Programme detail
Personality Disorder and the Criminal Justice System
Personality disorder is a recognised mental disorder, but an underdeveloped area of mental health. It affects many people in society, most of whom do not commit offences. For some, however, it significantly contributes to offending and risk related behaviours. Approximately two-thirds of prisoners meet the criteria for at least one type of personality disorder (Stewart, 2008; Singleton, 1998).
For a relatively small number, in its more severe forms, it can be linked to a serious risk of harm to others. These offenders have highly complex psychological needs that create challenges for staff in the NHS and National Offender Management Service (NOMS) in terms of management, treatment and maintaining a safe working environment.
This is a population that tests boundaries, breaks rules, challenges authority, has failed in other interventions and persistently re-offends in harmful ways. These challenges are being addressed through specialist assessment and treatment units within the prison estate and a secure hospital (Rampton hospital, HMP Whitemoor, HMP Frankland and, for women at HMP/YOI Low Newton).
This approach has been in full operation since 2005 with assessment and treatment lasting between three and five years. The approach provides a thorough assessment of their personality disorder and risk related factors. Work focuses on improving motivation and engagement in treatment, learning to understand and control the impulses and strong emotions which are connected with their offending, and addressing factors from the past that have had a damaging effect on their personality.
The units work with offenders on factors such as learning to establish a relationship, perhaps for the first time, living within the boundaries and rules of the unit’s community, and acquiring basic educational, occupational and life skills. The overarching aim is to prevent repetition of serious violent or sexual offending.
It is too soon to establish re-offending outcomes as few prisoners have progressed to the community. However, evidence is developing that shows a significant decrease in adjudications and violent incidences. The units have demonstrated the ability to manage the most difficult and challenging offenders safely and constructively, and deliver high quality therapeutic approaches.
In 2009 the Primrose Unit at HMP Low Newton won the prestigious World Health Organisation (WHO) Health In Prison Project (HIPP) Award at European level for the category of ‘Best practice regarding health care services provided to prisoners’.
This programme has also encouraged improved partnership working between the National Offender Management Service (NOMS) and the NHS, which has contributed to developing a highly skilled workforce that has benefits beyond these units.
The government is reviewing the options for the future management of this population. A new strategy is being developed that builds on the learning from these assessment and treatment units. This addresses the need for joint responsibility and shared operations between the NHS and NOMS. It aims to strengthen the offender pathway by providing an enhanced community to community approach to the offender management of this population: early identification, high quality sentence planning, appropriate treatment and effective management.