Engaging the LD Offender I’m talking today about a therapeutic community for offenders who have committed serious offences and have a learning difficulty/disability. To avoid having to say learning difficulty/disability every time I hope you’ll forgive me if I use the acronym LD. According to Pearce and Haigh the roots of therapeutic communities can be traced back to the Middle Ages with a community set up at the shrine of St Dymphna at Geel in Flanders. They say that this was probably a community for people with LD. However, I would like to suggest that the founding father of therapeutic communities was actually Pachomius in fourth century Egypt. Pachomius was living the life of a hermit and was widely known for his holiness, groups of young men came to him wishing to learn about the way to holiness. Initially, Pachomius tried to show them how they should behave, waiting on them and caring for them in the hope that they would copy his example, unsurprisingly to modern day readers, they did not. In response Pachomius came up with the first set of community rules, and, I think therefore, can lay claim to being the founder of therapeutic communities even if what he was trying to set up was monastic communities. Pachomius’ work was carried on by St Benedict whose rule is still widely read today. Anyone interested in therapeutic communities may find it worth exploring this short and simple text. Should you wish to look at this issue further there is a conference on April 20 th titled “Concepts of Community” which is set up to use the comparison between monastic communities and therapeutic communities, to help us understand what we want in a well-functioning community. To move a little closer to the present day in 1796 The Retreat hospital opened in York founded on the basis of what was called “moral treatment”, the basis of this was to treat insane people as closely to how so called “normal” people were treated as was possible. On the other side of the Atlantic a fairly well known community was set up by Quakers in Pennsylvania in 1817, working to a similar model. This early phase of TC’s was relatively short lived however as physical treatments for mental difficulties and psycho-analysis gained ground. However, the need to find ways to treat those traumatised by the Second World War resulted in work at Northfield Military Hospital and Mill Hill Hospital which gave this way of working considerable emphasis, and revitalised the whole therapeutic community idea, with the phrase “Therapeutic Community” first being used in 1946. The therapeutic community with which I am concerned is at HMP Grendon which is a Category B prison with a roll of approximately 220. The prison has six wings and each wing is run as a therapeutic community, which makes us very lucky. Wings B, C, and D, are mainstream wings, A wing is for those who have committed sexual offences, G Wing is an assessment community, and F Wing where I’m the clinical lead, is for those with LD. All communities have community meetings on Mondays and Fridays and, except G Wing, small therapy groups on Tuesday, Wednesday, and Thursday. A new arrival stays on G Wing for between 3 – 6 months. If they pass their assessment and choose to stay a resident is then allocated to a wing where he will become a member of the community and, if he can stay engaged with the therapy, usually live for a minimum of 18 months or three years on F Wing. On F Wing we also accept residents direct from other establishments and carry out our own assessments, which take four months.
The resident is expected to abide by the wing constitution, this varies slightly from wing to wing but core elements are the “No sex, drugs or violence” rule and the Four Pillars of the community; Democracy, Community Living, Tolerance and Reality Confrontation. Residents are also expected to keep matters confidential to their wing. Residents are open to challenge by their peers and staff and are expected to challenge in their turn in an appropriate manner. At the end of the assessment period a meeting is held in which staff will discuss with the resident their progress and set them a series of treatment targets. Progress on these targets is assessed every eight months on F Wing and targets may be altered or removed if felt to be no longer appropriate. While in the prison residents are expected to have a job or be in education; they are also expected to have a “rep job” which is an unpaid job which gives something back to the community. Rep jobs vary in responsibility and trust from watering the wing’s plants to being the Chairman of the wing. Off wing jobs also can involve highly trusted positions such as Prison Equality Mentor. Any man wishing to take up a post needs to get backing from his group and then the community as a whole. The discussion about this usually covers such issues as how it will further his therapeutic work, what challenges there are for him and how he will manage the challenges. Most aspects of a resident’s life are open to discussion by the resident’s therapy group or the community. There is provision for rule breaking and the hope is that such behaviour can be thought about and understood by the community to help the resident in question to make changes. A serious breach of the rules may result in a commitment vote; a discussion by the whole community as to a resident’s commitment to therapy, which can result in the resident being asked to take part in certain sanctions, or being asked to leave the community. All this is the same as the other wings. In individual therapy the relationship with the therapist is the agent of change, in Group Analysis it is the relationship with the therapy group; in a therapeutic community it is the relationship with the whole community which is the agent of change. This allows a resilience which would not otherwise be possible and the addressing of issues rooted in profound disturbance. The TC+ units sprang out of the lack of facilities for offenders with LD to progress, they are a relatively recent innovation the oldest, the community at HMP Dovegate having opened at the beginning of 2013 and the unit at HMP Gartree opening a couple of months later. F Wing at HMP Grendon is fairly late to the party having opened in April 2014. I’ve mentioned the ways that TC+ is similar to the mainstream communities; however, there are some important differences. Firstly is the issue of numbers, experience has shown that residents with a lower IQ can find it difficult to get involved in discussions in larger communities and tend to fail to engage in the therapeutic process in larger groups. Accordingly the wing has a roll of 20 as compared to 40 – 45 residents for wings for those with a higher IQ. This is also reflected in the size of our therapy groups with members being six or seven to a group as opposed to approximately nine on the other wings. In contrast we have a much higher staff to resident ratio, something approaching one to one when we are fully staffed. The next issue is time. It is usually accepted that people with LD tend to have a shorter attention span than those with a higher IQ. Accordingly our therapy groups meet for 40 minutes have a 15 minute break and then meet for a further 45
Recommend
More recommend
