Page 1 of 6 Adolescent Forensic Psychiatry Special Interest Group (AFPSIG)
MINUTES
AFPSIG Meeting
Belfast
5.45pm, Thursday 6th March 2014
1. Attendance & Apologies Attendees: § Ollie White (Chair) § Enys Delmage § Paul Monks § Jenny Shaw (research discussion only) § Feroza Saheb § John O’Brien § Suzanne Coghlan § Kavita Praveen § Sarah Whitaker § Lynne Daley § Nert Sind § Hannah Kate Williams § Michael Crawford § Mehdi Veisi Apologies § Nick Hindley § Cesar Lengua § Peter Misch § Richard Church § Alixe Lewis 2. Minutes from last meeting in Edinburgh, September 2013 Discussed and approved. Page 2 of 6 3. Update from Executive Committee Community (Nick Hindley) § NH unable to attend meeting but the following update was provided in advance via email: o Community FCAMHS being considered as the appropriate model for ‘outreach’ services within the NHS England Secure CAMHS commissioning agenda. Further pilot work as a ‘spend to save project’ due to be undertaken in the next year. If successful, this may inform future national commissioning of such services o Some CAMHS and FCAMHS services have taken on the police point of contact youth justice liaison agenda and are commissioned to provide the C and A limb of this project (commissioned by Health and Justice (formerly Offender Health) following the Bradley Report) Finances (Ollie White) § Current balance remains stable at approximately £1,400 § No recent expenses or sources of income § Annual one-­‐day conference is main income and expenditure Higher specialist training (Ollie White) § There remains only one dual training scheme -­‐ at Oxford Deanery. § The C&A and Forensic Training Programme Directors in the Wessex Deanery have expressed an interest in developing a dual training scheme in the near future. § OW and SC are aware of 1-­‐2 trainees who are currently undertaking “double training – i.e. full higher training in one speciality immediately following completion of training in the other speciality. Website (Richard Church) § RC unable to attend meeting but the following update was provided in advance via email: o The AFPSIG RCPsych website has been updated with basic details (e.g. new AFPSIG Executive Committee members) but a broader review of the whole website would be a good idea. Please send me any ideas. o A suggestion from me...I think it would also be a really good idea to re-­‐instate a Newsletter, even if twice yearly ("Winter" and "Summer" ?) Any volunteers...? Or ideas for an interesting name for the publication? (e.g. "Grounded" -­‐ which could refer to evidence based medicine, psychological/psychodynamic needs for practitioners in the field, and an informal term for a parental curfew!) Medico-­‐legal (Peter Misch) § PM unable to attend meeting but the following update was provided in advance via email: o Legal aid funding cuts have been cutting incrementally deeper and deeper with the the latest cuts hitting in December 2013 decreasing to £72 for a criminal case for London based psychiatrists. The LSA are generally not approving higher rates even for complex forensic cases. o I do not have any objective evidence of the impact of this but can only imagine that it will result in a degradation of medical expertise for those who can not afford to pay higher fees Page 3 of 6 §
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LD stated that the cut in legal aid funding is such that prisoners are no long able to receive funding for legal assistance regarding prison adjudications. It was agreed that this was a particular issue for vulnerable young people. LD advised that those aware of specific cases where this is an issue should highlight to the prison governor, who can request the appointment of an independent adjudicator. Concern was also expressed about the fact that legal representative are paid a flat fee regardless of whether the defendant pleads guilty or not guilty, and that this may result in undue pressure being placed on vulnerable young people to plead guilty. ED reported that the House of Lords are currently considering a Bill regarding the minimal age of criminal responsibility o This has been informed by the discussions and subsequent publications following the last AFPSIG conference ED also noted that he continues to liaise with the Law Commission regarding the promotion of the introduction of Developmental Immaturity as a specific defence o LD suggested that he links with the lawyer Laura Janes re this. LD reported that she is currently undertaking a investigation into a specific case of a young woman who was in custody 10 years ago via a s.91 sentence, whose mental health needs were not adequately recognised o She is considering a recommendation that any psychiatric court reports for adolescents who are facing s.91 sentences should be conducted by a psychiatrist with specific expertise in adolescent forensic psychiatry. o This was welcomed by attendees at the meeting. Independent Sector (Paul Monks) § A further meeting of psychiatrists working within young people in secure settings within the independent section is planned – date to be arranged. § It was reported that the national bed crisis in Tier 4 CAMHS is having a significant knock-­‐on impact on demand for low-­‐secure and PICU beds within the independent sector. Forensic Developmental Disability (Ernest Gralton) § No update Prisons (Alixe Lewis) § AL unable to attend meeting but the following update was provided in advance via email: Population issues o The closure and re-­‐rolling of YOIs and reduction in the number of STC beds has continued to have an impact on the nature of population within the remaining secure establishments. Whilst the overall numbers of under 18s in custody or secure care have dropped by 34% over the last 5 years, those who are remanded or receive custodial sentences have higher levels of mental health need and exhibit more disturbed behaviour. o At HMYOI Feltham we have noticed an increase in the number of 15 year olds we are receiving over the last 6 months and observed that those received seem to exhibit a higher than usual level of challenging behaviour and violence. Page 4 of 6 o HMYOI Feltham is now taking sentenced prisoners up to aged 23 years old. As a result of the rising levels of violence and gang issues at HMYOI Feltham there was a plan that all remand 18-­‐23 year olds should go to the adult London prisons and not come to Feltham. It was hoped that the resulting move to a sentenced prison would increase stability within the prison. However, a practice has developed whereby any remand prisoner aged 18-­‐23 who is deemed to be ‘vulnerable’ or ‘risky’ or ‘challenging’ is sent to HMYOI Feltham so the prison is in fact seeing an increasing level of behavioural instability. New screening tool for use in YOIs/STCs o The main issue the secure establishments are facing is the introduction of a new screening tool for all those aged under 18. The Comprehensive Health Assessment Tool (CHAT) has to be implemented across the secure estate by Spring 2015 but HMYOI Feltham has been told that the commissioners wish it to be used from April 2014. o CHAT comprises a screening tool to be done within 2 hours of reception followed by additional screening tools covering physical health (to be done within 3 days), substance misuse (within 5 days), mental health (within 3 days) and neurodisability (which includes head injury/ ASD/ LD but not ADHD) (within 10 days). o The tool has been 10 years in development and has been piloted at HMYOI Hindley (a small training prison with approx 10 receptions/week). It was evaluated by OHRN who published their findings in Sept 2013. The evaluation found that there were a number of implementation problems particularly the need for staff to be experienced RMNs & RGNs in order to administer it correctly, the amount of time administration took, the way the tool removed clinical judgement as it has pathways that must be followed and does not allow for any clinical discretion, duplication of effort and the number of false positives raised (especially for ADHD, learning disability and educational problems and anxiety). o At HMYOI Feltham we have 60-­‐70 new receptions a week and have great concerns as to how we can implement this tool. Our concerns are not only related to completing the screens but also to how we can respond to any needs identified given that many of our resources will be diverted to completing the screening process. o The YJB plans to extend use of the tool to screen all young people referred to YOTS and there has also been a proposal to pilot it with the 18-­‐23 year old population. Scotland (Aileen Blower) § No update § It was noted that Aileen Blower has moved to a different post and it was thought that she is no longer directly involved with Forensic CAMHS in Scotland. A new AFPSIG rep for Scotland may therefore be required. Forensic Faculty Liaison (Cesear Lengua) § No update Child & Adolescent Faculty Liaison (Abdullah Kraam) § No update Page 5 of 6 Senior Trainees (Suzanne Coghlan) § As per Higher Specialist Training update 4. Update re national specialist commissioning developments OW and PB gave feedback from the Secure CAMHS Clinical Reference Group § Focus to date has been on developing low secure service specification § Community services are being considered within the context of outreach services (see above). § Attention is now turning to the development of PICU service specification § Consideration has also been given to highlighting relative strengths, weaknesses, opportunities and threats (SWOT analysis). § There has been some recent thinking regarding future (5-­‐year) planning, with various themes being submitted to the overarching mental health Programme Board. 5. Research ED reported on two research projects that are currently being planned: § fMRI study of conduct disordered female adolescents o International study hosted by Birmingham University o Dr Stefane De Britto is lead researcher o Initially with a community focus, but also likely to include inpatients § Outcomes post discharge from adolescent secure hospital o UK Multicentre research project lead by St Andrew’s o ED is lead o Ardenleigh (Birmingham), Alnwood (Newcastle) and Bluebird House (Southampton) also planning to participate o Currently at stage of obtaining ethics approval Professor Jenny Shaw from the Offender Health Research Network in Manchester attended the meeting for this agenda item. She reported on three relevant projects: § Development of Comprehensive Health Assessment Tool (CHAT) o Now complete (see Prisons update above) § Screening of mental health and neurodevelopmental difficulties in 8 year olds in school § Using the SAVRY as a measure of outcome at point of discharge from adolescent secure units o Charlie Lennox lead researcher o It was discussed that this could potentially link very well with the planned outcomes research as described by ED above § It was agreed that ED would link with Charlie Lennox Wider collaboration between the AFPSIG and the Offender Health Research Network was discussed § ED gave some background to the developing research group that was formed at the last AFPSIG meeting § It was noted that the case register of outcome data from the medium secure network is no longer maintained, although the network is collating more details outcome measures in a coordinated manner. Page 6 of 6 §
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It was emphasised that clinicians within the AFPSIG have various research ideas, but would benefit from guidance and support from researchers. Jenny Shaw reported that the Offender Health Research Network would potentially be able to provide support and guidance. ED and JS will link further. 6. Next AFPSIG conference This has been arranged: § Theme is Young People and Secure Provision: A review of the current legal, clinical and sociological situation with a view to the future.
§ Wednesday 12th March 2014 at the RCPsych, London. § Further details on the AFPSIG website page on the RCPsych website.
§ Places still available.
7. EFCAP Conference, Manchester, 7-­‐9 May 2014 § The biannual European Association for Forensic Child & Adolescent Psychiatry (EFCAP) conference will be held in Manchester on 07 to 09 May 2014 § Entitled: “Youth, Risk and Mental Health: Multiple Roads to Recovery” § The programme is being finalised § There will be reduced rates for trainees § There was discussion regarding AFPSIG sponsorship of a CT1-­‐3 trainee to attend the meeting o It was agreed that an essay would be a good way of selecting who would attend o It was suggested that there should be no set title for the essay, but that it should be within the broad theme of Child and Adolescent Forensic Psychiatry o NH and OW will discuss further 8. AOB § It was noted that the RCPsych offer a bursary for a trainee to complete a period of special interest abroad o It was agreed that applicants from within the AFPSIG would be welcome 9. Next AFPSIG Meeting § There will be a meeting at the Annual Meeting of the RCPsych Forensic Faculty o September 2014 in Cardiff § It was also suggested that there should be a meeting at the EFCAP Conference o May 2014 in Manchester o OW will d/w NH Minutes by Ollie White March 2014