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S.E. Scotland
Forensic Addiction
Services
Dr Alistair Morris
Consultant Forensic Psychiatrist
NHS Fife
15th March 2013
Fife
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Elements of Fife wide service – overview
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Triage Assessment
Established in 2007
Regular drop-in clinics throughout Fife staffed by third sector agencies.
Designed to improve access into appropriate services for those seeking
help with alcohol and/or drug problem
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Provides initial assessment to;
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establish which intervention or service would best suit an individual
signpost or refer on to appropriate services/agencies including addiction
services
prison liberations, in order to reduce the risks of overdose and drug related
deaths and streamline services, to ensure continuity of care. Individuals will
be provided an appointment with 24-48 hours of liberation.
Fife Addictions Services 2
Forensic Drug Treatment Team
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Work with patients on a court order
at risk of custody
Evidence of a direct link between
their drug use and offending
behaviour (thefts etc.)
Intensive input by nursing staff
Treatment plans same as CDS
Progress discussed regularly with
the sheriff
Fife Addictions Services 3
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1-1 individual sessions for motivational interviewing / relapse
prevention Naloxone & overdose risk assessment and training.
Community alcohol detoxification / assessment for tier 4 inpatient
services
Community drug detoxification / maintenance treatment for
Opiate / benzodiazepine dependence.
Public Health Nurse in Addictions – currently being reviewed,
however there are link workers for child protection who have
monthly core group meetings.
Partnership working – work with 3rd sector agencies, providing
psychological interventions and support and guidance. Other
health professionals dealing with both mental / physical health
needs.
Forth Valley
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Tiered structure to addictions service –
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Criminal Justice Drug Treatment Service incorporating DTTO and Community Payback
Order with addictions treatment requirements.
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This interfaces with;
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CADS (for complex drug/alcohol problems with concurrent complicating issues such
as severe mental health problems /child protection concerns).
Addiction Recovery Service - more stable caseload group, working actively towards
recovery.
Signpost Recovery and Addictions Support and Counseling - through which we access the
community rehabilitation programme, and for transfers at the end of the Orders dependent upon the individual issues and the progress made during the Order.
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Occasional joint outpatient work between any of above Substance Misuse Services and
forensic CMHS on a case by case basis where need dictates and shared cases via
enhanced CPA.
Forth Valley 2
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Psychological therapies –
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Consultant Clinical Psychologist and an experienced trainee clinical
psychologist within the substance misuse service.
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Pilot trauma group for women, joint with CMHT. This group is based on
the Trauma, Recovery and Empowerment Model (TREM) and is part of
a Scotland-wide research project. Specific work is also being
undertaken with female substance misuse treatment clients, with at
least one criminal conviction, who are participating in a study asking
them about their experiences with social relationships in relation to their
substance misuse and criminal behaviour.
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We work collaboratively with the prison medical staff around joint
protocols and ways of working through the clinical governance
prescribing subgroup but do not clinically 'in-reach' as such.
Borders/Dumfries
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HMP Dumfries has an Addictions Nurse who assesses for
alcohol and/or drug detox, dispenses methadone and other
medications including Pabrinex. She also provides Take Home
Naloxone training prior to release, harm reduction advice etc.
3 Through care addictions workers previously employed by
Phoenix Futures, now TUPE'd to the NHS who cover the
transition between prison and community.
ADS alcohol counsellor (half time) who does 1:1 and group
sessions.
Smoking Matters do work in the prison re smoking cessation.
Edinburgh
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NHS Lothian only have the Orchard Clinic medium secure unit (no low secure
facilities or forensic mental health team) so most interventions outside Orchard
Clinic might be termed 'non-forensic'.
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Within the Orchard Clinic forensic service, Psychology run a drug and alcohol
group on a rolling basis which it is hoped most patients will be able attend at
some point. Psychology also see people for individual drug and alcohol work as
required. Outside of these forensic services, NHS Lothian has multiple
resources that we can link in with. There are multidisciplinary drug and alcohol
teams in local areas. (See attachment - This is a bit out of date but gives you the
general shape of things).
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For severe cases there are detox services and a Residential Referral
Team. This team is for people who have tried everything available in the
community but continue to have major problems. They are put on a residential
programme for several months designed to help them adjust to life without
alcohol/drugs. It also encourages them to examine their past behaviour
and manage their lives better.
Edinburgh
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Lothian's & Edinburgh Abstention Project (LEAP)
Semi-residential NHS Minnesota Model Drug & Alcohol Rehabilitation Unit
Addiction as a stress induced bio-psycho social disease.
Chemicals as midbrain solution.
Prior to chemicals…behavioural defence mechanisms which are ….anti social!!!! Hence
forensic!!!
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Treatment:
Detox (remove chemicals)
Cognitive behavioural change (dismantle defence mechanisms and develop healthy
ways of functioning) – Group therapy; AA/NA meetings; “Stay out of jail group”
12 weeks to reinforce change
Aftercare
Mutual aid
Recovery community
Recovery house
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Abstinence not possible if behaviours are dysfunctional (forensic)
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Fin