Diary Of A Forensic PWP

Hello and WELCOME to PsychAssist. We have a truly SPECIAL article for you today and one that is very unique. This week’s guest article is by Sarah-Jayne Holmes who is a PWP working within the prison services. Now we don’t know about you, but we have never heard of PWP’s working in these types of environments so this story really stood out for us. Within this article, Sarah gives you a brief insight into her daily life as a Psych Grad working therapeutically within an unfamiliar setting. We hope you enjoy this one as much as we did.

 

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I qualified as a Psychological Wellbeing Practitioner (PWP) in 2013, after studying the Postgraduate Certificate in Low-Intensity Psychological Therapies at Nottingham University. Following my initial role in community IAPT teams in Lincolnshire, due to wanting to be closer to home, I accepted a role at HMP Lincoln. On my first day, it all felt a little alien, from leaving what I could only describe as neat, magnolia NHS offices and clinic rooms, to an imposing, gothic establishment, decorated handsomely with razor wire, locked gates and the echoing sound of voices, resonating through an abundance of radios. My first walk on to ‘A’ wing, was an experience I will never forget, it was association period and the noise levels were intense. I felt very alone and the eerie feeling of being stared at, from all four landings, was a little unnerving. I initially found it most odd, being referred to as ‘Miss’ and had to practise the addressing of other members of staff on the landings as Mr or Miss too.

 

The role of the PWP tends to alter slightly in different establishments, with regards to the number of assessment and treatment sessions; however we work on the expectation of meeting a target of 7 contacts a day. Appointments are booked back to back in blocks, fitting in with the regime and lock up times of the prison. Instead of being a stand-alone service like IAPT in the community, the mental health office is part of an integrated team within the healthcare department. We work alongside, nurses, psychiatrists, GPs, dentists, opticians and physiotherapists. This enables a continuity of care within the setting and a faster referral process which, in turn promotes collaborative working and as a whole team, we meet at daily handovers to discuss concerns for clients and events of the day. We will also liaise closely with prison staff, safer custody, activities, education and chaplaincy, to aid the collaborative approach.

 

There are many challenges to be aware of for a PWP working within a prison setting, very different to those faced in the community. Incidents on the wings can escalate to a point where all movements are stopped, meaning all appointments have to be cancelled. Some clients have difficulty reading and writing, resulting in a need to adapt sessions by using drawings and pictures to discuss interventions and support. In a local remand prison, offenders can be transferred within days/weeks, effecting engagement and creating a need to handover to other prisons. The restrictive setting can also create a necessity for adaptation to interventions, for example CBT for insomnia can be difficult in a shared cell and certain aspects of exposure therapy may possibly have to be discussed further with senior officers.

 

In the community, IAPT clinicians refer on to secondary nursing and psychiatry. Behind the gates however, we can work alongside secondary, sometimes to reduce symptoms for clients presenting with acute anxiety from psychosis, persecutory thoughts, even dual diagnosis. Symptom reduction can have a profound effect on reducing self-harm and suicidal ideation for secondary and primary clients, helping them to build on coping strategies. There is no crisis team to refer to, as we would have in the community, someone who presents as a risk to themselves or sometimes from others, are supported by the ACCT process, a prison document which is opened when risk is identified. The client’s risk is assessed and observation checks are agreed, with regular, supportive appointments attended by a senior officer and a member of the mental health team.

 

There is a considerable importance for transparency working within a forensic environment, for collaboration with the officers and prison staff and also due to the nature of the PWP role. PWPs build strong, therapeutic alliances to aid recovery, therefore a need for strict boundaries and agendas must be set, being mindful of potential risk scenarios. We need to be aware of possible manipulation and not to show preference, which can create a deal of animosity between offenders. There are significant challenges to the role, we can be subject to verbal abuse and aggression and we do witness traumatic events, scenarios we would probably be very unlikely to see outside the gates. It helps to remember there is always a reason behind all behaviour and an ability to see things holistically can help calm down a situation. Maintaining an awareness of using supervision effectively for these situations is paramount.

 

Working within offender health is a challenge, no two days are the same but it can be immensely humbling and rewarding to witness someone, who has had little support or compassion throughout their lives, suddenly address positive change, slowly through their sessions and begin to realise they can have a significant, positive impact on their future. It is not a role for everyone and is a true vocation, you either love it or hate it but for the right-minded person, it can be a truly fulfilling and purposeful role.  It took me six months to settle in to prison life, questioning whether I had made the right decision, however I look back now and feel so happy I stuck with it. I have made some amazing friendships with colleagues on the way and not only that, I have learnt a new language, the prison language, a diverse concoction of lingo used across establishments such as ‘double bubble ’, ‘on the road’ and ‘bang up’. It certainly is a different career, which can be a very colourful and rewarding one. One that requires a deal of compassion and empathy, from this come the rewards of the biggest smiles and thank you’s and the knowledge you may have supported someone to turn their life around.