North East London Integrated Community Pathway

The London Offender Personality Disorder (OPD) Partnership is consortium of London NHS trusts that work with the Probation Service and other third sector organisations to deliver psychological treatment to complex high-risk offenders in the community and prisons.

Challenges faced by people in contact with the justice system can include disruption to the continuity of care and treatment and exclusion from access to treatment. This case study describes the challenge and solution for one young man in our services.

Kenneth is 29-year-old black British gentleman born and raised in East London. He experienced a chaotic childhood; his mother struggled with substance misuse and was a victim of intimate partner violence from multiple partners. Kenneth’s mother was unable to offer him or his siblings emotional support or physical protection. Kenneth recalled memories of being in his room as a child and hearing his mother being assaulted in another room; he reports a strong threat response to banging sounds to this day.

As an adolescent, Kenneth found a sense of belonging and safety after joining a local gang. His participation in serious group offending (SGO) also provided him with financial independence, at the cost of regular exposure to extreme violence. He began carrying weapons, initially to threaten and engage in SGO, but later as a safety behaviour. He has convictions for robbery, possession and distribution of illicit substances, and carrying weapons.

Whilst involved in SGO, Kenneth’s sense of threat and vulnerability increased. He was the victim of and witness to multiple acts of gang violence, and his local area was rife with SGO rivalries and conflicts. In 2019, he witnessed the death of a close friend. Kenneth was present and charged with the possession of offensive weapons in public. The investigation is on-going, but it is understood that the murder was committed by members of a rival SGO organisation. Following his friend’s death, Kenneth’s weapon carrying increased and has remained an on-going concern; weapon carrying become a primary means of managing feelings of anxiety and vulnerability when in public. Kenneth has also reported vivid flashbacks and other symptoms consistent with PTSD following his friend’s death.

Positively, Kenneth appears to have distanced himself from SGO associations in recent years. He was first referred to Changing Lanes (NE Integrated Community Pathway Service) in 2020, where he engaged in psychological assessment and worked with a Clinical Practitioner to address housing issues and develop a daily structure (as best as possible during the COVID-19 lockdown). Noting his history of complex trauma and active PTSD symptoms, Kenneth was also referred to EMDR (eye movement desensitisation and reprocessing) therapy with an ICPS psychologist in late 2021.

Kenneth readily engaged with the ICPS from 2020 to 2022. During his EMDR treatment, he was recalled to custody following arrest and conviction for a historical violence disorder (pre-ICPS). This unfortunately disrupted his community Pathways plan.

In December 2022, his probation practitioner requested consultation with the local Probation Delivery Unit (PDU) OPD psychologist and queried a re-referral to the NE ICPS. Kenneth had also expressed a desire to return to the service and continue with his EMDR treatment on release. It was agreed this would be beneficial to his risk management plan and overall psychological wellbeing. In Q4, he was released and promptly reopened to the NE ICPS. He has recommenced EMDR with his previous EMDR therapist and ICPS psychologist, ensuring a continuity of care.

As Kenneth is excluded from several East London boroughs, he was unable to attend NE ICPS premises. Changing Lanes staff helpfully formed a positive working relationship with his GP clinic. They have generously provided us with a therapy clinic room in North London for our weekly EMDR sessions.