The Beacon - HMP Garth

Personality disorders are particularly prevalent among people in prison. According to the Prison Reform Trust 62% of male and 57% of female sentenced prisoners have a personality disorder. Treatment intervention on the Beacon is based upon attachment and trauma models of personality development and disorder and also recognises and is informed by bio-psycho-social models.

The treatment model

Treatment intervention on the Beacon is based upon attachment and trauma models of personality development and disorder and also recognises and is informed by bio-psycho-social models of the same.

The over-riding therapeutic framework for service delivery is Livesley’s (2012) phases of treatment which are aimed at facilitating gradual and progressive skill-building before entrenched patterns and difficulties are addressed. The appropriate treatment planning and sequencing is proposed as necessary to match an offender's needs at different stages of his recovery; thus the focus and intensity of interventions may change during the pathway and will be responsive to the individual. The promotion of social inclusion, hope and empowerment for change are central tenets of the recovery-based philosophy.

How do we do it?

The Beacon provides a programme of specific treatments following the structure outlined by Livesley (2012) (see below) that are founded on principles of therapeutic change and utilise specific treatment methods derived from evidence-based therapies such as cognitive analytical therapy, schema therapy, cognitive behavioural therapy, mentalisation and mindfulness therapy. In addition to the more psychologically-based treatment methods, a variety of other treatment interventions are provided including occupational therapy, creative therapy, nurse therapy and social work. All interventions offered are aimed at enhancing positive interpersonal relationships and functioning, reducing risk and improving psychological wellbeing.

Livesley’s (2012) phases of treatment:

• establishing safety
• containment of symptoms
• regulation and control
• exploration and change
• integration and synthesis

How is it assessed?

Progress in treatment and therapy is reviewed through pathway meetings and staged review meetings. Pathway meetings take place monthly and focus on reviewing treatment goals as well as recognising positives and identifying any difficulties individuals may be experiencing. The staged review meetings take place at 3 months, 9 months, 18 months and 23 months involving all professionals within the individual’s core team alongside the offender manager. The meetings aim to get a more detailed understanding of an individual's risks, strengths, difficulties and the treatments most likely to be helpful to him as he progresses through the programme.

An important element of treatment is the focus on interactions, particularly between staff and prisoners. This aim is to promote a safe, positive and empowering environment, effective functioning and relationships, and reduce the potential and need for risk and offending behaviour as ways of coping and relating.

What is an enabling environment?

• A place where people live, work or come together for a specific purpose.
• It enables participants to feel safe enough to develop relationships and to share experiences and ideas with others.
• It allows individuals to be involved in making decisions on matters that affect them and support them to take risks and be open to new ideas and relationships.

The ten standards which outline the core values of a healthy environment are:

1. Involvement - Staff and residents share responsibility for the environment.
2. Boundaries - There are expectations of behaviour and processes to maintain and review them.
3. Structure - Engagement and purposeful activity is actively encouraged.
4. Belonging - The nature and quality of relationships are of primary importance.
5. Safety - Support is available for both staff and residents.
6. Openness - External relationships are sought and validated.
7. Communication - It is recognised that people communicate in different ways.
8. Development - There are opportunities to be spontaneous and try new things.
9. Leadership - Leadership takes responsibility for the environment being enabling.
10. Empowerment - Power and authority are open to discussion.

Our enabling environment

A fundamental aspect of treatment on the Beacon is the focus on the day to day therapeutic environment or milieu (every contact counts’ and ‘every interaction is a potential therapeutic interaction). The aim of this is to develop a culture which is aware of the role of current interactions as an opportunity to learn.  

We aim to do this by upholding the ten standards of an enabling environment (see above) allowing for a safe, supportive and enabling environment for all who live and work on the Beacon. We also run the further enabling the environment group which aims to maintain and enhance the enabling environment by working through areas of the Beacon that the community feel need further review.

The community have identified the following expectations which are inclusive of both staff and prisoners:

• The need to respect each other’s right to privacy and personal space
• The need to listen to and respect each other’s views/thoughts/feelings
• To maintain confidentiality
• The need to respect an individual’s right to engage in groups
• To support and encourage each other to try new things and take positive risks
• The need to create an environment where people feel confident to speak up
• Everybody has a shared responsibility towards the environment
• The need for individuals to feel valued on the Beacon
• To ensure that people feel safe within the environment of the Beacon
• The need for people to feel empowered

The Beacon is a multi-disciplinary team comprising of a range of disciplines bringing specific expertise, including:

• Clinical lead for the service (responsible for the overall care and interventions)
• Operational manager (responsible for the management and organisation of the service)
• Custodial manager (responsible for the management and organisation of prison staffing and resources and the links between NHS and prison staff)
• Prison officers (the officers have a wide range of skills and training and are dedicated officers for the Beacon)
• Consultant psychiatrists
• Clinical psychologists
• Occupational therapists
• Creative arts therapists
• Social workers
• Psychological and occupational assistants
• Nurse therapists
• Admin support.

The staff team here at the Beacon is made up of individuals from a wide range of professions including admin staff, prison officers, psychiatrists, psychologists, occupational therapists, social workers and nurse therapists. Each staff member holds a role within the unit that is specific to their discipline but also holds a more general practitioner role. Both roles are viewed as equally important in supporting the residents on the unit.

Core practitioner role

Every staff member is expected to adopt this approach. This approach is an attempt to maximise the therapeutic potential of every interaction. It involves validating the experiences of others, sensitively challenging/exploring the men’s clinical and risk presentations and utilising core psychological principles and techniques to achieve the same.

Team secretaries

This role involves receiving referrals at the first point of contact with the referrer, collation of information and providing an administrative service for the team and the service. In addition they are involved in all procurement activities, minute-taking, work as PA to the clinical and operational leads, and supporting the organisation of the staffing rota to ensure that cover is provided at all times.

Clinical lead

The role of the clinical lead is to develop, manage and ensure the delivery of systematic, comprehensive and coherent clinical interventions and a clinical programme which is consistent with the model of intervention as outlined within the service specification for the Beacon. The clinical lead also has responsibility for ensuring the programme is up to date with developments in research and the evidence base for personality disorder treatment and risk management. The clinical lead ensures appropriate supervision, training and support for all members of the team to maintain an effective and appropriate clinical programme. This work is undertaken in partnership with operational managers across the clinical and officer team and with colleagues within the offender PD pathway.

Clinical operational manager

The role of the clinical operational manager is to take lead responsibility for the development, operational management and day to day delivery of the HMP Garth offender personality disorder service, in partnership with HMP Garth key prison personnel. The post-holder maintains an integral role within the partnership to ensure key elements and deliverables are met in accordance with the key principles underpinning the DH and MoJ charter for offender personality disorder services.

Custodial manager

The custodial manager is responsible for the operational running of the service as well as the management of all operational prison staff working on the Beacon. The post-holder ensures that the Beacon operates as a partnership between HMPPS and Mersey Care NHS Foundation Trust and adheres to prison rules, policies and procedures. The custodial manager also has responsibility for delivering staff briefings, attending meetings and ensuring security reports are received and compacts are signed and agreed prior to a prisoner's transfer to the Beacon. Alongside this, the post-holder will also participate in Beacon reviews and referral meetings and in the interview and selection process of both clinical and operational staff.

Prison officer/key worker

A hybrid role that involves prison officer duties whilst also working collaboratively as a core practitioner with clinical staff within the service.

Psychiatrist

To provide assessment of men referred to the service and to provide assessment and consultation regarding mental health difficulties experienced by residents on the unit, including assessment for medication.

Psychologist

Psychologists in the service work to support both staff and residents in developing a psychological understanding of the type of difficulties experienced by residents and to implement effective psychological interventions. This involves providing 1:1 and group psychological sessions to develop an understanding of the men’s experiences and needs and working collaboratively with all other disciplines in the development and implementation of interventions to bring about positive change and reduce risk.

Assistant psychologist

Assistant psychologists on the unit work under the supervision of qualified clinical psychologists. Assistant Psychologists provide support to residents throughout their time on the Beacon, working collaboratively to develop an understanding of their experiences and provide psychological intervention to support residents in bringing about positive change.

Occupational therapist

Occupational therapists on the unit provide activity and meaningful occupation to develop skills, work towards goals and identify interests through adaptation of activity and providing support to remove barriers to engagement. For further information on occupational therapy please see Appendix 1.

Occupational therapy assistant

Occupational therapy assistants deliver structured and meaningful activity sessions for residents following recommendations from Occupational therapy staff generally based around productivity and leisure occupations.

Social worker

Social workers on the Beacon support the men to develop and maintain relationships with families/friends and wider social support networks. This can be achieved through 1:1, group work sessions and undertaking home visits to family members in the community. This can support the men to repair and build relationships with family members as part of their overall treatment plan. Regular liaison with offender managers and external agencies also allows for a multi-agency and collaborative approach to an individual’s treatment plan. In addition, safeguarding plays an important role of social work on the Beacon, helping people with care and support needs to live lives free from abuse and neglect. This includes working to prevent abuse, minimising risk without taking control away from individuals, and responding proportionately if abuse or neglect has occurred.

Nurse therapist

Nurse therapists at the Beacon work closely with all disciplines, both within the Beacon service and also providing an important liaison service with the wide prison healthcare team. The role involves 1:1 and group work with residents, looking at both mental and physical health needs. In addition, nurse therapists on the unit offer 1:1 structured psychological therapy.

Art therapist

Art therapy is a form of expressive therapy that uses the creative process of making art to improve a person’s physical, mental and emotional wellbeing and help to resolve issues as well as develop and manage behaviours and feelings. It can reduce stress and improve self-esteem and awareness.

The overall aim of practitioners is to enable a client to effect change and growth on a personal level through the use of art materials in a safe facilitating environment. The art therapist will often work on a 1:1 basis with residents

Some of our residents and officers share their experiences on the Beacon

A former resident writes of his experiences on the Beacon:

My time on the Beacon has been far from easy, but it has definitely been worth every minute. The person I am today as opposed to the person I was on my first day, the contrast is astonishing.  For me the Beacon has been a place where I have learned and been allowed to find my identity in a settled and safe environment.  So grateful am I to all of the staff who work here.  They are good staff and of the many therapy units I have been on, the Beacon has been by far the most rewarding.

Thank you

“I’ve benefited and progressed and learned a lot more about myself and PD and things I couldn’t deal with in the past”.

“The Beacon is a supportive environment where I’m helped to reflect on my troubled past and getting support on how to make sense of it”.

“The staff respect you, when you need help you’ve got support from them”

"It’s the easiest jail you’ll do and also the hardest”

“It’s a funny environment, it’s serious when it needs to be serious and the activities are fun and you get rep roles. The staff are fun to be around. They can have a laugh, it’s a more relaxed environment.”

“Try it, you’ve got nothing to lose.”

“Working on the Beacon can be challenging at times but can also be very rewarding. The thought of being influential in changing somebody else’s life can be profound.”

Officer

“Give it a try. You get out of it what you put in.”

“It’s given me confidence to talk openly with clinical staff.”

“The Beacon has given me insights into my behaviours and the causes of them and a better understanding of my life. Living with individuals can be challenging but you’ve got to expect that in a unit like this.”

If you’re prepared to take a look at yourself and you want to change, it’s not going to be easy and at times frustrating, but if you persevere it will be worth it”