Offender personality disorder pathway Intensive Intervention Risk Management Service (IIRMS): Barriers to engagement and a vision for the future
| DOI | 10.1177/0264550520979363 |
| Date | 01 March 2021 |
| Published date | 01 March 2021 |
| Subject Matter | Articles |
Article
The Journal of Community and Criminal Justice
Probation Journal
Offender personality
2021, Vol. 68(1) 47–63
ª The Author(s) 2020
disorder pathway
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DOI: 10.1177/0264550520979363
Intensive Intervention
journals.sagepub.com/home/prb
Risk Management Service
(IIRMS): Barriers to
engagement and a vision
for the future
Nicole Webster
and Stephanie Gardner
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
Abstract
As part of the national Offender Personality Disorder (OPD) pathway, Intensive
Intervention Risk Management Services are commissioned to offer the opportunity for
some eligible offenders to access individualised intervention to support their treatment
needs, upon their transition from custody to the community (Skett and Lewis, 2019).
However, it has previously been acknowledged that psychological services often fail to
reach offenders due to a range of potential psycho-social reasons (Byng et al., 2012;
NOMS, 2014; Skett et al., 2017). The current study aims to explore National Pro-
bation Service (NPS) and National Health Service (NHS) staff perceptions of the
Intensive Intervention Risk Management Service (IIRMS), within the Cumbria, North
and South Tyneside regions, including their perception of potential barriers to service
delivery. Further, areas of improvement that may overcome potential barriers to
engagement are discussed and comparisons are made to barriers identified to
engagement within other NHS/NPS partnerships pathways; specifically the Mental
Health Treatment Requirement (MHTR) (NOMS, 2014). Results indicate that the IIRMS
is useful. However, a number of staff barriers, service user barriers and barriers within
the method and delivery of the service were indicated. Results of the study offer the
opportunity for shared learning across the pathway and with other services engaging
with the most marginalised offenders within our society.
Corresponding Author:
Nicole Webster, Bamburgh Clinic St Nicholas Hospital, Jubilee Road, Newcastle Upon Tyne NE3 3XT, UK.
Email: Nicole.Webster1@justice.gov.uk
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Probation Journal 68(1)
Keywords
offender personality disorder, interventions, partnerships, probation
Introduction
The Offender Personality Disorder (OPD) pathway is a joint partnership between the
National Health Service (NHS), Her Majesty’s Prison Service (HMPS) and the
National Probation Service (NPS). It aims to support offenders assessed as having a
presentation consistent with a severe personality disorder (National Offender
Management Service and NHS England, 2015).
The pathway itself has evolved over the years. The current pathway programme
was initiated in 2011 and was developed from the Dangerous and Severe Personality
Disorder (DSPD) programme. Prior to the current pathway’s conception, a review of
the DSPD programme (Bradley Review, 2009) identified and outlined some areas of
required improvement. It concluded that there was not a clear pathway of care for
offenders presenting with personality disorder and that there was a limited focus on
early identification and community integration within the programme. The OPD
pathway aimed to address this by recognising the need for offenders to be managed
across a pathway that starts and ends in the community, and which understands the
nature of the complex needs of offenders with personality disorder (Skett and Lewis,
2019). Additional y, the pathway recognises that times of transition between services
may be particularly difficult for offenders with complex needs who may also suffer
with mental health difficulties (O’Meara et al., 2019).
Through co-commissioning the pathway jointly, it was recognised that there is the
opportunity to merge the expertise of the two distinct partners. This partnership aims
to promote a culture of innovative practice developments, enhancing traditional risk
management (Ramsden et al., 2016). This joined-up approach further aims to
support offenders’ transition between services and to minimise the potential for
offenders to experience services as fragmented and rejecting systems (Ryan et al.,
2019). By adopting a ‘whole systems approach’, it is envisaged that support can be
initiated as early as possible into an offender’s sentence and that this will enable
active participation within their care.
Following early identification, the OPD pathway aims to support practitioners
through consultation and formulation of the complex needs of the offender, and to
help inform sentence and treatment planning. Additionally, within community ser-
vices, the pathway offers the opportunity for some offenders to access additional
individual intervention to support their identified treatment needs (Skett and Lewis,
2019).
The IIRMS fulfils this requirement. It aims to support the outcomes of the OPD
pathway by providing a community based service that delivers individually tailored
and psychologically informed interventions directly to offenders, increasing access
to community resources for offenders transitioning into the community and reducing
the usage of secure NHS and independent sector beds where possible (OPD
Pathway IIRMS Specification, 2018; 2020).
Webster and Gardner
49
Intensive Intervention Risk Management Services (IIRMS)
The Guidance for Implementation of the IIRMS Specification (updated in September
2018 and again in April 2020) notes that IIRMS services should link with other
pathway services including Core Community Services, Psychologically Informed
Planned Environments (PIPEs), Housing and Accommodation Support Services and
Approved Premises. Further, the guidance proposes two key delivery aims: stan-
dard IIRMS delivery and enhanced IIRMS delivery, depending on the proportion of
funding available to the particular team delivering the service.
Standard IIRMS delivery should focus on a psychologically informed approach to
case management in which basic needs are prioritised, that is to say that IIRMS
should facilitate the development of opportunities for meaningful integration into the
community and access to appropriate supports and services (OPD Pathway IIRMS
Specification, 2018; 2020). Within this delivery the approach taken in determining
the intensity of intervention required, should be flexible and based on identified
need(s) at that specific time.
Enhanced IIRMS delivery should focus on delivery of more intensive psycho-
logical therapies over a period of 18–24 months, providing opportunities for
offenders to engage in a range of therapeutic activities and to become part of the
wider community (Ryan et al., 2019). This delivery will only be available in areas
where additional funding has been granted and once standard IIRMS has been
delivered (OPD Pathway IIRMS Specification, 2018; 2020). It is forecast that the
enhanced IIRMS delivery should only be made available to service users who have
an on-going psychological need relevant to reducing risk, have the capacity to
benefit from talking therapies and be excluded from mainstream NHS therapy
provision.
There are currently approximately 20 IIRMS services established nationally. All
have been developed individually and therefore have distinct formats. Prior research
published within this journal and elsewhere provide details of the approaches taken
by different services, service experiences and considers challenges faced (e.g.
O’Meara et al., 2019; Ramsden et al., 2016; Ryan et al., 2019).
The ‘Rebuilding Lives Standard IIRMS’, facilitated by the Forensic Community
Personality Disorder Team (FCPDT), in partnership with NPS, fulfils the role for
health services in the North East and Cumbria Regions, specifically Cumbria, North
Tyneside and South Tyneside. In this area, once an offender is screened and
accepted into the OPD Pathway, the health team work in partnership with the NPS
offender manager, within the core community service, to consult and create a for-
mulation which best supports the offender in the community. In a limited number of
cases, the team may offer individualised intervention sessions to an offender if he/
she meets the criteria for inclusion in the standard IIRMS service. The team aims
specifically to support successful transition to community services.
Once an offender is identified as potentially being suitable for IIRMS, a member
of the health team offers up to six joint working sessions with the offender manager
to assess engagement of the offender and to identify required intervention. IIRMS
intervention is then offered and may last up to 12–18 months, depending on need
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Probation Journal 68(1)
and engagement. The health team is made up of a range of practitioners, including
psychologists, occupational therapists, nurse practitioners and social workers, with
a range of qualifications in various therapeutic approaches, including cognitive
behaviour therapy, cognitive analytical therapy, psychodynamic approaches and
trauma therapies (for example, Eye Desensitization Movement and Reprocessing).
The key component of this standard IIRMS however is a relational approach, which
holds personality difficulties at its centre, and adopts a flexible approach to
intervention.
Engaging offenders within psychologically informed
services
However, there may be a range of barriers inherent within the delivery of IIRMS given
the complex nature and challenges facing eligible offenders. It has previously been
acknowledged that psychological services often fail to reach offenders due to a range
of potential psycho-social reasons (Adamson et al., 2013; Brooker and Glyn, 2012;
Byng et...
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