RFL - Forensic Psychology in Practice: mental health rehabilitation

Rehabilitation Services

• Detained under the Mental Health Act 1983/2007 with or without a MoJ restriction (ministry of justice)

• Voluntary

• Multi-agency Public Protection Arrangements (MAPPA)  - number of other professionals e.g. police, who are all involved in decision making and putting things in place to protect the public

• Common Diagnoses:

  • Schizophrenia (paranoid)

  • Bipolar disorder

  • Personality disorder (EUPD)

  • PTSD / Complex PTSD

Psychology department

• 1 full time Registered Psychologist

• 3 part-time Registered Psychologists

• 1 full time Forensic Psychologist in Training

• 1 full time Assistant Psychologist

• 2 x experience roles (1 day a week)

Multi-disciplinary Team

• Consultant Psychiatrist (RC)

• Nursing

• Social Work

• Occupational Therapist

Maslow's Hierarchy of Needs

Positive Behavioural Support

• Comes from the scientific understanding of behaviour

• Sims to find the meaning behind the persons behaviour and find how we can get their needs met

• Using scientific ways to collect information to understand why the individual is having challenges

• Involves strategies to avoid what is harming the individual, teaching them coping strategies, ideas to help the person when they feel upset and clear guidance when a person - helps them to improve their quality of life and wellbeing

• PBS is the most ethical way of support and has growing evidence that it works

• It is about improving quality of life, developing skills and practitioners working with them, understands all behaviour happens for a reason, psychological therapies used, uses decisions on facts and research, a PBS plan tells people what to do to prevent the behaviour from happening and know what to do

• Evidence based approach

Good Lives Model

Originally created by T. Ward (2002) increased to 11 following empirical research by  Purvis in 2006 (published in 2010) - everyone strives to meet these values (as humans we are trying to achieve certain values)

• life (including healthy living and functioning)

• knowledge (how well informed one feels about things that are important to them)

• excellence in play (hobbies and recreational pursuits)

• excellence in work (including mastery experiences)

• excellence in agency (autonomy, power and self-directedness)

• inner peace (freedom from emotional turmoil and stress)

• relatedness (including intimate, romantic, and familial relationships)

• community (connection to wider social groups)

• spirituality (in the broad sense of finding meaning and purpose in life)

• pleasure (feeling good in the here and now)

• creativity (expressing oneself through alternative forms).

(Primary goods - to achieve these we need the secondary good)

GLM in practice

1. Asking increasingly detailed questions about a patients’ core commitments and what day to day activities and experiences they value

2. Identifying the goals and underlying values that were evident in their offence related actions.

Formulation

Formulation is:

• “Understanding a client's psychological difficulties. This is formed through assessment and integration of psychological theory” (Thrower et al., 2024)

• “It aims to explain the development and maintenance of a client's difficulties and informs a plan of intervention” (Cole at al., 2011).

• There are a variety of models that can be used to support when developing a formulation.

Key considerations when Developing a Formulation

• Obtain a thorough handover/case history
  (where possible, liaise with the service user – make this collaborative)

• Be mindful of culture/identity/religion and how this may impact on the service user

• Use theory to support the claims/hypothesis within the formulation

• (Where possible) share the completed formulation with the service user

The 5 P's Formulation

One of the most used templates for developing a formulation is the 5 P’s formulation.

This explores:

• Predisposing factors (vulnerabilities)

• Precipitating factors (triggers)

• Presenting problems

• Perpetuating factors (maintenance)

• Protective factors