of cognition and/or emotional regulation resulting from an acquired brain damage
Taking a neurobehavioural approach we are experienced in psychological assessment and behavioural analysis to formulate positive behavioural management plans
Our model of care
Our model of care enables us to draw upon a wide range of interventions, from environmental changes to medication, or person-centred support plans and specialised diets
At St Peter’s Hospital our focus is on reducing distress, maintaining personhood and improving quality of life.
Promoting connection is at the heart of our approach to psychosocial intervention – connection with other people; connections with a sense of self through memories and familiar occupation, and connection with the surrounding environment
Therapies
At St Peter’s Hospital we are committed to reducing the use of antipsychotic medication for our patients with neuropsychiatric conditions
Where possible, we offer a variety of evidence-based nonpharmacological interventions including:
Patients enjoy spending time with each other in the hospital’s communal spaces and socialise regularly with a range of group activities including gardening, art sessions and cinema club
In addition, each patient also has their own spacious room which is fully customisable to their tastes, as well as access to the extensive facilities across the hospital including the reminiscence room, sensory room, beauty salon and Occupational Therapy kitchen.
Case study: Walter
St Peter’s Hospital received an urgent referral for Walter, a man in his ‘80s who was diagnosed with an antisocial personality disorder, hypersexuality and schizophrenia, with a significant forensic history of sexual offending.
Walter was serving a prison sentence and whilst in prison his mental health began to deteriorate requiring an admission to a Psychiatric hospital for treatment Walter was transferred to a medium secure unit under Section 47/49 of the Mental Health Act
He received a range of therapeutic interventions and his mental health symptoms were partially controlled by high doses of psychotropic medications Walter continued to present with behaviours of concern and demonstrated other violent behaviours towards others
Staff began started to observe a gradual deterioration in his cognition and ability to communicate, leading to a diagnosis of dementia Walter became extremely vulnerable to abuse and exploitation by other patients He was increasingly confused and unable to cope with the basic activities of daily living
His profile of needs and risks had changed, a medium secure environment was no longer appropriate, and he was referred to St Peter’s
What treatment did St Peter's Hospital offer Walter?
Drawing from our extensive experience and expertise, the MDT at St Peter’s committed to:
Providing Walter with a robust assessment, treatment, and care pathway for his dementia,
Identifying and managing Walter’s risks associated with his forensic history,
Enhancing Walter’s quality of life, and treating hid comorbid mental health conditions,
Facilitating the treatment of Walter’s physical health conditions,
Ensuring any restrictions on Walter’s freedoms were maintained at the lowest possible level and in his best interest, whilst maintaining his safety and the safety of others around him
How did we meet our commitments to Walter's care?
Walter has been accommodated in a spacious individual bedroom with its own bathroom in compliance with Sterling University guidelines
As a locked rehabilitation service, St Peter’s has been able to offer the environmental and procedural security to manage Walter’s risks
Walter’s complex clinical presentation and his needs and risks profile have been under continuous assessment by our multidisciplinary team composed of neuropsychiatrists, psychologists, specialist nurses, and therapists
Walter is offered numerous therapeutic and leisure activities including OT, music therapy and physiotherapy
Compliance with the Mental Health Act and Mental Capacity Act has been ensured by the collective involvement of the MDT Walter also has access to the services of Independent Advocacy, as well as the in-house social worker
The team communicates with Ministry of Justice, MAPPA and Walter’s commissioners, other agencies, and professionals involved in his care through regular CPA and MDT reviews as well as through direct contact where appropriate
What have been the outcomes for Walter?
When Walter arrived at St Peter’s he was involved in 20 to 30 incidents per month At present, he has not had an incident in the last 6 months
A successful reduction in his psychopharmacological treatment At present Walter copes successfully without any psychotropic medications
A successful reduction of the intensity of observations from initial 1:1 staffing support 24 hours a day to general observations at 15-minute intervals during the day and night
Despite the advanced progression of his dementia, Walter can still enjoy mealtimes and interactions with staff during his therapeutic and leisure sessions.
Plans are now being made to for Walter to apply to the Parole Board to release him into the community
If you would like to find out more about St Peter's Hospital, arrange a visit or discuss someone you are working with who we may be able to support, please contact Becky James: Becky.james@lshealthcare.co.uk