Dr Arden R Tomison

1
Welcome

• Dr Arden R Tomison
• Consultant Forensic Psychiatrist
• Clinical Director-Secure Services AWP
• Pathfinder Team Lead

2
The Pathfinder Team

• A Specialist Service for the Community Care
  Treatment of Offenders with Personality Disorders
  where violence is a prominent feature

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PERSONALITY DISORDERNO LONGER A DIAGNOSIS OF
EXCLUSION

• NIMH(E)
• www.nimhe.org.uk

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48 ppReview of prevalence
diagnostic featuresScope of current
servicesUsers requestsReview of Treatment
EfficacySynopsis of proposed new MHARecommended
service models - G.A.
Psych. - ForensicStaff
Selection, Supervision, Education and Training
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Epidemiology

• Prevalence correlates of personality disorder
  in Great Britain
• Coid et al
• British Journal of Psychiatry 2006
• Vol 188 pp 423-431

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Cluster A - odd Paranoid
eccentric Schizoid SchizotypalCluster B
- dramatic Histrionic emotional
Narcissistic erratic Antisocial B
orderlineCluster C - anxious
Obsessive-compulsive
fearful Avoidant


Dependent

• Definition

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Epidemiology

• Prevalence 4.4 men5.4 women3.4

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Epidemiology

• Cluster C 2.6
• Cluster A 1.6
• Cluster B 1.2 men 1 women 0.2

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Correlates

• Cluster A separated/divorced
• unemployed
• low S/E groups
• low income
• ho LA care in childhood
  (x3)

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Correlates

• Cluster B younger
• male
• separted/divorced
• low s/e groups
• co-morbid mental
  illness
• criminality/imprisonment
  
• ho LA/institutional care

11
Correlates

• Cluster C few distinguishing features
• relative economic
  inactivity
• ? Co-morbid anx/dep
• ? More generic
  counselling

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A Tiered Approach

• Tier 6-DSPD
• Tier 5-Secure Care Forensic
• Tier 4-Specialist IP (non-forensic)
• Tier 3-Intensive Day Services
• Tier 2-Community-based PD-specific
• Tier 1-General services

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Development of Service to date

• Forensic Psychotherapy SpR Training Scheme
• MDT commitment to Psychological Therapies
• MDT cohort trained in DBT
• Integrated model of service delivery
• PD Interest Group established
• Pathfinder Team Established