ASPD and the Probation Service
A New Approach to an Old Role
Dr Celia Taylor
BSc, MB.BS, MRCPsych, Diploma Forensic Psychiatry
Consultant Forensic Psychiatrist
Lead Clinician & Head of Service, Millfields Unit
Overview
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A new role for clinicians too.
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The culture of the probation service.
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The experience of being “embedded” / working with Specialist Probation Officers
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The psychological impact of the work.
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Experiences of interagency working – case examples.
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Some conclusions.
A new role for clinicians
Ramsden & Prince, The Psychologist (2011)
General drive within CJS for interventions to be psychologically informed.
Practitioner’s guide, Working with Personality Disorder is based on an approach
grounded in attachment theory.
Radically different role for NHS clinicians, whose more usual role is assessment
and treatment of {diagnosed} individual cases.
A new role for clinicians
Instead, the task of the clinician is to lead the development of a psychologicallyinformed workforce that is able to:
 Apply psychological theory to enable Probation Officers to think more
accurately and creatively about risk.
 Understand complex dynamics that prevent them from properly engaging
with their clients and working collaboratively with colleagues and agencies.
 Maximise the capacity of criminal justice services to empathise, provide
emotional containment and consistency.
 Support a pathway across systems, through custody back into the
community.
 Reduce dependence on over-stretched non-statutory agencies, inpatient,
emergency and crisis services.
 Reduce the risk of reoffending?
Ramsden & Prince, The Psychologist (2011)
The life of a Probation Officer
More of the same, AND a period of great change and uncertainty:
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Privatisation
Excessive caseloads
Tight timescales and deadlines
Privatisation
Dual role
Lack of control over the work
Privatisation
Serious further offence reviews
The culture of the probation service
Social Systems as a Defence Against Anxiety
Isabel Menzies Lyth, 1960
A classic paper which created a new way of thinking about the functioning of
organisations., in particular the NHS.
Her thesis was that in order to avoid the anxieties aroused by the work, the
organisation develops defences to avoid psychological involvement with patients.
The anxieties of the probation service:
 Violence
 Death
 Strangers
? Changing to a culture where avoidance of blame is prioritised over everything else.
A culture of blame
Serious Further Offences (SFOs)
1) 2005: Hanson & White
Convicted of murder of John Monckton and attempted murder of his wife .
“Collective failure in London Probation Area.”
2) 2005: Anthony Rice
Convicted of murder of Naomi Bryant whilst on Life License.
“A sequence of deficiencies in the form of mistakes, misjudgements and
miscommunications … amounting to a cumulative failure.”
3) 2008: Sonnex & Farmer
Convicted of the torture and murder of two French students.
Probation officer had 127 cases . Name leaked to press.
Chief Officer for London Probation told by Jack Straw that he faced
suspension and a “performance capability review”.
P.O.’s stress & burnout associated with caseload events
Lewis KR, Lewis LS & Garby TM (2012). Surviving the trenches: the personal impact of the job
on Probation Officers. American Journal of Criminal Justice
Probation Officers who reported these events related to offenders in their
caseloads scored significantly higher on measures of traumatic stress and burnout
than officers who did not (n = 309).
Role of Specialist Probation Officers
Central to the project:
 In charge of case management of high-risk, high-harm personalitydisordered offenders
 Co-ordinating link between Offender Managers and new personality
disorder services (PIPES, Belmarsh, Swaleside, etc)
 Screening
 Case formulation
 Pathways planning
 Training
Caseload reduced by 50%, but this has taken
time and the pressures can be enormous.
Range of cases
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Domestic violence
Gangs and guns
Organised crime
Street and pub fights
Prolific offenders
Child sex offenders
Internet pornography
Terrorists
Managing the Nurse-Patient Relationship
with People Diagnosed with Personality Disorders in
Therapeutic Community and
Secure Mental Health Settings
Anne Aiyegbusi
RMN, MSc, PGCE, Diploma Forensic Psychotherapeutic Studies
2011
Psychological GBH
In keeping with the trend of launching multiple forms
of painful interpersonal transactions at nurses by
way of an onslaught, aggressive behaviour
frequently takes the form of verbal abuse,
accusations, rejections and personalised attacks.
“You bloody bitch, you wanker, you fat piece of shit”.
“I’ll find out what type of car you are driving and I’m going to make sure someone
follows you home.”
A specialist Probation Officer was advised by the police to move to work in a different
borough after an offender made threats from prison to have her killed – “That
disturbed me”.
Psychological GBH
These episodes of verbal abuse sometimes took place in full view of the
others, which resulted in the nurse feeling particularly exposed,
vulnerable and humiliated.
He shouted at me down the video link, so loudly that the whole office could
hear.
Anger
Nurses stated that patients became angry when
they had been confronted or challenged
about anything:
“A lot of them exhibit a lot of anger, so they
don’t like to be challenged and so they
become very angry, most of them”.
Threats of legal action from solicitors.
“A lot of them {DV offenders} deny or minimise, so they don’t like to be challenged and
they don’t especially want to be confronted with the facts.
Complaints and contempt
A pattern of making allegations against and
complaints about nurses in order to inflict
emotional distress on nurses was described by
those working with men in the DSPD service.
“Yes, I mean, with this complaint going though at
the moment I’m feeling low. I’m probably feeling
the lowest I’ve ever felt.”
“Never let anger consume you, get even, not revenge. Complain whenever you can”.
“Charlatan” – someone who pretends to have a special knowledge or ability – is an apt
description of probation staff that hide behind “professional opinion”, which rapidly
withers under critical scrutiny.
"The word Probation officer is red rag to a bull to me. It’s like dealing with Neanderthals,
they are so terminally stupid . . . ”
Idealisation and denigration
The development of an intense, idealised
attachment can lead to self-destructive
behaviours, such as cutting or even physical
attack in order to increase proximity to the
nurse.
Idealisation could quickly turn to denigration and hatred in some patients who were
vulnerable in attachment terms, when their infatuation was not reciprocated by the
nurse.
“He is absolutely fantastic, and it meant a great deal to me that I got to know him
before I was released. I trusted him from the outset, because he gave me a lot of
support and advice and I can tell he was genuinely interested in how I’m
progressing.
"I had a recent case where threats were made by an offender towards someone else,
and that got passed on to the police. It made me very unpopular with him, and I
had to deal with that when he turned up being very threatening and aggressive.
Inter-agency working
Meetings with Forensic Mental Health Services to explain the project:
 We prioritise mental illness, and can only address Personality Disorder if
there are any resources are remaining.
 What treatment do you offer?
 We don’t accept referrals from probation officers.
 It’s not my role to supervise sex offenders in the community.
 Can we refer to you for treatment?
No cases referred so far.
Inter-agency working
Case example 1:
64-year-old Asian male, married twice and father to 10 children.
I.O. Indecent Assaults/Rape x 24 against daughters (4+) and their friends. Life sentence.
“Given the frequency of his offending (nearly daily) there was probably a level of
sexual preoccupation that dominated much of his life.”
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Claimed to have degrees in “Preparatory Medicine” and Psychology; had worked as a
Clinical Psychologist. Had also worked as an agent for a Life Assurance company, and was
in the “top 1%” of this profession. Had been a spy for the Government; offered to profile
fellow prisoners as he was an expert in biostatistics.
Probation Officer noted that his conversation was difficult to follow or interrupt. Emotionally
labile. Hostile and aggressive to prison staff. Grandiose and delusional. Believes PO is a
Muslim convert and wrote a letter of complaint to SPO because he wouldn’t admit it.
Unable to grasp seriousness of offending.
Psychiatric assessment:
“No mental health problems, but some evidence of Personality Disorder with Narcissistic traits.
Interagency working
Case example 2:
21-year-old Arab male.
I.O. Assaults/Battery against younger siblings, including attempted throttling and knife attacks.
Community Orders and Restraining Order. Reoffended whilst on bail. Siblings terrified –
either locked themselves in their rooms or fled the house. Parents wrote pleading for help.
Probation Officer’s observations:
Unable to understand other peoples’ thoughts and feelings. Discusses his violence with a
detached air, and lacks any understanding of the impact. Parents were wrong to call the
police over something “so small “. Shouted at them in English, Arabic and Norwegian that he
would “cut their heads off”. “There’s something wrong with him.”
CMHT: “Too high risk” for us to take on; “a psychopath”.
Forensic Mental Health: Referral took many months to process, meanwhile he reoffended.
“No mental illness”.
Social Services: Closed case, saying it was the mother’s responsibility to safeguard her children.
MAPPA Level 3: Probation Officer told by psychologist on panel to get a psychological
assessment.
Inter-agency working
Case example 3:
26-year-old White male.
I.O. Malicious Wounding, Possession of Offensive Weapon. Victim stranger outside a pub. H/o
Indecent Assault on a female under 14 (cousin). Also ABH and Common Assault. Truanted
from school; numeracy and literacy difficulties. No friends. Frequent police call-outs to the
home for violence against parents and antisocial behaviour. Known severe self-harm,
overdoses and alcohol misuse.
Probation officer referred to CMHT pre-sentence
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Psychiatrist wrote a letter to court but provided no report.
Case adjourned.
Probation officer chased up psychiatric report; no response.
Further adjournment.
Four months later, psychiatrist agreed to write a report. None received so far.
Probation Officer suggested meeting to discuss . No response.
CMHT has had three reshuffles since May 2013
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No process for providing reports to courts, except on a private basis.
Probation Officer only learns about appointments from offenders themselves.
Concerned about inability to plan appropriate Pathway in this case.
Inter-agency working
Case example 4:
23-year-old Asian male.
I.O. Attempted Rape & Sexual Assault x 3. Victim woman who lived in the same YMCA hostel –
went back a second time. 6-year determinate sentence. Previous drugs offences since age
13. Excluded from school. Mother unable to manage him. Denied offences.
Due for release early June 2014. Suspected by police of committing a series of rapes
against prostitutes: likely to be gate arrested. Level 3 MAPPA.
Behaviour in prison:
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Refused to engage in any programmes.
28 adjudications and many warnings. Periods in seg and HCC. Threats and aggression
towards staff and fellow prisoners; spitting; setting off fire alarm; keeping most of wing
awake. Cell “a disgusting mess”. Refusing to wash.
Bizarre , e.g. ringing cell bell constantly at night, wanting officer to set light to a HCC leaflet
and pass it through to him so he can light incense sticks; howling.
Female officers refusing to work on his landing.
Psychiatric assessment:
“Odd” but no mental illness. Recommended moving him to MH inpatients for observation, but not
done by MHIRT.
Some conclusions
1)
We still work in comparative silos.
2)
Other agencies - in this case probation – need our help to navigate the NHS.
3)
The probation service can’t say “no” (until the offender’s license has expired).
4)
Is a change in our practice required?
5)
Understanding the perspective of another agency requires a conscious effort
to mentalize.