"Let's Do More Than Talk About Sex: Promoting Good Lives In

Practice"

• Dr F Douds, Consultant LD Psychiatrist, The State Hospital

• Dr M Doyle, Forensic Psychologist, NHS Fife

Process for use when considering facilitating a sexual relationship between community clients with forensic

needs and other adults

Matter raised at forensic team meeting

Multi-agency discussion re community forensic client. Key question:

•Level of risk posed by client to partner? (given forensic history and/or previous

relationship history)

Multi-agency re partner. Key questions: •Is partner unable to give informed consent to

sexual relationship?•Is partner a vulnerable adult?

Yes to one or both questions No to both questions

Convene vulnerable adults case conference to consider appropriate

course of action

Convene multi-agency case conference to develop action plan and necessary protocols

(action plan likely to include socio-sexual education for one/both parties – some of which may be done jointly)

Take protocol to multi-agency risk management group

Attempt to facilitate relationshipRelationship appropriate?

No

Document reasons

Yes

Convene multi-agency case conference (see above)

NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place

What makes your life a ‘Good Life’?What makes your life a ‘Good Life’?

• Choose three things Choose three things in you life that are in you life that are important to you. important to you. (count partners as (count partners as one thing & children one thing & children as a different one ) as a different one )

• Nothing too sensitive!Nothing too sensitive!

• Write each one on a Write each one on a separateseparate post-it post-it..

• What do they What do they contribute to your contribute to your life? Why are they life? Why are they important?important?

• Which would you give Which would you give up first? Second? up first? Second? Third? Third?

$$ SURVEY OF US LOTTERY WINNERS $$

• WHAT DO YOU VALUE MOST?

• NUMBER ONE ANSWER?

• CAN MONEY BUY IT?

Good Lives

‘All meaningful human action reflects attempts to achieve primary human goods’

Ward & Mann (2005)

Autonomy

Relationships & Community

Inner Peace

Achievement

Purpose

The Good Lives Model The Good Lives Model (GLM)(GLM)

Key ArgumentKey Argument

Human behaviour is directed Human behaviour is directed towards goal of achieving towards goal of achieving fundamental needs or fundamental needs or ‘primary human goods’.‘primary human goods’.

Difficulties in achieving Difficulties in achieving primary goods in socially primary goods in socially appropriate ways will appropriate ways will possibly lead to anti-social or possibly lead to anti-social or offending behaviour.offending behaviour.

Strengthening the ability of Strengthening the ability of offenders to achieve primary offenders to achieve primary human goods in socially human goods in socially appropriate ways will reduce appropriate ways will reduce their offending behaviourtheir offending behaviour

Achieving Achieving Primary GoodsPrimary Goods through through Secondary GoodsSecondary Goods

Relatedness

Friends

Intimate Partners

Staff

Family

Social skills

Money, work

Secure

Consist-ency

The Good Lives Model (GLM)The Good Lives Model (GLM)

• Central role of construct of Central role of construct of personal personal identity identity and and self-narrative.self-narrative.

‘…‘…not enough to simply equip not enough to simply equip individuals with skills individuals with skills to control or manage risk factors, it to control or manage risk factors, it is imperative is imperative they are also given the opportunity they are also given the opportunity to fashion a to fashion a more adaptive personal identity..’ more adaptive personal identity..’

Ward & Ward & Gannon (2006)Gannon (2006)

Not ‘New me’ but perhaps ‘Better Not ‘New me’ but perhaps ‘Better me’.me’.

The Good Lives Model (GLM)The Good Lives Model (GLM)

• ‘‘Twin focus’Twin focus’

‘‘managing the delicate balance between managing the delicate balance between the …. the …. promoting offender goods promoting offender goods and ..reducing risk. Erring on and ..reducing risk. Erring on the side of either goal can have the side of either goal can have disastrous social and disastrous social and personal consequences…’ personal consequences…’

Ward, Mann Ward, Mann & Gannon, (2007) & Gannon, (2007)

• Human action is context-dependent. Human action is context-dependent. Ability of an individual to implement Ability of an individual to implement coping strategies is dependent on the coping strategies is dependent on the social and physical environments they social and physical environments they inhabit.inhabit.

• Treatment plan needs to address all of Treatment plan needs to address all of human goods needed for psychological human goods needed for psychological well-being and should be well-being and should be explicitly explicitly constructed in form of a ‘good lives constructed in form of a ‘good lives formulation’. Goal of treatment is to formulation’. Goal of treatment is to recognise individual agency and build recognise individual agency and build capacity and opportunity to meet capacity and opportunity to meet primary goods in socially appropriate primary goods in socially appropriate ways. ways.

• Requires a strong ‘therapeutic Requires a strong ‘therapeutic alliance’ non-confrontational, alliance’ non-confrontational, motivational and collaborative motivational and collaborative approach. approach.

• Implies creating ‘bespoke’ person-Implies creating ‘bespoke’ person-centred holistic interventions to centred holistic interventions to address individual need.address individual need.

The Good Lives Model (GLM)The Good Lives Model (GLM)

SAPROF(Structured Assessment of Protective Factors)

Internal factors 1. Intelligence ❑2. Secure attachment in childhood 3. Empathy ❑ ❑4. Coping ❑ ❑5. Self-control ❑ ❑Motivational factors 6. Work ❑ ❑7. Leisure activities ❑ ❑8. Financial management ❑ ❑9. Motivation for treatment ❑ ❑10. Attitudes towards authority 11. Life goals ❑ ❑12. Medication n/a ❑ ❑ ❑External factors 13. Social network ❑ ❑14. Intimate relationship ❑ ❑15. Professional care ❑ ❑16. Living circumstances ❑ ❑17. External control ❑ ❑

Good Lives Assessment & FormulationGood Lives Assessment & Formulation

‘Jim’• 29 years old; ‘mild’ learning

disability

• History of serious offences from ages 9 years to 16 years against female children.

• Convicted age 17. (1998)

• Lynebank Hospital (via HMP Edinburgh)

1998 – 2003

• Community-based CTO

2003 - 200824/7 ‘Core & Cluster’ Support Package

• 2008 – 2009 Community Outreach Support

Good Lives Assessment & FormulationGood Lives Assessment & Formulation

‘Jim’• ‘Hopeless’ – ‘never get out’

• Clear set of future goals obscured by ‘anger balloon’

Marriage

Family

Work

Motorbike

Home

Jim’s Good Lives Assessment & Jim’s Good Lives Assessment & FormulationFormulation

Knowledge

Sexual Knowle

dge

Problem-

Solving

Insight

Empathy

Jim’s Good Lives Assessment & Jim’s Good Lives Assessment & FormulationFormulation

Autonomy

Relationships with female peers

Motorbike

Tenancy

Stepped reduction

in support

Sex Offences

Group

Jim’s Intervention HistoryJim’s Intervention History

1:1 Emotiona

l Regulatio

n

Social ProblemSolving

Work Placemen

ts

Engaged to

Girlfriend

Motorbike

The Good Lives Model (GLM)The Good Lives Model (GLM)

‘Jim’ and SRAG/MAPPA

• Jim and Anne.

• Jim and Claire

• Motorbike

• Stepped reduction in support

Process for use when considering facilitating a sexual relationship between community clients with forensic

needs and other adults

Matter raised at forensic team meeting

Multi-agency discussion re community forensic client. Key question:

•Level of risk posed by client to partner? (given forensic history and/or previous

relationship history)

Multi-agency re partner. Key questions: •Is partner unable to give informed consent to

sexual relationship?•Is partner a vulnerable adult?

Yes to one or both questions No to both questions

Convene vulnerable adults case conference to consider appropriate

course of action

Convene multi-agency case conference to develop action plan and necessary protocols

(action plan likely to include socio-sexual education for one/both parties – some of which may be done jointly)

Take protocol to multi-agency risk management group

Attempt to facilitate relationshipRelationship appropriate?

No

Document reasons

Yes

Convene multi-agency case conference (see above)

NB: Disclosure of previous sexual offending. At which point of pathway, if any, will this take place