- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Wednesday, November 27, 2019

i RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Day one of my second Health & Justice Summit was very enjoyable and informative. The title even had me wondering whether I have inadvertantly referred online, or in conversation to the conference as 'Justice & Health'. This one, like January's in Liverpool demonstrates the balancing act that is: health (care) and justice.

Sometimes given the all-encompassing nature of Hodges' model you might think nothing stood out on day one. There is key learning here for me as on Monday I take on a ready-made caseload with an 'Adult' Community Mental Health Team. The team / service designations (Adult / Older Adult) are not mine (but, yes I am part of this 'system') and within teams due attention is given to ageism and 'where' patients are best suited whatever their age. While not specifically prison health, the new part-time role includes references to substance misuse, self-harm, history of violence, personality disorder and post-traumatic stress disorder. (The current political context was also acknowledged and applied on several occasions.)

As I start to write this (25th Nov) PM on BBC Radio 4 is deliberating on violent incidents and the need to toughen up on sentences, the glamourising of certain lifestyles and expectations for life chances, employment, police numbers, youth services, political manifestos, social media and understanding 'all this'. Amid what is a complex background the event's agenda was context packed, but for me several sessions stood out.

Suicide and Self-Harm across the Criminal Justice Pathway with Dr Louise Robinson
Suicide and Self-Harm across the Criminal Justice Pathway
with Dr Louise Robinson

Prison health is a challenging context. The prison health community are not just asking hard questions, they are clearly researching them, as in 'Suicide and Self-Harm across the Criminal Justice Pathway' with Dr Louise Robinson. The research pathway was outlined. Interventions discussed included 'skin camouflage' for self-harm; and Psychodynamic Interpersonal Therapy [PIT].

The development of the study from feasibility to WORSHIP I & "Women Offenders Self Harm Intervention Pilot I":

Walker, T., Shaw, J., Turpin, C., Reid, C., & Abel, K. (2017) The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm, The Journal of Forensic Psychiatry & Psychology, 28:2, 158-171, DOI: 10.1080/14789949.2017.1301529

- through to the latest WORSHIP III. It must be marvellous to be part of evidence-based thought and practice development and with future plans delineated: Complete WORSHIP III, COVER RCT; Cell-Soothe and PrisScope.

Miranda Davies of the Nuffield Trust reported work on "Prisoners' use of hospital services in 2017/18. Many were shocked hearing that 31% prisoners miss out-patient appointments, in contrast to a general did-not-attend - DNA rate of 8.6%. Was this due to the 'patient', or prison reasons? With frequent talk of the need for increased productivity and its neighbours of efficiency and effectiveness: this is painful. Miranda Davies also questioned the limits of hospital data: what (and how) healthcare is provided in prisons; wider aspects of the prison environment; whether researchers are capturing all the activity associated with prisoners from post code alone and coding quality.

Defining trauma

Emma Facer-Irwin explained “The role of trauma and PTSD on negative behaviours among male prisoners: Toward a model of Trauma-Informed Correctional Care in the UK”. When revising and updating - definitions are always welcome.

This definition is useful as on twitter and elsewhere you cannot fail to notice an addition to the debate, critique and vitriol on PTSD with the companion of Complex PTSD.

Differentiating between PTSD and Complex PTSD
This slide 'gave' me the lead for this blog post. It stresses the 'self' and interpersonal difficulties which can create humanistic chaos, by undermining relationships old and new 'in' the Sociological domain. The intra-personal and reflexive aspect is found in the re-experiencing centred on the inter-interpersonal domain as memory, emotional response, dreams (nightmares) and avoidance behaviours that can also affect other people.

In another session the bias, stigma and damage associated with the diagnosis of personality disorder as a 'bin' was noted. This was very positive to hear and later ('elsewhere') on twitter, negative responses in cases of self-harm in casualty by nurses were also called out. I remember this being highlighted in the late 1990s - early 2000s, a surprise that such negative attitudes from mental health professionals can still be expressed and felt.

Here in a tweet are organisers, supporters and sponsors who made the event possible:

More to follow ...