Faculty of Forensic Psychiatry

Online Conference

3-5 March 2021

@rcpsychForensic #RCPsychForensic21

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Useful Information

Registration Please join at 09:25 ready for a prompt start at 09:30 Poster presentations We encourage you to view the gallery of virtual posters. Conference Programme You can view the conference programme here. Speaker Abstracts and Biographies Speakers for Wednesday 3 March Speakers for Thursday 4 March Speakers for Friday 5 March Twitter Join the discussion online using @rcpsychForensic or #RCPsychForensic21 Accreditation This conference is eligible for up to 6 CPD points per day, subject to peer group approval. Certificates of attendance Certificates of attendance will be emailed to delegates within one week of the conference. Speaker presentations Presentations will be available online within one week of the conference, for up to two months. All delegates will be sent details of this after the conference. Please be aware that these presentations are kindly provided by the speakers but on some occasions, it is not possible to make these publicly available. Feedback We would appreciate your feedback. All comments received remain confidential and are viewed in an effort to improve future meetings. Leave feedback for Wednesday 3 March Leave feedback for Thursday 4 March Leave feedback for Friday 5 March

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Speaker biographies and abstracts

Wednesday 3 March

09:30-10:30

Forensic faculty welcome and update

Chair: Dr Josanne Holloway, Chair, Faculty of Forensic Psychiatry

Mr Alain Aldridge, Patient representative, Faculty of Forensic Psychiatry

Biography: Alain graduated as an Engineer from the University of Nottingham in 1995 with a 2.2 in Environmental Engineering and Resource Management. After seven years' work as a sales engineer, his life came to a halt. Through stress and unemployment, he developed an illness and went on to commit an offence. Alain was later diagnosed with a mental disorder.

Alain spent eight years on and off detained under the Mental Health Act. It was whilst in hospital that he started work as a Ward Representative. He started to represent the views and opinions of other Service Users (in-patients) at patient and staff meetings. The work was voluntary to begin with and after a year, it became a paid position.

Whilst an in-patient, together with other service users, Alain produced some basic animation films called ‘Park Life’ and’ The Tiger and the Butterfly’, which received Koestler awards.

Alain then applied for a position with the Quality Network for Forensic Mental Health Services (QNFMHS). He was successful and started as a Service User Expert. This work involved visiting Medium Secure Units and helping to share ideas and good practice with the Units.

During this time, Alain started to work for the Royal College of Psychiatrists as a Patient Representative on the Forensic Executive Committee. This led to the recording of ‘A Patients Journey’ as three Podcasts.

https://www.rcpsych.ac.uk/members/your-faculties/forensic-psychiatry/news-and-resources

Alain currently works for the Southern Health NHS Trusts Specialist Forensic Community Team as a Peer Group Support Worker. Here he shares the knowledge and experience he has acquired as a service user and encourages other patients to engage onto a recovery path.

Ms Sheena Foster, Family and Carer representative, Faculty of Forensic Psychiatry

Biography: Sheena Foster is the carer rep. on the Faculty and also involved in the Forensic Quality Network. She sits on the AS CRG and was influential in the development of the Secure Carers Toolkit.

www.england.nhs.uk/securecarerstoolkit

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Dean’s Update

Dr Kate Lovett, Dean, Royal College of Psychiatrists

Abstract: Not available at time of publishing.

Biography: Not available at time of publishing.

President’s Address

Dr Adrian James, President, Royal College of Psychiatrists

Biography: Adrian was elected President in 2020. He holds this role until 2023 and leads the RCPsych on behalf of its members and associates.

Adrian is Consultant Forensic Psychiatrist at Langdon Hospital in Dawlish, Devon. He is a former Medical Director of Devon Partnership NHS Trust and Founding Chair of the School of Psychiatry at the Peninsular Deanery (2006-2008).

He was the elected Chair of the South West Division of the Royal College of Psychiatrists (2007-2011) and sat on the College Council in this capacity. In 2010 he was appointed Chair of the Westminster Parliamentary Liaison Committee of the Royal College of Psychiatrists (attending the three main Party Conferences 2011-14 in this capacity).

He was Clinical Director for Mental Health, Dementia and Neurology, working for NHS England South West (2013-2015, interim from 2012-13). He has also acted as a Reviewer and Clinical Expert for the Healthcare Commission and its successor organisation the Care Quality Commission (CQC).

He has chaired expert review groups on Integrated Care Systems, Cannabis, Prevent and Learning from Deaths. In addition, he set up the Quality Improvement (QI) Committee and Workforce Wellbeing Committee at the College.

His priorities as President are:

1. Establishing a pathway to parity for mental health services

2. Equality and diversity

3. Sustainability

4. Workforce Wellbeing

Adrian is a keen cyclist.

11:00-12:00

Assessment and treatment of paraphilic disorders

Chair: Professor Don Grubin, Emeritus Professor of Forensic Psychiatry, Newcastle University

Using crime scene behavioural scales to improve diagnostic reliability of coercive sexual sadism disorder and paedophilic

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Dr Michael Davis, Consultant Forensic Clinical Psychologist, Melbourne; Adjunct Research Fellow, Centre for Forensic Behavioural Science, Swinburne University of Technology; Adjunct Senior Lecturer, Department of Psychiatry, Monash University; Honorary Fellow, Department of Psychiatry, University of Melbourne

Abstract: Identifying deviant sexual interests can have important repercussions for the management of offenders. Unfortunately, formal ICD-11 and DSM-5 diagnoses offer little guidance when attempting to detect paraphilic offenders as they largely rely upon offenders’ self-report. Indeed the reliability of paraphilic disorder diagnoses has been questioned. Accordingly, analysis of offending behaviour can offer crucial insights. Previously the almost exclusive domain of Behavioural Investigative Advisers, recent years have seen the development of several behavioural rating scales that can be utilised by forensic mental health professionals. This paper will provide an overview of the behavioural analysis of sexual offences and homicides. Rating scales will be introduced to assist forensic psychiatrists in the identification of Coercive Sexual Sadism Disorder (SESAS and SADSEX-SH) and Paedophilic Disorder (SSPI-2); as well as non-sadistic forms of ritualistic rape (NSRRS). The reliability and validity of these scales will be described along with recommendations for clinical practice and research.

Biography: Dr Michael Davis is a Consultant Forensic Clinical Psychologist in full-time practice. He is the Victorian Branch Chair, and National Chair-Elect, of the Australian Psychological Society College of Forensic Psychologists. Dr Davis has adjunct appointments at Swinburne, Monash, and Melbourne Universities and is a consultant to the Victorian Institute of Forensic Mental Health (Forensicare). His practice is divided between clinical-forensic assessment tasks (particularly the assessment of risk, personality disorder, and sexual deviance) and providing behavioural investigative advice to police agencies. He has consulted with police in several countries across three continents and is the only mental health professional in Australia to be elected to membership of the International Criminal Investigative Analysis Fellowship. Dr Davis also serves as an Instructor to the Behavioral Analysis Unit of the FBI and is on the editorial board of the Journal of Investigative Psychology and Offender Profiling.

Pharmacological treatment of paraphilic disorders and paraphilia-related disorders

Dr Rajan Darjee, Consultant Forensic Psychiatrist, Problem Behaviour Program, Victorian Institute of Forensic Mental health, Melbourne; Senior Lecturer in Forensic Psychiatry, Centre for Forensic Behavioural Science, Swinburne University of Technology

Abstract: This presentation will give a clinically focussed overview of the pharmacological treatment of paraphilic disorders (such as paedophilic disorder and coercive sexual sadism disorder) and paraphilia-related disorders (such as compulsive sexual behaviour disorder) in men who have committed or are at risk of committing sexual offences. The focus will be on anti-libidinal agents which reduce testosterone activity (such as anti-androgens and gonadotrophin releasing hormone agonists) and selective serotonin reuptake inhibitors. Areas covered will include: the theoretical and scientific basis for such treatment, the evidence base for treatment, clinical guidelines, and legal, ethical and systems issues. It will be argued that psychiatrists have an

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important role to play in treating the significant minority of men who pose a sexual offending risk and who can benefit from such treatment, both in terms of preventing sexual abuse but also improving their lives. Treatment should be voluntary and regimes in some jurisdictions which mandate treatment are ethically questionable.

Biography: Raj trained and worked in forensic psychiatry in Scotland before moving to Melbourne in 2018. He has been a consultant for 15 years and his primary clinical interests have been community forensic mental health, sexual offending, stalking, personality disorders, paraphilic disorders, and violence risk assessment and management. In Scotland he had a national clinical lead role for the development and implementation of policies in the areas of multi-agency public protection and sexual offending. He was the first expert accredited by the Scottish Risk Management Authority to assess serious violent and sexual offenders being considered for indeterminate sentencing and the first mental health expert appointed to the Scottish Criminal Cases Review Commission. He has researched and written on legislation for mentally disordered offenders, schizophrenia and violence, violence risk assessment, sexual offending, and sexual homicide. He co-edited the Routledge International Handbook of Sexual Homicide Studies. He is president of the Victorian Branch of the Australian and New Zealand Association for Psychiatry, Psychology and the Law.

Discussant

Dr Sodi Mann, Consultant Forensic Psychiatrist, Greater Manchester Mental Health NHS

Biography: Dr Sodi Mann (Consultant Forensic Psychiatrist and Consultant Psychiatrist in Deaf Mental Health Care)

Medical Lead for the Antilidinal Service in Manchester (Edenfield Unit, Prestwich Hospital, Manchester M25 3BL)

Lead Consultant & Clinical Lead at the John Denmark Unit, National Service for Deaf Mental Health, Manchester M25 3BL)

12:25-12:45 Medical student essays

Chair: Dr Aideen O’Halloran, Consultant in Forensic Psychiatry, West London Mental Health NHS Trust

3rd Prize

Violence and Mental Illness What is the link between violence and mental illness? Does mental illness cause violence or is it only associated with violence?

Poppy MacInnes

2nd Prize

Is the prohibitive stance on sex and relationships in the UK Forensic System justifiable?

Elena Taylor

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1st Prize

Ethical Considerations and Political Abuse Within Forensic Psychiatry

Beth Mitchell

12:45-13:30

Keynote: Alcohol and violence: prevention is better than cure

Chair: Dr Pradeep Pasupuleti, Chair, Forensic Faculty, RCPsych in Scotland and Medical Director, Priory Hospital Glasgow

Biography: Pradeep is a Consultant Forensic Psychiatrist and Medical Director for Priory Hospitals in Scotland. He has trained and worked in Scotland for over fifteen years. Prior to that, he worked in South London and Maudsley NHS Trust. He is the outgoing Chair of the forensic faculty in Scotland having been elected to the position in 2017. He is also an External Advisor for consultant appointments in NHS Scotland; a member of the Law Society of Scotland Mental Health and Disability Committee; a medical member for the Mental Health Tribunal Service for Scotland and a Designated Medical Practitioner for the Mental Welfare Commission for Scotland. He represents the forensic faculty in Scotland on the Forensic Mental Health Services Managed Care Network Advisory Board and RCPsych in Scotland on the Mental Welfare Commission for Scotland Advisory Committee.

Professor Jonathan Shepherd, Professor of Oral and Maxillofacial Surgery, Crime and Security Research Institute, Cardiff

Abstract: Alcohol intoxication is a powerful driver of violence and vulnerability to violence. Violence is traditionally considered by governments to be a problem for criminal justice systems. Over the past few decades new insights and solutions have come from the health sector, including on alcohol related violence. Combined with policing and local government, a new multiagency approach has emerged, underpinned from 1997 by the Crime and Disorder Act and, in 2019, by 18 new violence reduction units in England and Wales. The Cardiff Model for Violence Prevention, in which unique information from emergency departments is used by city and regional violence prevention units to identify and target violence hotspots is central to this approach and has been widely adopted in the UK and overseas. Evidence from trials of brief advice shows where this is effective in this violence context. The creation and development of the UK’s What Works Centres and Council and the professional bodies for policing and probation which resulted from this Cardiff perspective will be described.

Biography: Jonathan Shepherd graduated from King's College London and after clinical training in London, Oxford and Leeds, a research fellowship in Oxford and a senior lectureship at Bristol University, he was appointed professor of oral and maxillofacial surgery and head of department at Cardiff University in 1991. His research on alcohol misuse and community violence has made many contributions to clinical and public policy and legislation. Prompted by his discoveries he led the development of the UK's prototype violence prevention board which he chaired for 20 years and which was used as a model in the Crime and Disorder Act and for violence reduction

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units across England and Wales. He initiated and developed the Universities' Police Science Institute in Wales, the information sharing Cardiff Model for Violence Prevention which was adopted by successive UK governments and in the 2018 Serious Violence Strategy and has been widely implemented in the UK and overseas, and the care pathway for people harmed by violence published by the Royal College of Psychiatrists. His 2008 proposal for an independent professional body for policing led to the new UK College of Policing. He initiated and chaired the 2014 launch by the President of the Supreme Court of the Probation Institute, the independent professional body for probation. He won the 2008 Stockholm Criminology Prize - the UK's first recipient. He is a member of the Home Office Science Advisory Council.

14:00-15:00

Debate - This house believes that the increasing use of tele-health for forensic mental health assessments after Covid-19 leads us to trade psychological depth for convenience

Chair: Dr Tim McInerny, Consultant in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust

Biography: Dr Tim McInerny was Honorary Consultant Forensic Psychiatrist at Broadmoor Hospital from 1999 to 2007 where he ran the Young Persons Unit, and Clinical Tutor at the Institute of Psychiatry in London. Since 2007 he has been Consultant Forensic Psychiatrist at the River House Medium and Low Secure Units at the Bethlem Royal Hospital where he is the clinical lead for pre-discharge rehabilitation. His team provides inpatient treatment and care for men aged 18-65, who have mental health problems and a history of serious offending. His pre-discharge ward is for people who have responded well to treatment and are being prepared for discharge from hospital to the community. He has wide medical legal experience and has given evidence in courts for the prosecution and defence in serious criminal cases. He has provided over 400 expert psychiatric reports to the criminal courts, tribunals, probation, parole boards, the MoJ, Serious Fraud Office and family courts. He regularly lectures on forensic issues and participates in the training of medical students, expert witnesses, Judges and lawyers. He is a Fellow and Honorary Bencher of Gray’s Inn. He is a medical member of the MHRT and psychiatrist member of the Parole Board. Dr McInerny is a strong advocate for using art and creative therapies as an integral part of a patient’s recovery. He has been visiting psychiatrist to the Falkland Islands for 14 years.

Dr Andrew Carroll, Associate Professor in Forensic Psychiatry, Swinburne University of Technology and Consultant Forensic Psychiatrist, Victorian Institute of Forensic Mental Health (Forensicare), Melbourne

Biography: Andy Carroll completed his psychiatric training in North Yorkshire before completing a research fellowship at the University of Edinburgh. He was then fortunate enough to work under Paul Mullen as a Consultant Forensic Psychiatrist at the Victorian Institute of Forensic Mental Health (Forensicare) in Melbourne, where he remains. He has worked as a forensic psychiatrist in both treatment and assessment roles in Australia for over two decades. He currently carries out treatment work in a prison clinic, medicolegal assessment work in both criminal and civil fields and is an Adjunct Associate Professor at the Centre for

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Forensic Behavioural Science (Swinburne University of Technology). He is also co-director of ‘Our Curious Minds’, a mental health training enterprise aimed particularly at meeting the needs of the non-governmental sector. He has published on a range of topics including decision-making, the Recovery approach and the interface between mental disorder and sentencing in the criminal courts.

Dr Elizabeth Zachariah, Consultant Forensic Psychiatrist and Clinical Director, Oxleas NHS Foundation Trust

Biography: Not available at time of publishing.

Dr Chantal Edge, Specialty Registrar in Public Health and NIHR Clinical Doctoral Research Fellow, UCL Collaborative Centre for Inclusion Health

Biography: Chantal Edge is a Specialty Registrar in Public Health, currently undertaking an NIHR Clinical Doctoral Research Fellowship at University College London. Her PhD fellowship centres on the implementation and evaluation of telemedicine for secondary care appointments within prisons in England. During the first wave of the COVID-19 pandemic Chantal assisted NHS England with the rollout of telemedicine capability across the English prison estate.

Dr Justin Barry-Walsh, Chair, Faculty of Forensic Psychiatry, Royal Australian and New Zealand College of Psychiatrists

Biography: Dr Justin Barry-Walsh is a consultant forensic psychiatrist working at the Regional Forensic Psychiatric services in Wellington New Zealand. For reasons that are 20% ambition, 30% timing and 50% bad luck he has been Chair of the Faculty of Forensic Psychiatry of the RANZCP for the last four years and destined to remain so for another three years. He works half-time with the Fixated Threat Assessment Centre New Zealand which is shamelessly copied from the UK service and this is likely to remain his main career interest until his rapidly approaching dotage arrives. When not being a forensic psychiatrist he cycles the roads and hills of Wellington caressed by the gentle zephyrs the city is renowned for and shops on-line for craft beer which he is then forced to drink. His considerable debating prowess is likely to be blunted by the tyranny of time zones.

15:30-16:30

The practical implications of the Supreme Court Judgement in MM for restricted patients and their conditional discharge - learning from the context of Learning Disability and Autism Services

Chair: Dr Sandeep Mathews, Consultant in Forensic Psychiatry, Greater Manchester Mental Health NHS Foundation Trust

Session Abstract: This presentation will explore the current clinical challenges facing professionals working in England and Wales to support people with a Learning Disability and/or autism subject to MoJ restrictions from inpatient care to the community and prevent their recall once conditionally discharged.  Drawing on the Practice Guidance issued in March 2020 the presentation will include background to

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the current legal position; clinical challenges and focus of pathway specific work to support progress to discharge. 

Dr Roger Banks, National Clinical Director, Learning Disability and Autism, NHS England and NHS Improvement

Biography: Dr Roger Banks FRCPsych FRCGP(hon) FIPD is a Consultant Psychiatrist with 30 years of experience of working with people with learning disabilities, autistic people and their families. From 2020 he is National Clinical Director for Learning Disability and Autism in NHSEngland NHSImprovement. He was previously Senior Psychiatrist Lead with the Learning Disability and Autism Programme.

Roger is a previous Vice-President of the Royal College of Psychiatrists, an Honorary Fellow of the Royal College of General Practitioners, Fellow of the Institute of Psychotherapy and Disability. He is Vice President of the Association for Research and Training on Integration in Europe (ARFIE) and immediate past President of the European Association for Mental Health in Intellectual Disability.

In 2009-10 he was jointly responsible for drafting “Better Health – Better Lives” the World Health Organisation’s Declaration and Action Plan for the Health and Wellbeing of Children and Young People with Intellectual Disabilities and their Families and he continues to work as a consultant to WHO-Europe on intellectual disability issues.

Roger is an author and previous member of the board of directors of Books Beyond Words, publications for people with learning disabilities.

Christine Hutchinson, Nurse Consultant and Approved Clinician in Learning Disabilities, Lancashire Care NHS Foundation Trust

Biography: Christine Hutchinson is Consultant Nurse Approved Clinician with Lancashire and South Cumbria NHS Foundation Trust for their Learning Disability Services and Autism Services.

Christine has been a learning disability nurse since 1986 working in both community and inpatient settings with experience across the life span. Following a variety of roles in health, social care and higher education, she was appointed as Consultant Nurse in 2002; gained Nurse Prescriber Competency in 2005 and Approved Clinician status in 2014.

Christine continues in clinical practice and has been/is a Responsible Clinician for detained and restricted inpatients and conditionally discharged patients; she also leads on Mental Health Act; Mental Capacity Act and Deprivation of Liberty implementation. She has particular expertise in forensic rehabilitation; co-existing mental illness; challenging behaviour and co-existing autism.

Christine was a clinical member of the national task and finish group working closely with the national team on the impact of MM and led the development of clinical guidance published in March 2020. She continues to be called upon to advise on the practical impact of this judgement and other matters relating to mental health and capacity law and effective health services for people with learning disability

Christine also practices independently providing clinical consultancy and training and acts as an expert witness in Court of Protection matters.

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Thursday 4 March

09:30-10:30

Same hymn or different sheets: the roles of forensic physicians and their relevance to forensic psychiatrists

Chair: Professor Taj Nathan, Consultant Forensic Psychiatrist and Director of Research and Effectiveness, Cheshire and Wirrall Partnership NHS Foundation Trust, and Visiting Professor, University of Chester

Session Abstract: Fitness to be interviewed (FTBI) by the police is assessed by healthcare professionals (HCPs) in police custody centres and governed by Code C of the Codes of Practice of the Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine (FFLM) provides training for HCPs who work in police custody, it awards a Diploma in Legal Medicine, a Licentiateship and Membership, and it sets quality standards. Its Membership is open to forensic psychiatrists. We describe two cases, one where FTBI was a live issue in the police custody setting and the other where the reliability of admissions made in police custody was subsequently a trial issue for forensic psychiatrists. In the context of an environment where FTBI assessments are increasingly being made by HCPs who do not have the necessary knowledge, training, experience or qualifications and / or where quality standards are not achieved, forensic psychiatrists will increasingly be called upon for assistance when the reliability of police interview evidence is a trial issue.

Dr Margaret Stark, President, Faculty of Forensic and Legal Medicine, Royal College of Physicians

Biography: Margaret Stark is the current President of the Faculty of Forensic and Legal Medicine (FFLM). She is Chair of the Forensic Science Sub-Committee and the Training and Education Sub-committee of the FFLM, Lead Facilitator for the Faculty’s course in General Forensic Medicine, and an educational advisor for the Faculty’s examinations. She has been a forensic physician for over 31 years, currently working with the Metropolitan Police Service (MPS). She was the first Medical Director of the Forensic Healthcare Service in London and was also the Director of the Clinical Forensic Medicine Unit for NSW Police, based in Sydney, from 2011 – 2014.

She has a Master of Science in Medical Education from UCL, and a Master in Law from Cardiff. She was the Founding Academic Dean for the FFLM and was awarded the David Jenkins Professorship in Forensic and Legal Medicine 2011/12 and was an Adjunct Professor at Sydney University from 2012-2015. She is Editor of ‘Clinical Forensic Medicine’ A Physician’s Guide, the fourth edition published in 2020.

Professor Keith Rix, Mental Health and Intellectual Disability Lead, Faculty of Forensic and Legal Medicine of the Royal College of Physicians, and Honorary Consultant Forensic Psychiatrist, Norfolk and Suffolk NHS Foundation Trust

Biography: Keith Rix’s involvement in the forensic field began in the 1960’s when he lived in hostels in London with ex-offenders and assessed prisoners for hostel admission. Whilst a senior lecturer in psychiatry in Leeds he became a visiting

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consultant psychiatrist at HM Prison, Leeds, and established the Leeds Magistrates’ Court Mental Health Assessment and Diversion Scheme and the city’s forensic psychiatry service. He has provided expert evidence to courts and tribunals for over 38 years, including on a pro bono basis in capital cases in the Caribbean and Africa. He is the editor of A Handbook for Trainee Psychiatrists and co-editor of Rix’s Expert Psychiatric Evidence. He is Visiting Professor of Medical Jurisprudence, University of Chester, Honorary Consultant Forensic Psychiatrist, Norfolk and Suffolk NHS Foundation Trust and Mental Health and Intellectual Disability Lead, Faculty of Forensic and Legal Medicine of the Royal College of Physicians.

11:00-12:00

Sentencing offenders with mental disorders – a conversation

Chair: Professor Pamela Taylor, Professor of Forensic Psychiatry, Cardiff University

Sentencing offenders with mental disorders, developmental disorders, or neurological impairments

HHJ Rosa Dean, Council Lead, The Sentencing Council

Abstract: In this talk, Judge Rosa Dean will introduce the new “Overarching Principles: Sentencing Offender with mental disorders, developmental disorders and neurological impairments” which can be found at www.sentencingcouncil.org.

Who is the sentencing council, why are these guidelines needed and what are their key principles?

Professor Pamela Taylor and Rosa will then discuss the Guideline and the difference in approach a Judge may take when passing sentence from a psychiatrist who is treating an offender. They will look at these differences when discussing difficult issues such as culpability, addiction, hybrid orders, public safety, and the place of the victim.

Pamela and Rosa will open up the discussion to questions from the audience.

Biography: Rosa Dean was called to the bar in 1993 and practiced mainly criminal law on the Midlands and South Eastern Circuits. In 2006 she was appointed as a Deputy District Judge (crime) and in 2011 became a Circuit Judge. She is the resident judge at Harrow Crown Court and a course director with the Judicial College.

Questions and discussion

Dr Penny Brown, Consultant in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust

Biography: Not available at time of publishing.

12:30-13:30 Joint keynote: Race and equality issues in forensic mental health

Chair: Dr Gunvant Patel, Forensic Psychiatrist, Racism Awareness Group, Victorian Faculty of Forensic Psychiatry, Melbourne

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Biography: Dr Gunvant Patel is a member of the recently formed ‘Racism Awareness Group’ in the Victorian Branch of the Royal Australian & New Zealand College of Psychiatry (RANZCP). He is Deputy Chair of the Victorian Subcommittee of the Forensic Faculty of RANZCP. Dr Patel has worked in Adult Psychiatry since 1994 and in forensic psychiatry since 2001. He has also trained in group psychotherapy with the Australian Association of Group Psychotherapy. Dr Patel qualified from the University of Sheffield in 1981 and was a senior house officer in psychiatry in north Manchester in 1983/84. Dr Patel migrated to Melbourne, Australia in 1986 and trained in psychiatry during the period of rapid deinstitutionalisation in Victoria. Dr Patel is the son of Indian villagers who moved to the UK in the 1950s. He was born and grew up in Bradford during the 1960s and 1970s.

Session Abstract: The last year has highlighted the existing stark inequalities in access, experience and outcomes in health, particularly for those from ethnic minority groups. There is increasing evidence that social disadvantage, and trauma, including racial trauma are associated with worse mental health outcomes. The RCPsych recently published its ambitious Equality Action Plan that spans the experience of patients and carers as well as mental health staff and uses a multi-pronged approach to reduce ethnic disparities and advance equality in mental healthcare.

This keynote will outline the facts around mental health inequalities and unpick the evidence underpinning the reasons why these disparities exist, with a focus on the mental health of ethnic minority individuals, who are particularly over-represented in secure care.

Forensic services are faced with a unique challenge because of this massive over-representation and the poor experience of ethnic minority patients. Addressing this is imperative. In line with the RCPsych initiatives, there are measures that forensic mental health services can implement to reduce these inequalities and improve outcomes for all groups.

Dr Shubulade Smith, Clinical Director, Forensic Services, South London and Maudsley NHS Foundation Trust, and Race Equality Lead, RCPsych

Biography: Dr Shubulade (aka Lade) Smith is a Consultant Psychiatrist at the South London and Maudsley NHS Foundation Trust and Visiting Senior Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, Kings College London.  She graduated in Medicine from Guy’s Hospital Medical School, London, winning prizes in Psychological Medicine. After training in psychiatry at the Maudsley, she completed a Research Fellowship in antipsychotic side effects, supervised by Professor Sir Robin Murray.  She subsequently set up a joint medication review/physical health clinic, a “one stop shop” aimed at health promotion and management of physical problems in people with SMI, leading to her being nominated as a “Woman of the Year” and a BMA Pioneer award for innovation in psychiatry. Having trained in general psychiatry, she is now a forensic psychiatrist. She is the Lead for the Acute Forensic Pathway of the South London Partnership and Clinical Director of the Forensic Services at SLaM. She is also the Clinical Director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists, providing medical leadership for the team developing mental health guidelines. She sat on the core working group of the Independent Mental Health Act Review, chaired by Professor Sir Simon Wessely and

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was responsible for some of the key recommendations, including those for patients with forensic issues. Recommendations aimed at improving outcomes for Black people with mental health problems have now been taken up by the government. Dr Smith was awarded a CBE in the Queen’s Birthday Honours in June 2019 for services to Forensic Intensive Psychiatric care. In November 2019 she was awarded Psychiatrist of the Year by the Royal College of Psychiatrists. She recently featured in HSJ’s list of 100 influential BAME leaders.

Dr Rajesh Mohan, Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust and Chair, Rehabilitation Faculty and Race Equality Lead, RCPsych

Biography: Dr Raj Mohan is a consultant in Rehabilitation psychiatry and works at the South London and Maudsley NHS Foundation Trust, in London. He completed his medical school in India where he also specialised in Psychiatry, before coming to the UK. He is a fellow of the Royal College and is the current Chair of the Faculty of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists. Along with his Faculty chair role, he is a member of the RCPsych Council.

In 2020, he was appointed as one of the two presidential leads for Race and Equality (along with Dr Lade Smith) at the RCPsych. He is supporting the implementation of an Equality Action Plan aligned with the College’s Strategy to further initiatives to address discrimination, for its staff, all its members & trainees and within the wider mental health services, for all patients and carers. Dr Mohan teaches medical students at Kings College and campaigns for better funding for mental health services, equality, and social justice. He is a firm believer in integrated care approaches and person centred psychiatry.

14:00-15:00 Sustaining the lessons of Covid-19

Chair: Dr Derek Tracy, Consultant Psychiatrist, Oxleas NHS Foundation Trust

Neurological and neuropsychiatric complications of Covid-19

Dr Tim Nicholson, Clinical Senior Lecturer, Institute of Psychiatry, Psychology and Neuroscience, King’s College London and Honorary Consultant Neuropsychiatrist, South London and Maudsley NHS Foundation Trust

Abstract: Not available at time of publishing.

Biography: Dr Tim Nicholson is a Clinical Senior Lecturer at the Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London. He is also an Honorary consultant Neuropsychiatrist at the South London and Maudsley NHS Foundation Trust. He clinical work has largely been focused on Functional Neurological Disorder (FND) but has recently been involved in setting up Long COVID clinics at King’s College Hospital.

His academic work has predominantly been on mechanisms, treatments and outcome measures in Functional Neurological Disorder (FND) but he also has a longstanding interest in the biological causes of psychiatric symptoms,

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including immunopsychiatry. However, his recent focus has been on the full spectrum of neuropsychiatric symptoms resulting from COVID-19.

He is on the executive committee of the faculty of neuropsychiatry of the RCPsych, the British Neuropsychiatry Association and the council of the Fellowship of Postgraduate Medicine. He is director of the MSc in Clinical Neuropsychiatry at the IoPPN.

NHS Scotland Forensic Network-response to COVID-19

Professor Lindsay Thomson, Professor of Forensic Psychiatry, University of Edinburgh

Abstract: This presentation examines the patient and staff infection rates with COVID-19 in a high secure psychiatric hospital; the clinical response to delivering appropriate care whilst preventing virus transmission; the effects on the wider forensic estate in Scotland; and the outcomes of the strategies used. Information was gathered from national guidance, the COVID-19 Support Team and the Forensic Network.

Results: Within the State Hospital twelve patients and 38 staff members have contracted COVID-19 up until 15/2/21. All have survived. To stop the spread of infection the Interim Clinical and Support Service Operational Policy was put in place on 30/3/20 that restricted integration. The model and subsequent major modifications will be outlined. Across the Forensic Network patients have been infected in two medium and four low secure units. Three patients have died.

Clinical Implications: The monitoring system to manage an inherently counter-therapeutic model will be described with the benefits to physical versus mental health considered in ethical terms, and the mechanisms to gradually modify the model and to work towards a new, improved service outlined.

Biography: Lindsay has been Medical Director of the State Hospitals Board for Scotland and of the Forensic Mental Health Services Managed Care Network, and Director of the School of Forensic Mental Health since 2007. She has been an Honorary Consultant Forensic Psychiatrist at The State Hospital from February 1998. She is Professor of Forensic Psychiatry at the University of Edinburgh.

Lindsay graduated in medicine from the University of Edinburgh and has Master of Philosophy and Doctorate of Medicine postgraduate degrees. She is a Fellow of the Royal College of Psychiatrists. Lindsay is fully trained in general adult and forensic psychiatry. Her research interests include outcomes in mentally disordered offenders, risk assessment and management of harm to others, the impact of legislative change, and interventions and service design for mentally disordered offenders.

She has a particular interest in teaching and established the School of Forensic Mental Health under the auspices of the Forensic Network. The School won the Scottish Public Service Award for Employee Engagement and Skills in 2014. Lindsay works extensively with health, social and criminal justice services on educational programmes in forensic mental health. She was presented with a Lifetime Achievement Award in 2015 at the NHS Education Scotland Medical Directorate Awards.

She co-authored the first textbook on psychiatry and the Scottish legal system and legislation: Mental Health and Scots Law in Practice which is now in its second edition.

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Lessons from the London Nightingale: staff well-being during and after the pandemic

Dr Derek Tracy, Consultant Psychiatrist and Clinical Director, Oxleas NHS Foundation Trust

Abstract: The London Nightingale hospital was designed to be the largest field hospital in post-war Britain, to accommodate up to 4,000 covid19 ventilated patients, supported by 16,000 staff. A specialist mental health team was established to embed and deliver a tiered, evidenced-based model of support for the staff, who were considered vulnerable to moral injury and developing mental illness in this trying situation. This talk will describe that experience, as well as ways in which the 'demedicalised forward psychiatry' model might be applied to contemporary healthcare environments.

Biography: Derek Tracy is a Consultant Psychiatrist and Clinical Director at Oxleas NHS Foundation Trust, London. His directorate is a nationally innovative integrated model encompassing adult social care, mental and physical health services.

He is a Senior Lecturer at King’s and University College London, running three MSc modules, and he has published over ninety peer-reviewed scientific papers and seven book chapters. In 2018 he was elected to the executive of the Royal College of Psychiatry’s academic faculty. His current research interests include novel psychoactive substances (‘legal highs’), and Derek is a member of the Advisory Committee on the Misuse of Drugs that provides expert scientific advice to the UK Home Office on drug harms.

Derek is a board member of the British Journal of Psychiatry, writing its Kaleidoscope and Highlights columns. He is the journal editor for public engagement, running its twitter, podcast, and blogs. In 2020 he was elected to the Royal Society of Medicine’s Psychiatry Council.

He is a Fellow of the Higher Education Academy, the Faculty of Medical Leadership and Management, the Royal Society of Arts, and the Royal College of Psychiatrists. In 2019 he was awarded the Royal College of Psychiatrist’s “Communicator of the Year” award.

15:30-16:30

Research session: Legal and risk issues in Forensic Psychiatry (ten minute talks)

Chair: Professor Seena Fazel, Professor of Forensic Psychiatry, University of Oxford

Abstract: Seena Fazel is professor of forensic psychiatry and a Welcome Trust senior research fellow at the University of Oxford, and an honorary consultant forensic psychiatrist. His research focuses on relationships between severe mental illness and violent crime, violence risk assessment, and the mental health and suicide risk of prisoners. He has given evidence to the UK Government Justice Select Committee and the UN-backed Khmer Rouge war crimes tribunal. He is currently Section Editor for Forensic Psychiatry for Evidence-Based Mental Health and BMC Psychiatry.

An analysis of existing legislation for autism under the Mental Health Act 1983

Dr Carlo Thomas, Consultant Forensic Psychiatrist, Rampton Hospital

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Abstract: Not available at time of publishing.

Biography: Dr Carlo Thomas is a Consultant Forensic Psychiatrist at The National High Secure Learning Disability Service at Rampton Hospital.

Carlo’s interests include looking at applying new and innovative bio-psycho-social treatment models to the care of patients with complex presentations associated with autism, learning disabilities and poly-offending.

Previously he has worked with St Andrews Healthcare and Priory Healthcare in medium secure, low secure and community settings for patients with learning disabilities and autism. In these settings, Dr Thomas has conducted studies relating to risk assessment and risk management of patients with autism, learning disabilities and comorbidity. He has also done studies relating to spirituality in forensic psychiatry, psychiatric needs in prison populations, delayed discharges, and offending profiles of patients with autism in secure settings.

Subjective representations of risk: a neglected topic in clinical practice and research

Professor Taj Nathan, Consultant in Forensic Psychiatry and Director of Research, Cheshire and Wirral Partnership NHS Foundation Trust, Visiting Professor, University of Chester

Abstract: The technical definitions of ‘risk of violence’ convey the impression that ‘risk’ is a tangible entity with objective properties. Introspection reveals, however, that in-vivo risk-related clinical activities usually do not rely on an objectively definable entity. Rather, in the course of these activities the clinician experiences an often ill-defined and changing subjective state that can be characterised along a number of dimensions, such as the nature of imagined scenarios (e.g. involving harm to others and/or consequences for the clinician), the type and degree of associated feelings (e.g. ranging from equanimity to intense anxiety), and the degree of embodiment (e.g. a free-floating notion of risk or one specifically linked to the individual under examination). Structured professional judgement approaches to risk assessment and management operationalise the way information is collected and appraised, but even after such an approach is undertaken, clinicians will still experience a subjective risk conception which is bound to influence the decisions they make. Greater attention to the subjective representation of risk is necessary to inform (i) how clinicians approach risk-related clinical activities, (ii) how serious incidents are investigated after the event, and (iii) how researchers evaluate the practice of risk assessment and management. In this talk, there will be an overview of the difference between subjective and objective notions of risk (with a focus on the former) so that attendees are more able to understand mind-based representations of risk and apply this understanding to clinical practice, safety governance processes, and research.  

Biography: Prof Taj Nathan (MB, BCh, MRCPsych, MMedSc, DipFSc, MD) has worked as a Consultant Forensic Psychiatrist within the NHS for twenty years, during which time he has led the development of innovative services such as in the areas of forensic personality disorder and ASD. Alongside his clinical roles, Taj is currently also Director of Research in Cheshire and Wirral Partnership NHS Foundation Trust,

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Honorary Senior Research Fellow at the University of Liverpool, Visiting Professor to the University of Chester, Adjunct Professor at Liverpool John Moores University, and North West Coast Specialty Research Group Lead, Mental Health (NIHR). Taj’s current research interests are understanding risk, process-level understanding of violence, subjectivity and psychopathology, and clinical decision-making. His forthcoming book (Dangerous Minds, John Murray Press, 2021) introduces forensic psychiatry and explanations for serious violence to a wider audience.

Suicide is not the answer: an exploration of the morbidity and mortality of a Scottish Forensic cohort over 20+ years

Professor Lindsay Thomson, Professor of Forensic Psychiatry, University of Edinburgh

Abstract: The morbidity and mortality of all Scottish high secure patients in 1992/3 was examined through ‘The recovery approach for patients within high secure care: A 20+ year follow up’. Health and mortality data were extracted from national data sets and examined in conjunction with baseline and follow up information. High rates of death at an early age was evidenced. In stark contrast to previously reported forensic (Fazel et al, 2016) and mainstream psychiatric findings (Olfson et al, 2016) exceptional rates of suicide and unnatural deaths were not observed. This presentation considers factors that may explain this finding.

Biography: Click here to view biography

Violence risk in general psychiatry – epidemiology, need and the development of a clinically useful prediction tool

Dr Daniel Whiting, NIHR Doctoral Research Fellow, Department of Psychiatry, University of Oxford

Abstract: Advances in epidemiological approaches have provided a more refined knowledge of the relative risk of violence in psychiatric disorders. Whilst risk of serious violence is overall low, in many disorders – particularly psychotic illnesses, substance misuse and personality disorder - absolute risks are at a level that makes it an important adverse outcome for clinical services to consider. With forensic services only typically becoming involved when a serious violent offence has already occurred, the bulk of early, upstream risk assessment is undertaken by general psychiatric services. This is particularly relevant to Early Intervention in Psychosis services, who assess individuals in a high risk phase of illness.

Currently, no standardised approaches or practical, structured methods exist to support clinicians to assess and manage risk in these settings. One potential way to improve this is the use of scalable, validated prediction tools. In order to be of utility, such a tool needs to not only have predictive accuracy, but have a well-developed understanding of its clinical feasibility, acceptability and role. With this in mind, work is currently ongoing to validate and pilot the use of the ‘OxMIV’ violence risk assessment tool in Early Intervention in Psychosis services, and findings from this work will be presented.

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Biography: Dr Whiting is a forensic psychiatrist and clinical research fellow based in the Forensic Psychiatry Research Group at the University of Oxford’s Department of Psychiatry. His work is focusing on using prognostic research methods to develop approaches to violence risk assessment and intervention in first episode psychosis – validating a risk prediction tool for violence, and examining how this can be translated into clinical practice.

Friday 5 March

09:30-10:30

Adolescent forensic mental health services – current and future developments and challenges

Chair: Dr Heidi Hales, Consultant in Forensic Psychiatry, West London Mental Health NHS Trust

Current and future developments in adolescent forensic health care

Professor Prathiba Chitsabesan, Consultant Child and Adolescent Psychiatrist, Pennine Care NHS Foundation Trust, National Speciality Advisor and Co-Chair of the Clinical Reference Group, NHS England, Visiting Professor, Manchester Metropolitan University.

Abstract: Not available at time of publishing.

Biography: Professor Prathiba Chitsabesan is a Consultant in Child and Adolescent Psychiatry working in a large mental health and learning disability trust in Greater Manchester (Pennine Care NHS Foundation Trust). Lead consultant since 2005, she became Clinical Director in 2015 and subsequently Associate National Clinical Director for Children and Young People’s Mental Health in 2017 and Co-Chair of the Tier 4 CYPMH Clinical Reference Group in 2019 (NHS England and NHS Improvement). She has an interest in the mental health and neurodevelopmental needs of children and young people in contact with the criminal justice system. Over the last 15 years she has published in peer reviewed journals and books and contributed to national reports and guidance. She continues to be research active as a Visiting Chair (Manchester Metropolitan University) and has been involved in a number of regional and national transformation programmes.

A view from Her Majesty’s Inspectorate of Prisons

Angus Mulready-Jones, Team Leader – Children and Young Adults, HM Inspectorate of Prisons

Abstract: Not available at time of publishing.

Biography: Angus is the HM Inspectorate of prisons lead for Children and Young Adults. He has a background in the voluntary sector running safer custody, family relationship and resettlement programmes in prisons. In addition, he has undertaken

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prison reform projects in Europe, Australia and the United States. Outside of criminal justice he has held several roles overseeing children’s services in East London.

Health, welfare or justice: a global overview of differences between countries in the scale and approach to secure placement of young people

Fleur Souverein, Forensic Psychologist, Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, The Netherlands

Abstract: With a team of scientists and practitioners from all over the globe – representing England, Wales, Republic of Ireland, Northern Ireland, Scotland, Norway, Denmark, Sweden, France, The Netherlands, India, New Zealand, Australia –  we try to unravel why, how, where and under what circumstances children and young people are deprived of their liberty. With this presentation we share our first results, comparing countries on the scale and approach (health, welfare, justice) to secure placement. We further lay out the issues and questions we find along the way that may serve as input for a critical discussion around the organization and ethos of secure placement of children; and what we have learned so far from looking beyond our own borders.

Biography: Fleur Souverein graduated cum laude (with distinction) at the University of Amsterdam and holds two master titles in Social Psychology and Clinical Forensic Youth Care. During her studies she completed a research internship at the University of Cape Town and worked for Young in Prison as a life-skills training facilitator in several correctional facilities in South Africa. After completing her education in 2015 she worked as a psychologist at de Waag for outpatient forensic treatment and as a sociotherapist at Van der Hoeven clinic for the daily supervision and mentoring of patients who had been detained under a hospital order. In 2017 she started a PhD project at the VUmc department of Child and Adolescent Psychiatry, in collaboration with the Academic Collaboration for (at risk) Justice-Involved Youth (AWRJ); focusing on small-scale community-integrated youth justice facilities and relational security. Aligned with her PhD Fleur is involved in several policy evaluations of (youth) justice reforms in the Netherlands. Fleur is affiliated with Melbourne University (School of Social and Political Sciences) as a visiting scholar involved in a project on comparative criminology and policy transfer of youth justice practices.

11:00-12:00

Expert witness bias in psychiatry – sources and expression

Chair: Professor Tom Fahy, Professor of Forensic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Session Abstract: The expert witness practice (EWP) of forensic psychiatrists is under constant scrutiny by both the courts and professional bodies, in terms of not only technical competence but also ethical probity. And the avoidance of bias represents the greatest technical and ethical challenge. The presenters will describe the sources of EWP bias psychologically, including through cognitive heuristics, and the legal definitions and judicial recognition of EWP bias. They will suggest that bias arises from both within the expert and within the interaction between the expert and the subject; but that it is also an inherent reflection of the adversarial legal process itself. They will suggest that bias is then expressed throughout the methods of assessment, report

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drafting and the giving of oral evidence. They will also argue that it is impossible to exclude ‘values’ from expert witness evidence, and that the greatest danger lies in assuming that they can be excluded. Finally, they will suggest that the courts often offer inadequate safeguards against the expression of expert witness bias; and that the best routes to safeguarding lie in personal professional insight and peer review.

Dr Richard Latham, Consultant in Forensic Psychiatry, East London NHS Foundation Trust

Biography: Richard Latham is a community forensic psychiatrist in East London and clinical director of the North London Provider Collaborative. Dr Latham has a degree in mental health law and his thesis concerned the topic of expert mental health evidence. He is an author of the Oxford Handbook of Forensic Psychiatry.

He has a moderate expert witness practice in two areas of law: serious crime and mental capacity law. His expert witness practice has included numerous murder cases, high profile terrorist extradition cases and landmark cases involving mental capacity and refusal of medical treatment.

He works pro bono for the Death Penalty Project and has conducted assessments on appellants in Kenya, Trinidad & Tobago, St Vincent and Belize. He has led training sessions in several countries on the use of expert evidence in capital cases

Professor Nigel Eastman, Emeritus Professor of Forensic Psychiatry, St George’s, University of London

Biography: Nigel Eastman is Emeritus Professor of Law and Ethics in Psychiatry at St George’s, University of London and an Honorary Consultant Forensic Psychiatrist in the NHS. Prior to completing medical training he was called to the Bar. He has carried out research and published widely on the relationship between law and psychiatry; and, for example, is first author of the Oxford Specialist Handbook of Forensic Psychiatry. A major focus of his work has been public policy concerning law and psychiatry; and he has, for example, given evidence to Parliamentary Select Committees and been an advisor to the Law Commission. He has extensive experience of acting as an expert witness in both in the UK and other jurisdictions, including in relation to a many capital cases. He has also educated the judiciary, in the UK and abroad, including in relation to the death penalty; as well as having published books directed at judicial and clinical education in capital jurisdictions.

12:45-12:30

Recognising and managing psychological trauma in our prisons

Chair: Dr Deirdre MacManus, Clinical Reader in Forensic Psychiatry, King’s College London

Session Abstract: In this symposium, Dr MacManus will discuss how recent international research has identified a high prevalence of PTSD in prison populations worldwide and yet it remains underdiagnosed and undertreated in the UK. Dr Emma Facer-Irwin will present our findings from the first UK research into the prevalence of both PTSD and Complex PTSD in a male UK prison population and associated rates of

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comorbidity and negative behavioural outcomes. Jude Kelman will present research into the impact of prison (environment, relations, and interventions) on residents with prior histories of trauma which she has completed as part of a broader PhD exploring Trauma Informed Care in the UK female prison estate. We ask the question if prison systems can be truly trauma informed? Lastly, Dr MacManus will discuss existing evidence for the efficacy and feasibility of trauma focused interventions in prison and consider the future of Trauma Informed Care in Prison.  

PTSD in prison: prevalence, comorbidity and consequences

Dr Emma Facer-Irwin, Trainee Clinical Psychologist, University of Essex

Biography: Emma completed her PhD in Psychology at the Institute of Psychiatry, Psychology and Neuroscience (King’s College London) in 2019. She is now a Trainee Clinical Psychologist, studying on the Doctorate of Clinical Psychology at the University of Essex, in partnership with the Tavistock and Portman NHS Foundation Trust. Her research explores complex trauma and PTSD in imprisoned populations, including the impact on mental health and behavioural outcomes, and the development of Trauma-Informed Care initiatives in criminal-justice settings.  

In what way does imprisonment affect those with previous histories of trauma?

Jude Kelman, Estate Lead Psychologist, HMPPS

Abstract:“In what ways does imprisonment affect those with previous histories of trauma?”

This presentation will share some early findings from a study which forms part of the overall PhD, “Can prisons ever be trauma informed and trauma responsive?”. Given the high prevalence of histories of trauma and adversity in the lives of women in custody, this research focuses on the impact of imprisonment on women who have already lived through traumatic or adverse experiences. The findings are based on thematic analysis of in-depth interviews with 51 prison residents across three women’s prisons. Participants were asked about how they perceived the experience of imprisonment, as well as about their trauma histories, and the ways in which they felt that imprisonment affected them because of their prior trauma. The range of ways that residents perceived their prison experience and their treatment therein as a further traumatic experience will be discussed in the presentation.

Biography: Jude is a Forensic Psychologist and has worked for Her Majesty’s Prison and Probation Service (HMPPS) since 1995. Throughout the 25 years of her career, Jude has worked with a broad range of prison residents across a variety of types of prisons, including closed, open and higher security establishments. For the past four years Jude has worked as Lead Psychologist for the women’s prison estate and has team members based in women’s prisons across the country. She has strategic responsibility for the development and delivery of the forensic psychology service into women’s prisons, as well as management responsibility for the psychology team who deliver it. In addition to this, Jude continues to undertake some resident-facing work to maintain her competence and skills as a forensic psychologist. Jude is currently undertaking a part-time PhD at King’s College London, entitled “Can Prisons Ever Be Trauma Informed and Trauma Responsive?”.

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Treatment of trauma in prisons: can they be truly informed?

Dr Deirdre MacManus, Consultant Forensic Psychiatrist and Clinical Reader in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust and King’s College London

Biography: Deirdre is a Consultant and Clinical Reader in Forensic Psychiatry at King’s College London. A major focus of her research to date has been psychological trauma, its antecedents, outcomes and treatment in a variety of populations including forensic and military. Her clinical work is divided between South London and Maudsley NHS Foundation Trust, where she oversees the psychological trauma pathway in HMP Wandsworth, and Camden and Islington NHS Foundation Trust, where she is Clinical Lead for a regional NHS mental health service for military veterans and Consultant Psychiatrist with the Traumatic Stress Clinic, a specialist psychological trauma service. 

14:00-15:00

Research session: Interventions and needs in Forensic Psychiatry (ten minute talks)

Chair: Dr Ayana Gibbs, Forensic Psychiatrist and Head of Medical Affairs, Camurus UK

Biography: Dr Ayana Gibbs (MBChB, PhD, MRCPsych) is a Consultant Forensic Psychiatrist who completed her specialist training in adult and forensic psychiatry at the Maudsley and Bethlem Royal Hospitals in London in 2008 and her PhD in Neuroscience at the IoPPN, King’s College London in 2010. After leading research in forensic mental health and psychopharmacology as Clinical Senior Lecturer (Honorary Consultant) in Forensic Psychiatry at the University of Sussex, she transitioned to R&D in the pharmaceutical industry in 2013 and is currently Head of Medical Affairs at Camurus and Consultant Psychiatrist with Psychiatry-UK. She remains passionate about advancing forensic mental health research and her current areas of interest include addiction and ADHD.

Foreign national prisoners and their vulnerabilities in prisons and immigration detention

Dr Piyal Sen, Medical Director, Chadwick Lodge and Eaglestone View, Milton Keynes

Professor Andrew Forrester, Professor of Forensic Psychiatry, Cardiff University

Abstract: Foreign National Prisoners (FNPs) constitute around 12% of the prison population in England and Wales. They exhibit more complex mental health needs, including suicidality, isolation, immigration uncertainties, language barriers, discrimination, and pre-existing trauma. They are also under-referred to in-reach teams.

Recent immigration legislation has meant that FNPs are more liable to be detained for longer periods, or deported. The has been no systematic study within immigration removal centres.

We undertook a study of screened prevalence of common mental health disorders amongst 94 immigration detainees, with 28 FNPs. They had higher

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prevalence of all mental disorders, particularly mood disorders, drug and alcohol problems, autism spectrum disorder and attention deficit hyperactivity disorder. They were also detained for longer periods and had higher unmet needs.

Clinicians and service managers need to be aware that FNPs in immigration detention are likely to require enhanced and specialist provision and appropriate mental health screening.

Biography: Dr Piyal Sen is a Consultant Forensic Psychiatrist , Medical Director at Chadwick Lodge and Eaglestone View, Milton Keynes. He is a Visiting Senior Lecturer and Doctoral Researcher at Brunel University, also affiliated with King’s College, London.

He is a member of the Asylum Seeker and Refugee (ASR) working group of The Royal College of Psychiatrists (RCPsych) and co-facilitator of an on-line forum on treatment of refugees and asylum-seekers, on behalf of the RCPsych. He has represented the College view on immigration detention to external organisations and contributed to the College Position Statement on Immigration detention.

His other area of interest is personality disorder. He was previously one of the Directors and Treasurer of the British and Irish Group for Studies in Personality Disorder. He has won various awards from the Forensic Faculty like the Peter Scott and John Hamilton Fellowships, as well as best presentation award in 2017.

Clozapine – why wait to start a laxative?

Dr Stephen Attard, Consultant in Forensic Psychiatry, Central and North West London Mental Health NHS Foundation Trust

Abstract: The only evidence-based treatment for patients with treatment-refractory schizophrenia is clozapine, an atypical antipsychotic with relatively weak dopamine antagonism. Clozapine, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death.

CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Despite this, whilst strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We reviewed the available literature in our 2019 publication, Clozapine; why wait to start a laxative and recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.

Biography: Not available at time of publishing.

Medical skin camouflage for women in prison with self-harm scars (COVER): a randomised feasibility study

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Dr Louise Robinson, Consultant and Honorary Senior Lecturer in Forensic Psychiatry, Lancashire and South Cumbria NHS Foundation Trust and University of Manchester

Abstract: Self-harm in prison continues to increase, particularly in women. There has been little focus on the effects of living with self-harm scars. Medical skin camouflage (MSC) has been shown to improve quality of life for people in the community with scars. It was not clear whether an RCT could be used to evaluate the impact of MSC for self-harm scarring in prison. We tested the feasibility and acceptability of conducting an RCT of MSC for self-harm scarring at one prison in England. The intervention was delivered by long-term prisoners trained and supported by the research team. Results showed that recruitment, randomisation, retention and follow-up were possible. 51 women were randomised to the intervention or control group, and 45 completed follow up assessments. Staff and participants reported that MSC improved the women’s confidence and self-esteem. Valuable information was provided for a future trial in this complex environment. Important lessons were learned about how to ensure successful peer-delivery of the intervention.

Biography: Louise Robinson, Consultant Forensic Psychiatrist, Lancashire and South Cumbria NHS Foundation Trust, and Honorary Senior Lecturer, University of Manchester.

Dr Robinson is a Consultant in secure mental health services at Lancashire and South Cumbria NHS Foundation Trust and an NIHR Clinician Researcher. She completed her MD in prison research in 2015 and continues to conduct research in this area as part of the Mental Health and Safety and Women’s Mental Health groups at the University of Manchester. She is a Regional Specialty Representative for the College for the North West of England and a member of the conference organising committee.

Mental health transfers from prison to hospital over a 6-year period in a region of England

Laura Woods, Consultant Nurse, Forensic Health Care, Sussex Partnership NHS Foundation Trust

Laura Craster, Trainee Cognitive Behavioural Therapist, Camden and Islington NHS Foundation Trust

Professor Andrew Forrester, Professor of Forensic Psychiatry, Cardiff University

Abstract: There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983.

This session will discuss a project which reviewed all such transfers within one region of England, with an emphasis on differences across levels of security.

Over a six-year period (2010–2016), 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days.

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The session will explore the findings and consider the need for continuing future research, national guidance and policies to support improvements in prison transfers.

Biography: Laura Woods is mental health nurse with over 13 years’ experience working in PICUs, prisons and secure and forensic health care.

After nearly nine years working in PICU, Laura managed a healthcare service within the prison estate. During this time, she gained a MSc in Clinical Forensic Psychiatry with her research looking at prison transfers to general adult PICUs.

Laura is now working as Consultant Nurse for Forensic Health Care in Sussex. An independent Prescriber and Trainee Approved Clinician, Laura continues to undertake research in Forensic mental health services and continues to explore the interface between general adult psychiatry and secure services.

She remains passionate about mental health nursing and enjoys teaching colleagues and nursing students.

15:30-16:30

Mental illness and the prison revolving door: re-integration not re-incarceration

Chair: Dr Paul Devine, Chair, Forensic Faculty, RCPsych in Northern Ireland

Re-incarceration among prisoners with serious mental illness: Toronto experience

Dr Roland Jones, Forensic Psychiatrist and Clinician Scientist, Centre for Addiction and Mental Health, Toronto, and Assistant Professor, University of Toronto

Abstract: Individuals with serious mental illness are overrepresented in prison facilities relative to their prevalence in the general population, and a small proportion of those have rapid and frequent incarcerations. Two studies carried out in Ontario, Canada investigated reincarceration among those with serious mental illness will be presented. In the first study, we investigated a cohort of 4,704 men and women discharged from a correctional mental health service, and followed for a median of 535 days. We investigated social, clinical, demographic and offence characteristics as predictors of return to the service using cox survival analyses. We found that a higher rate of return to custody was associated with schizophrenia spectrum / bipolar affective disorder and personality traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault negatively associated with return to custody. Within a one-year time period we found 7.2% of individuals had three or more incarcerations accounted for 19.5% of all re-incarcerations. In the second study we investigated a cohort of 3,327 people with a diagnosis of schizophrenia discharged from correctional facilities compared rates of re-incarceration to those without schizophrenia. Individuals with schizophrenia were 40% more likely to be re-incarcerated within 5 years of release than the control group after adjusting for demographic characteristics. The factors with the greatest likelihood of impacting reincarceration in our setting were to treat those with schizophrenia and substance use problems, particularly those using stimulants, and addressing homelessness.

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Biography: Dr Jones is a forensic psychiatrist and clinician scientist at the Centre for Addiction and Mental Health, Toronto, Canada, and Assistant Professor in the Division of Psychiatry at the Department of Psychiatry, University of Toronto. He trained and worked in psychiatry in the UK and New Zealand and completed sub-speciality training in both general and forensic psychiatry and is a Fellow of the Royal College of Psychiatrists. He completed an MSc in epidemiology at the London School of Hygiene and Tropical Medicine, and a PhD in psychiatric epidemiology at Cardiff University, UK. He was Chair of the Royal College of Psychiatrists Faculty of Forensic Psychiatrists in Wales, before moving to Canada in 2017. He has expertise in epidemiology applied to prison and health care services research, including the application of longitudinal and life-course methods to understanding relationships between mental disorder, violence, offending, and recovery.

STAIR (Screening, Triage, Assessment, Intervention and Reintegration model): what we know about R: re-integration not re-incarceration

Dr Sandy Simpson, Chief of Forensic Psychiatry and Clinician Scientist, Centre for Addiction and Mental Health, Toronto and Assistant Professor, University of Toronto

Abstract: Not available at time of publishing.

Biography: Not available at time of publishing.