Cygnet Health Care

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Therapies

The Psychology Department

Cygnet Hospital Beckton has three full time chartered psychologists who, between them, have many years experience in psychiatric rehabilitation, substance misuse, learning difficulties within psychiatric settings, female personality disorder, forensic settings.

Each ward has an allocated psychologist, and there is also specialist cross-over working. The department offers individual and group work in all areas of the hospital. An individual initial psychology assessment is offered within one month for PICU as standard and six weeks for LSU. After this period, reports are compiled and sent to the service providers, where recommendations are made for treatment and further assessment for those with imminent return to their host trust or a treatment focus plan for those who are longer term.

The psychology department is involved in all areas of assessment, including risk management, neuro-cognitive functioning and symptomology. Examples of utilised assessment tools include:

  • HCR – 20
  • PCL – R
  • RSVP
  • VRAG
  • SORAG
  • Risk Matrix 2000
  • WAIS III
  • WMS
  • An offending behaviour reduction programme: This is a cognitive skills programme which aims to reduce criminal behaviour by modifying the individuals underlying thoughts and attitudes. The programme consists of a series of modules that aim to tackle the following areas such as problem solving, social skills and personal control
  • Substance misuse C-BIT programme: B-BIT (Cognitive Behavioural Integrated Treatment) is a cognitive approach to substance misuse among individuals with mental health problem. The overall objective is to aid clients to negotiate and maintain behaviour change in relation to problematic drug/alcohol use. C-BIT is based on a harm reduction approach where the therapists and clients work collaboratively in stage wise steps
  • DBT: (Dialectical Behaviour Therapy) is a modification of cognitive behavioural therapy (CBT). It is designed specifically for individuals with self harm behaviours such as self cutting, suicidal thought, urges to suicide and suicide attempts
  • The inappropriate sexual behaviours group: This is based upon a cognitive behavioural model which focuses targets a reduction in the extent to which offenders minimise and justify inappropriate sexual behaviours. Further modules focus on the enhancement of victim empathy and development of plans to manage relevant risk factors.

In addition to these, the department also contributes to group activities in alliance with other professional groups, which include:

  • Symptom management
  • Anxiety management
  • Self esteem
  • Anger management
  • Psycho-sexual group work
  • BADS
  • Hayling and Brixton
  • Parenting Stress Index
  • Trauma Symptom Inventory
  • Personality Assessment Inventory

The department takes a lead in the development and implementation of individuals and group patient programmes. Working with individuals, the department approach is based on an integrative model (Livesley 2005). This model is based upon different models of therapy being appropriate for the client in different stages of treatment, by conceptualising treatment as a series of flexible phases, each addressing different problems with specific interventions to suit the client rather than the therapist.

To apply this, our psychologists are trained and skilled in such approaches as:

  • Cognitive Behavioural Therapy (CBT)
  • Rational Emotive Behavioural Therapy (REBT)
  • Schema Focussed Therapy
  • Dialectical Behaviour Therapy (DBT)
  • Motivational interviewing
  • Mentalisation
  • Behavioural programmes
  • Cognitive Behavioural Integrative Therapy (C-BIT)

With the predominantly female client group, a lot of the work of the department is specifically designed to meet the needs of women who are particularly complex and challenging in presentation. Thus the psychology department provides a number of specific therapeutic groups including:

  • Group psychotherapy – A closed integrative discussion group

The department offers training to psychology students both at undergraduate and post graduate levels. In addition to the psychologists, employed outside resources are available for psycho analytic group therapy and specific gender issues.

Occupational Therapy Department

Cygnet Hospital Beckton’s Occupational Therapy Department consists of two Occupational Therapists. Between them, they have many years’ experience in forensic mental health and Psychiatric Intensive Care Units (PICU) and challenging behaviours as well as in the areas of dual diagnosis and the needs of women in secure settings.

Cygnet Hospital Beckton has a Senior Activities Coordinator specialising in risk and challenging behaviours, offering supervision to the Activities Coordinator. The unit also has a further two activity co-ordinators, both from psychology backgrounds with special interests in psycho-educational groups and group work and anxiety management.

Occupational Therapists and Activities Coordinators are allocated to all wards. The occupational therapy staff and the activity organisers co-facilitate groups across the hospital, working closely with the psychology team.

The philosophy of the occupational therapy department is based on client centred occupational therapy. All groups and 1:1 interventions are created with cultural sensitivity in mind.

The main occupational therapy model used is the Model of Human Occupation, focussing on: volition, habituation, performance and the environment. Most standardised assessments used in the occupational therapy department are from the model of Human Occupation evidence base. However other assessments and outcome measures are available e.g. the Canadian Occupational Performance Measure (COPM)

Risk assessment is current practice within the department.OT’s are trained in the use of the HRC 20 and also complete a specific OT safety assessment for each client

The occupational therapy clinical care pathway (summarised)

Referrals:

  • Blanket referral to occupational therapy (OT) of all clients new to Cygnet Hospital Beckton
    Action: OT to introduce self and supply information about the service
    Response time: within 10 days

Screening:

  • Complete OT safety assessment and utilise other screening devices e.g. patient history and previous OT discharge summaries
  • Complete screening tool e.g. MOHOST and file in OT notes and transfer to patient file in nursing station
    Response time: Within 21 days of treatment

And

Initial Interview Assessment:

  • Complete Cygnet Hospital OT initial interview or appropriate other initial assessment e.g. MOHOST, AOF, OCAIRS etc

Baseline Assessment/Treatment Plan:

  • Assess functional abilities, strengths and weaknesses in the areas of self care productivity and leisure e.g. COPM
  • Identify occupational performance strengths and weaknesses affecting the above areas. Develop treatment plan in collaboration with the client and use of MDT consultation.
  • Action: OT report and treatment plan produced and filed in OT files, tabled at MDT/CPA and transferred to patient files in the nurses station
  • Individualised goals set with the client in order to use as outcome measures

Specific assessments:

  • E.g. Assessment of communication and interaction skills, Volitional Questionnaire, Role check list, Community Skills Assessment completed when needed

Reviews and Discharge:

  • Reviews as indicated by patient progress, treatment plan and outcome measures
    Response time: 6 monthly minimum as determined by CPA review dates
  • On discharge – Summary of assessment, interventions and outcomes, stored on patients notes in the nurses station and the OT file, forwarded on to the next service

Multi Disciplinary Team Contribution:

  • Participation at MDT meeting
  • Participation at CPA meetings
  • Contribution to the MDT assessment of potential patients by attending referral meetings and undertaking assessments with other disciplines
  • Participation in the development of hospital policies and practices
  • The development and forensic services at the hospital

External links:

The Therapy department has a good relationship with local educational facilities, e.g. The Beckton Globe. The clients with leave are able to access free educational courses ranging from Floristry to computing

Newham Leisure centre is an important part of the clients daily routine e.g. swimming groups

Psychologists Standards

PICU

  1. Initial assessment within four weeks
  2. Psychology consultation with ward staff
  3. Psychology client drop in session
  4. Individual referrals as appropriate
  5. Psychometric assessments as appropriate

Low Secure Services

  1. Initial assessment completed within six weeks (1st CPA)
  2. Psychometric assessments as appropriate
  3. Neuro psychological assessments as appropriate
  4. Personality assessments as appropriate
  5. Offending assessments as appropriate
  6. Every client is offered 1:1 treatment focused sessions
  7. Every client has a psychologist allocated to psychologically case manage
  8. Drug and alcohol group
  9. Offending group
  10. Psychotherapy group
  11. Dialectical behaviour therapy group (Bewick ward)
  12. Psychologist will offer staff consultation as appropriate
  13. Psychologist will offer staff training as appropriate

Occupational Therapist's Standards

PICU

  1. Initial assessment completed within 4 weeks
  2. Treatment plan completed within 4 weeks
  3. Individual referrals as appropriate

Low secure Services

  1. Initial assessment completed by six weeks
  2. Carry out base line assessment
    • Assess functional abilities (occupational strengths and weaknesses)
    • Check interests
    • Assess role function
  3. Write up Treatment Plan and set goals for individualised Outcome Measures
  4. Specific Assessment/reassessment where necessary
    • Activities of Daily Living e.g. cooking, community, personal
    • Independent living capacity
    • Physical
    • Psychological and cognitive responsibilities
    • Communication and interaction skills
    • Prevocational Skills
    • Environmental assessments
  5. Every client will have an individualised time table, including 1:1 time with
    their occupational therapist
  6. Symptom Management
  7. Anger Management
  8. Anxiety Management
  9. Coping with depression
  10. Other activity based groups offered
  11. Structured ward jobs offered

Activity co-ordinator standards

PICU

  1. Introduce clients to the ward programme
  2. Complete activity summaries report after 4 weeks
  3. Lead facilitator of ward based activities
  4. Working in conjunction with nursing staff, OT and psychology
  5. Complete Section 17 leave observation form
  6. Attend Multi-Disciplinary Team Meeting (MDT) as required

Low Secure Services

  1. Introduce clients to the ward program
  2. Complete activity summaries report after 4 weeks
  3. Lead facilitator of ward based activities
  4. Working in conjunction with nursing staff, OT and psychology
  5. Complete Section 17 leave observation form
  6. Attend Multi-Disciplinary Team Meeting (MDT) as required

Cygnet Hospital Beckton

Contact the hospital

Cygnet Hospital Beckton 23 Tunnan Leys Beckton London E6 6ZB Tel: 020 7511 2299
Fax: 020 7511 3399

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