Containment in the Community

David Reiss, MA, MBBChir, MPhil, PgD, FRCPsych, FAcadMEd, is a Consultant Forensic Psychiatrist, West London Mental Health NHS Trust and Honorary Clinical Senior Lecturer, Imperial College London. His research interests are in the interface between clinical forensic psychiatry and public policy, including work on personality disorder, recidivism, homicide inquiries and educational issues. His clinical and educational work focuses on enabling the multidisciplinary team to gain an enhanced understanding of patients, thereby improving care and reducing risk. Alla Rubitel MD MRCPsych, is a locum consultant psychiatrist in forensic psychotherapy at the Portman Clinic and locum consultant psychiatrist in psychotherapy at the Gordon Hospital, Central and North West London NHS Foundation Trust. Her interests include psychoanalytic approaches to understanding and treating patients suffering from perversions, violence and delinquency, offenders with personality disorder, supervision and teaching of medical and non medical staff, and research on the Adult Attachment Interview. She is a psychoanalyst in private practice.

Contributors:John Adlam, Jina Barrett, Ruth Berkowitz, William Crouch, Oliver Dale, Rob Hale, Gabriel Kirtchuk, David Morgan, David Reiss, Rosemary Richards, Alla Rubitel, Christopher Scanlon, Mike Solomon, Philip Stokoe, Richard Taylor, Jessica YakeleyWith a foreword by R.D. HinshelwoodThis volume is designed to support the day-to-day practice of all staff working in the community that need to support individuals who manifest antisocial behaviour often complicated by chronic mental disorder, or people whose presentation causes similar stressful dilemmas. The book draws on experience gained across a wide spectrum of settings: within the NHS, the National Offender Management Services (NOMS) and the wider criminal justice services, as well as various services for children, young people and their families.The subject matter of this text covers antisocial, offending and challenging behaviours: in particular behaviours that create unusual levels of anxiety in practitioners or the public. Valuable insights are offered, with examples, into ways of thinking about these problems and practical guidance is offered on the way professional teams and the individuals within them can develop and maintain effective work. Whilst not explicitly focussed on those identified as having a personality disorder, the material concerns individuals with psychological difficulties that are pervasive, enduring and which have a particularly intrusive impact on caring staff members working with them.This book is a valuable contribution to service improvement and provides essential support for our ability to provide effective intervention and a more capable workforce to assist those with complex and often challenging needs.'It is an exceptionally difficult task for practitioners working in this complex and demanding field to find the time and space to think reflectively about the challenges and anxieties they face. Containment in the Community achieves the rare and enviable goal of facilitating a wide-ranging therapeutic discourse, and at the same time never loses its focus on the application of good clinical practice for real people in real settings. This book should be read by anyone with an active interest in forensic mental health services.'- Michael Howlett, Formerly Director, The Zito Trust'The criminal justice system is swamped with people, of all ages, suffering from some form of mental health problem, for whom too little is done. Fundamental to any action are trained mental health practitioners. This collection of articles by a variety of experts is both welcome and timely because it presents stark realities to those responsible for determining both what must and what cannot at present be done.'- Lord David Ramsbotham, Former Chief Inspector of Prisons

• Preface , Foreword , Introduction , Working with hard-to-reach patients in difficult places: a democratic therapeutic community approach to consultation , The lived experience of rehabilitation work with forensic patients in the community , Sustainable organizations in health and social care: developing a team mind , Bearing and not bearing unbearable realities: the limits of understanding , Thinking about antisocial behaviour and mental health in Youth Offending Services , An alternative to slapping: multi-agency working with excluded young people exhibiting antisocial behaviour , Managing difficulty: a journey with a murderous adolescent by a CAMHS psychiatrist and team , The interface between forensic psychiatry and general adult psychiatry , Multi-agency public protection arrangements (MAPPA): can we work with them? , Gut feelings , Work discussion group for trainees working in forensic settings , Valuing the splits and preventing violence , The healthy and the unhealthy organization: how can we help teams to remain effective?