Working with prisoners in the field of mental health

1. Working with prisoners in the field of mental health Dr. Maura O’Sullivan Senior Clinical Psychologist Irish Prison Service

2. Psychology Service • The Psychology Service forms part of the Regimes Directorate of the Irish Prison Service (IPS) and applies psychological research, principles and skills to the needs of the prison service.

3. IPS Psychology Service • Eight Clinical Psychologists, • Seven Counselling Psychologists, • One Forensic Psychologist • Two Psychologists in Clinical Training. (further two next year) • Three Assistant psychologists (soon to be in post) • Clinical Psychologist (soon to be in post)

4. Psychologists draw on different theoretical foundations in working with individuals based on the client’s understanding of what is pertinent and the psychologist’s needs and strength based assessment with the client.

5. Often work is considered in terms of the cycle of change/ spiral with the understanding that building trust between the client and the psychologist is key.

6. The psychology service plays a modest, albeit important, role in supporting the psychological well-being of prisoners. • The operation of psychology services can only be optimised within the context of an appropriate and meaningful prison regime. • (Annual Report, 2007)

7. In particular, psychological well-being is impacted by the quality of custody, specifically the nature of prison conditions, the quality of staff-inmate relationships, the amount of out-of-cell time and the provision of meaningful occupation. • Consequently, in promoting the psychological well-being of prisoners, particular attention needs to be focused on these issues. • (Annual Report, 2007)

8. Outside Post release Education Probation Forensic psychiatry Pre release Parole Board Addiction services Operations Inside Chaplaincy Psychology Medical Services

9. Psychologists work with clients on an individual and group basis.

10. Group work • Anxiety Management Group; Inputs to the Lifers group, Emotion Regulation; Mindfulness. Dialetical Behaviour Therapy, Enhanced Thinking Skills (ETS), Anger Control Training (ACT), Motivational Enhancement Training (MET)

11. Assessment • Various assessment tools are used depending on the client and the referral question.

12. Dispositional factors (including anger, impulsivity, and personality disorders) • Clinical or psychopathological factors (including diagnosis of Axis 1 disorders, alcohol or substance abuse, and the presence of delusions, hallucinations or violent fantasies; obsessions)

13. Historical or case history variables (including previous violence, arrest history, treatment history, history of self-harm as well as social, work, and family history) • Contextual factors (including perceived stress, social support and means for violence) • Protective factors

14. Personality disorder • Narcissistic personality disorder (Factor one) • Antisocial personality disorder (Factor two) • (Logan, C 2008)

15. Specific Parole Board Assessments • Internation Personality Disorder Evaluation • Psychopathy Check List –Revised (PCL-R) • Violence Risk Scale; • Violence Risk Scale –Sex Offender (VRS-SO) • Personality Assessment Inventory (PAI) • Comprehensive Assessment of Psychopathic Disorder (CAPP)

16. CAPP: Comprehensive Assessment of Psychopathic Disorder • Self domain • Emotional domain • Dominance domain • Attachment domain • Behavioural domain • Cognitive domain • Cooke, Hart, Logan, and Michie

18. Relevant risk factors and protective factors • Formulation • Risk management • Supervision • Monitoring

19. Change • CAPP allows for the possibility of change • Maturation, medication, detoxification, and an environment of structure and control may bring about considerable behavioural, interpersonal, and affective changes. • It is therefore important to allow for adaptive responses to become apparent in any measure of psychopathy • Logan, C. 2008

20. Individuals must be perceived as resilient and having strengths before a strengths based approach can be sucessfully implemented (Utesch). • By emphasising strengths, the inate resilience of an individual is enabled to assist them in their attempts to overcome adversity.

21. Individuals typically seen as hopeless and without resources are persumed to be able to make significant positive strides when their own strengths and abilities are identified, emphasised, and built upon within the context of adverse conditions.

22. A strengths based approach is characterised by its emphasis upon capacities, competencies, and resources that exist within and outside of the individual, family or community. • Key researchers and writers in this area are Waters and Lawrence (1993) and Pianta (1990). These were my mentors in my years in Virginia!!

23. Strengths based approaches are developmental and process oriented. • They identify and reveal internal strengths and resources (resiliencies) that exist within an individual, family, or group as they occur in specific problem contexts.

24. Making the transition from a deficit to strength orientation can be difficult. There is a tendency to rely upon programmes to create resilience instead of using programming to facilitate strengths that capitalize on resilience factors that already exist.

25. Pianta, R. (1993) Beyond the Parent. The role of other adults in chidren’s lives. • Waters, D.B. & Lawrence, E.C. (1993) Competence, Courage and Change: An approach to Family Therapy.