By Lisa Wright
The Mersey Care Prevention Service, launched last year, developed from discussions between Mersey Forensic Psychology service, part of Mersey Care NHS Foundation Trust, and Merseyside Police. The Police recognised that some of the people they had arrested for sexual abuse may not have gone on to commit these offences if they had received help earlier. Knowledge of our work with convicted adults in the region led them to approach us and we jointly created and funded the new service.
The original idea was a service aimed at adults who had become concerned about their own sexual feelings or behaviours and were motivated to engage in psychological intervention to reduce the chances of them acting in an abusive or illegal manner. The ideal client would not have committed any illegal act but be concerned that they may do so without help. The Police hoped to identify individuals who came to their attention for problematic sexual behaviour but not reach the threshold for prosecution and we also sought referrals from GPs, counselling and mental health services and Social Care. However our criteria was later expanded due to difficulties in recruitment – very few ideal clients came forward!
We based the intervention approach on our prior work with adults who had sexually offended and our smaller client group of those people professionals had considered to pose a risk of sexual offending.
Mersey Forensic Psychology Service is foremost a therapy service, providing formulation based individual psychological therapies aimed at reducing risk of offending or re-offending. This takes place in the community and within North West prisons. The therapy approaches used vary and are based on the methods that we assess as most suited to the client and their formulation. We utilise EMDR and Schema Therapy most frequently as they are best suited to re-processing the trauma that we frequently find lies at the heart of the problematic behaviour we encounter.
These therapies have been used in mental health services to change the emotional and physiological feelings arising from trauma that drive problematic behaviours, including sexual behaviours, and have transitioned well to our setting. Clients feel understood, emotionally connected to the origin of their problems and report significant change in sexual feelings and behaviours.
The range of clients that have been referred to the prevention service has been varied and far from the ideal we had envisaged. Often Social Services have referred men who have raised concerns by behaving in inappropriate ways towards children but have not been prosecuted and are attempting to prove that they are not a risk to their children. They are therefore unlikely to ‘open up’ and engage in intervention. Other clients have already offended, been involved in on-going Police investigations or may believe that they have not offended but it emerges that they have committed a criminal act. These types of cases we are duty bound to discuss with the Police, causing some distress to the individuals involved – not ideal! These referrals have led to us revising the information provided to prospective clients and referrers to make clearer the remit and legal obligations of the service and avoid any of the above issues recurring.
We have had some more appropriate and successful referrals – men who appear not to have offended and are motivated to understand and change their feelings and behaviours – but they have been the minority of our overall referral list. Therefore in order to generate more interest we publicised the service in the local press.
The reaction to the publicity for the prevention service might help to explain why people we are attempting to reach are not coming forward. The hatred, anger and aggression expressed on social media towards people who might experience a sexual attraction to children was horrific. It’s not surprising that the vast majority of our clients have already come to the attention of a professional and then been referred on rather than deciding independently to seek help.
Increasing awareness of the service, in a way that minimises the risk to potentially interested people and doesn’t create negative publicity, is tricky. Furthermore, the referral process, approaches to safeguarding issues and reporting of information are obviously heavily influenced by both the founding organisations’ policies and procedures, which may be a significant barrier to engagement for some people but is difficult to get around.
We have now expanded the service to include individuals who have convictions for exposure. This was based on Police concerns and case examples of young men who had committed exposure and then later gone on to commit violent sexual contact offences. This has increased the numbers of appropriate referrals and widened the aims of the service.
We are therefore continuing to adapt to the situations we are faced with in trying to provide a meaningful and effective service to those who want it and to make it more attractive to those that currently don’t. The men who have engaged in therapy are progressing well and reporting significant psychological change. Overall then, the results of our intervention for those who have engaged in therapy, are largely positive and we will continue to explore ways of reaching more people who would benefit from the interventions that we can offer.