Men’s Mental HealthSt Andrew’s Northampton, Birmingham, Essex

Creating positive outcomes for complex needs

*Patients who are physiologically suitable for this service and aged under 55 would also be suitable and assessed individually.

Our mental health service also includes two highly specialist services:

• the largest medium secure deaf service in the UK, an environmentally and culturally sensitive service for deaf men with mental health issues

• specialist medium secure services for older adults aged 55+ in an age-appropriate environment.*

Introducing mental health services for menAs specialist providers of mental health services for the most complex and difficult to treat patients, we use our skills and experience to reduce challenging behaviour and to address patients’ forensic needs.

At St Andrew’s, we encourage our patients to take responsibility for their treatment by providing a quality care pathway that provides continuity of care. We support patients in managing their mental health and offending behaviours, with the aim of rehabilitating them to lower levels of security, including back into the community. Based centrally in Northampton and with regional sites in Birmingham and Essex, our services offer a broad range of therapeutic programmes coupled with access to education, vocational training, work experience and community facilities.

Overview: age-appropriate environments and therapy programmes for men aged 18-65+

comprehensive mental health care pathways from medium secure to step down housing

expert team of specialists with experience in managing complex and challenging patients with a range of mental illnesses including psychosis, schizophrenia and personality disorder (PD)

dedicated multi-disciplinary team (MDT) which includes Psychiatrists, Psychologists, Occupational Therapists (OT), Speech and Language Therapists (SaLT), Social Workers and Nurses

expertise in managing a range of index offences using Sex Offender Treatment Programme (SOTP), adapted SOTP, substance misuse programmes and firesetting groups

a wide range of modern facilities across our sites, that meet our patients’ social, cultural and spiritual needs including an arts and crafts workshop, music studio, information technology suite, gym, café, shop and pastoral service

strong links with education providers, offering basic literacy courses and vocational qualifications through to degrees

our Northampton site is set in over 120 acres of green space and our newly refurbished Essex site has peaceful grounds with excellent amenities

our mental health service is further enhanced by the addition of facilities in Birmingham, which opened in January 2011

specialist medium secure services for patients with mental health issues who are aged 18+ years, deaf or aged 55+, in addition to our general mental health services

psychiatric intensive care unit (PICU) services for men and women are available in Northampton and Essex.

All statistics taken from the period of July 2015 to June 2016.

We care for men:• aged 18-65+• with a primary diagnosis

of mental illness• who may have a history of:

- challenging and/or offendingbehaviour

- alcohol and/or substance abuse- repeated failed attempts at

community integration and/orprevious movement betweenthe mental health and criminaljustice systems

• who meet the criteria for detentionunder the Mental Health Act 1980.

These criteria are a guide for assessing suitability, each patient will be considered individually.

Nottinghamshire

She�eld

Oxford

London

CambridgeNorthampton

Birmingham

Essex

Birmingham• medium secure 18-65

• low secure 18-65

55+ (older adult)

Northampton• medium secure

18-65 (including deaf)

55+ (older adult)

• low secure 18-65

• inpatient care and rehabilitation

18-65

55+ (older adult)

• PICU 18-65

Essex• low secure 18-65

• PICU 18-65Working age services are for patients aged 18-65Older adult services are for patients aged 55+

Who we care forWe care for men with mental health issues across secure and non secure settings. With a range of care pathways across the Charity, we are able to provide extra care to our most challenging patients by accessing support from a range of clinical experts.

Patients benefit from other experts in specialist services such as learning disability, autistic spectrum disorder and brain injury if they have a co-morbidity/dual diagnosis and highly challenging behaviour.

months is the average length of stay for male mental health pathways

22

patients discharged196

patients cared for452

We aim to rehabilitate patients so that they can move back to their home areas, if appropriate, in either a community placement or in the least restrictive environment possible. We provide a safe, motivational and therapeutic experience,with a focus on:

• safeguarding• clinical needs and risk• treatment targets and intervention plans• treatment options in a relevant setting.

We pride ourselves on quality of care and our extensive range of therapeutic interventions are tailored for our very distinct patient group. Our therapeutic culture is based on the Kennard and Lees (2001) model. We support our patients by providing:

continuous examination of staff team dynamics, relationships and responsibilities – support for teams from a psychodynamic trained member of staff and provision of staff training in interpersonal relationships and boundaries

a clear treatment programme structure – individualised patient activity timetables

offering 25 hours of therapeutic interventions per week

an awareness of boundaries and containment – application of relational security, weekly ward-based reflective practice sessions, structured professional judgement risk assessment and management planning

an understanding of the treatment process – based on

multi professional assessment and the development of individual

formulations which are shared with the patient through

My Shared Pathway in order to develop individualised care plans

a culture of enquiry and learning – involving patients in exploring

the reasons for their detention and identifying treatment goals through

adult education, Workbridge, our vocational experience centre,

and our recovery centre

physical resources – through our specifically tailor-made environments to meet patients’ needs and providing resources to maintain and develop activities of daily living, educational, occupational and recreational needs

staff resources – a full time on-site MDT

Creating a therapeutic cultureOur overarching philosophy is recovery orientated and based on My Shared Pathway. We engage patients in their own treatment, empowering them to develop increasing responsibility for their mental health and, where appropriate, offending behaviours.

Vocational input

Patients have the opportunity to do vocational activities in a secure environment or outside utilising Workbridge which was designed to provide people with an opportunity to work as part of a team, teaching them both technical skills and, more importantly, life skills.

The patient’s voice is very important to St Andrew’s and we encourage an active involvement in interviews, their environment and their care.

PatientsNursing

OccupationalTherapy

Psychiatry

Education

Sports andExercise

Creative Arts

Senior NursePractitioners

Non Clinical

Vocational(EVOLVE)

Physical Healthcare

Chaplaincy

Health CareAssistance

Pharmacy

Psychology

4

Speech and Language Therapy

Social WorkPhysiotherapy

ClinicalDirector

ModernMatron

ServiceDirector

Dietetics

Our multi-disciplinary teamOur multi-disciplinary team are specialists in their chosen areas and also contribute to industry-wide research, education and the future development of our mental health services.

The team also includes Occupational Therapists, Social Workers, Nurses, Teachers, Practice Nurses, Dieticians, occupational health, pharmacy, dentistry, speech and language, General Practitioner (GP), and physiotherapy services.

Treatment programmes are selected from an extensive psychosocial treatment directory consisting of specific evidence-based or practice-based interventions. Treatment focuses on progressing patients from stabilisation, through active exploration and change, and finally, to maintaining change and moving on. Initially, we address the mental illness before addressing forensic needs.

A large number of therapeutic interventions are offered, including:

• psychiatric interventions• individual and group psychological

therapy• occupational therapy• dietetics• speech and language therapy• pharmacy• social work• physical healthcare• pets as therapy

• health and wellbeing sessions• vocational therapy• community outreach• music• physiotherapy• adult education• nurse-led sessions.

Therapy programmes are tailored to meet individual patients’ needs and treatments are adapted to patients’ level of functioning. Specific mental illness and offence-related treatments can include:

For mental illness needs:

• Cognitive Behaviour Therapy (CBT)

• Dialectical Behaviour Therapy (DBT)

• specific treatments aimed at psychosis:

- mindfulness for psychosis (group and 1:1)

- CBT for psychosis

- metacognitive therapy for psychosis.

For criminogenic needs:

• violence reduction programme (group and 1:1)

• sex offender treatment programme(group and 1:1)

• firesetters treatment.

“Patients are always at the heart of what we do.” Clinical Director, St Andrew’s

Our multi-disciplinary teamOur MDT work with patients to produce a treatment programme to meet individual needs and interests. We aim to provide our patients with, on average, 25 hours of therapeutic activity a week.

hours of therapeutic activity per week on average25

As he became more unwell and the psychosis worsened, Sam was admitted to a high secure hospital. As his risk levels decreased he was admitted to Robinson ward, a medium secure facility at St Andrew’s. Although he was initially very reluctant to take part in his therapy sessions, particularly psychology, he did eventually begin to engage and after a period of time his medication began to stabilise his condition.

Whilst at St Andrew’s, Sam completed a programme of Cognitive Analytical Therapy (CAT) to address his past and to allow him to understand the effect that his actions had on the victims of his crimes and those around him. He was also addressing his substance abuse through the Charity’s substance misuse groups.

The transition to low secure was absolutely pivotal for Sam. Frustration though began to set in for him when he felt ready to increase his level of unescorted leave but couldn’t as he needed to spend time building up to that level of freedom.

Given that his former life was fast-paced, he expected his recovery to be equally fast. However, after working well with the MDT and engaging in a structured therapy programme, he began to see that. The team worked hard to get him to see that his former lifestyle was not good for him and one that he needed to remove himself from.

It was important to work with Sam on things that mattered to him so that he engaged in therapy. Opportunities provided involved gym work based on the ward, which helped to keep him engaged and motivated in the therapy programme, even when he was not able to visit a gym based off the ward. This was managed in a very controlled way and allowed Sam to be rewarded without compromising his recovery. However, the team were concerned that he was using the gym to replace his previous addictions, so were keen that he gained self-esteem in a range of ways.

Sam made use of every opportunity available to him to attain and develop further skills. He had explained his goal was to have a job and earn his own money, so the occupational therapy team supported him in finding a range of voluntary posts within the local area. Through commitment and self-motivation, Sam worked through the care pathways within St Andrew’s which prepared him for these voluntary placements. It was through working collaboratively with the MDT that allowed him to take on further responsibilities for his recovery and identify meaningful roles he could pursue in the future.

Sam was encouraged to have contact with his mother and his sisters and was supported on visits to see his family. He now lives in supported accommodation within the community and works as a volunteer for a number of charitable organisations.

Case study: Sam’s story

After a chaotic upbringing and many years of drug taking, Sam was a member of a gang who committed armed robbery. He was placed in a regional secure unit where he met some dangerous people, so he kept up a “shield” to protect himself. Sam and a fellow prisoner took another member of staff hostage and tried to escape.

“Being at St Andrew’s has given me confidence to believe in myself and to believe in other people.”

“Ash was completely shut down and couldn’t engage in the world around him when he was admitted. Using this model, Ash is now able to give eye contact, wave and speak when he is spoken to. Nursing staff have played a really key role during the early stages with getting him to tune in with his senses. As Ash’s ability to engage improves, he will be able to participate in psychological therapies to support his recovery journey.” Senior OT, St Andrew’s Northampton

We use multiple measures to monitor progress and allow us to adapt management plans quickly. We use the following scales to measure clinical risk:

• HCR-20 (Historical, Clinical,Risk Management-20)

• RSVP (Risk for Sexual Violence Protocol)

• START (Short-Term Assessmentof Risk and Treatability)

• MOAS (Modified Overt Aggression Scale)

• SASBA (St Andrew’s Sexual BehaviourAssessment Scale)

• HONOS-Secure (Health of theNation Outcome Scale for securemental health).

Sex Offender Treatment Programme (SOTP)

We offer a group approach to sex offender treatment in order to encourage patients to open up more about their experiences. The groups have been running for over 18 months and are proving to be highly successful. Working with SOTP trained staff, patients are encouraged to think about their past experiences and to build empathy with their victims. The SOTP is supported by the Good Lives Model, promoting positive behaviours and relationships so that patients’ needs can be met in an adaptive, rather than maladaptive way.

Adapted Sex Offender Treatment Programme (ASOTP)

Our transitional patients (young adult males aged 18+) can access ASOTP, a model that was adapted for younger patients and utilised by Ashworth and Rampton. Prior to undertaking therapy to treat sexual offending, we recommend patients complete the DBT informed skills training. With personality disorders still emerging and learned behaviours less entrenched than in adults, we have found that our younger patients benefit from treatment to remediate emotional dysregulation and improve their interpersonal effectiveness skills.

Model of creative ability

Our medium secure mental health ward in Northampton was awarded a Centre of Excellence for the Vona du Toit Model of Creative Ability in 2015. With an alternative view of delivering OT, it encourages patients to become more aware of their environment and gives them the motivation to engage in everyday life. There are nine different levels of creative ability and the model tailors therapy to the patient’s current level of ability. It uses very short, intensive interventions if patients are on lower levels with a view to them moving up to their optimum level of ability.

Meeting complex needsAs experts in treating the most challenging patients, we constantly look at ways to adapt established therapy programmes to support our patients on their recovery journey.

HoNOS-Secure

The Health of the Nation Outcome Scale for secure mental health (HoNOS-Secure), is a tool for systematically assessing the severity of mental illnesses in secure services. Developed by the team at St Andrew’s, the scale is now an internationally recognised tool.

A study of schizophrenia and violence

St Andrew’s is leading a collaborative study with five NHS trusts and the Institute of Psychiatry to identify the illness specific risk factors that make people with schizophrenia violent. The research aims to advance mental health professionals’ understanding of violent behaviour in schizophrenia. The aim is to better prevent and manage violence and ultimately improve quality of life. This is a four year programme with approximately 100 patients from St Andrew’s and the NHS. Initial findings show that impulsivity and executive function deficits may cause violence.

This study has been shortlisted for a research award by the Royal College of Psychiatrists Forensic Faculty and has led to the first PhD on this subject.

Firesetting and mental health

Given that firesetting amongst mental health patients is a problem in forensic services with potentially damaging consequences, we have conducted a new review of firesetting and its interface with mental illness and mental disorder. The book, published by St Andrew’s, is the only text that brings together research, evidence, theory and practitioner advice from multiple perspectives in a single volume.

In 2012, our service for men was also involved in a multi-site pilot of a firesetters treatment programme (FIP-MO), developed by the University of Kent.

University of Birmingham and St Andrew’s Doctorate in Forensic Clinical Psychology

Alongside the University of Birmingham, we have developed the first practitioner Doctorate in the UK to provide people with a dual qualification in both forensic and clinical psychology.

We supported five trainees in 2013 and a further five in 2015, by paying their fees and a grant to support expenses.

Shaping the future of mental health

Our leading clinicians are at the forefront of research and innovation, and support the evolution of mental health.

Other published research

2015 Laura O’Shea a Research Assistant in the Academic Department collaborated with colleagues in the men’s mental health pathway to demonstrate the effectiveness of the HCR-20 assessment guide predicting the risk of sexual violence.

Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service. Criminal Behaviour and Mental Health, June 21st.

2015 Prof Camilla Haw published a study of the links between the economic environment and the risk of suicide.

International Journal of Social Psychiatry. Vol 61, Issue 1

2016 Nuwan Galappathie and Sobia Khan published a topical piece on end of life care following the withdrawal of the Liverpool Care Pathway.

BJPsych Bulletin vol. 40 no. 1 38-40 DOI: 10.1192/pb.bp.114.049684

For more information on our research, please visit

stah.org/research

Evolution of our serviceWith over 175 years of history, we have been pioneers in developing tools and therapy programmes for men with mental health issues. As a charity we have contributed to over 250 high profile research publications since 2010.

Our men’s mental health service provides beds across three locations, with PICU units in Northampton and Essex.

Medium secureRobinson – a 17-bed admission, assessment and rehabilitation ward for working-age adults.

Cranford – a 17-bed admission, assessment and rehabilitation ward for older men aged 55+ years with co-morbid diagnoses.

Prichard – a 15-bed ward for men aged 18+ years providing an admission, assessment and rehabilitation service.

Fairbairn – a 15-bed forensic ward for Deaf men, including British Sign Language users.

Edgbaston (Birmingham) – a 15-bed ward providing an admission, assessment and stabilisation service for men.

Hawkesley (Birmingham) – a 15-bed ward delivering treatment and recovery for men.

Low secureFenwick – a 10-bed ward providing a rehabilitation and recovery service.

Church – a 10-bed ward providing a rehabilitation and recovery service.

Speedwell (Birmingham) – a 16-bed ward for men with severe challenging behaviour and complex needs.

Northfield (Birmingham) – a 16-bed ward enabling rehabilitation and recovery for men.

Moor Green (Birmingham) - a 16-bed ward for working age men who require forensic rehabilitation and recovery.Lifford (Birmingham) – a 16-bed ward specialising in complex physical needs for working age men who require forensic rehabilitation and recovery.

Danbury (Essex) – a 16-bed ward focusing on admission, assessment and rehabilitation for adults of working age.

Inpatient Care and RehabilitationAshby – a 16-bed ward for working-age men providing a rehabilitation and recovery service.

Berkeley Lodge – a 6 bed step down setting providing rehabilitation and recovery.

PICUHeygate – a 24-hour locked PICU for men who require rapid stabilisation and mental health assessment.

Audley (Essex) – a 24-hour locked PICU for men who require rapid stabilisation and mental health assessment.

Personality DisorderHadleigh (Essex) – a 16-bed ward providing an admission, treatment and recovery service for men with personality disorders and complex needs.

Specialist care services leading to positive futures for men

Getting in touchFor more information about our male mental health service or to make a referral:t: 0800 434 6690 (we welcome text relay calls)e: enquiries@standrew.co.ukw: stah.org/men

Registered Charity Number 1104951 9_0119 Individuals pictured are models and are used for illustrative purposes only.

St Andrew’s Northampton

Cliftonville, Northampton, NN1 5DG

t: 01604 616 000

St Andrew’s Birmingham

70 Dogpool Lane, Stirchley, Birmingham West Midlands, B30 2XR

t: 0121 432 2100

St Andrew’s Essex

Pound Lane, North Benfleet Wickford, SS12 9JP

t: 01268 723 800

investedin the development of new facilities and buildings, the

enhancement of current wards, and other capital additions

£30m887 hours of vocational activitytook place on average each week

In the last year, the Charity provided

care for1,471 patients

We provided five days of additional training, investing in 3,000 clinical staff to reduce restrictive practices

32% reduction in restraints year on year

92.9%of our clinical staff were trained in the Management of Actual and Potential Aggression (MAPA)

2017/2018