The Offender Personality Disorder Strategy

Department of Health and Ministry of Justice consultation on the Offender Personality Disorder Pathway Implementation Plan

Between February 2011 and May 2011, the Department of Health and Ministry of Justice consulted on an implementation plan for a new approach to working with offenders who have severe personality disorders.
In October 2011 the Departments published their response to the consultation.

What is the The Offender Personality Disorder Pathway?  

Key Principles underpinning the strategy are that:

  • The personality disordered offender population is a shared responsibility of NOMS and the NHS;
  • Planning and delivery is based on a whole systems pathway approach across the criminal justice system and the NHS recognising the various stages of an offender’s journey, from conviction, sentence, and community based supervision and resettlement;
  • Offenders with personality disorder who present a high risk of serious harm to others are primarily managed through the criminal justice system with the lead role held by offender managers;
  • Their treatment and management is psychologically informed and led by psychologically trained staff; that it focuses on relationships and the social context in which people live;
  • Related Department of Education and Department of Health programmes for young people and families will continue to be joined up with the offender PD pathway to contribute to prevention and breaking the cycle of intergenerational crime;
  • In developing services account is taken of the experiences and perceptions of offenders and staff at the different stages of the pathway;
  • The pathway will be evaluated focusing on risk of serious re-offending, health improvement and economic benefit.

The pathway will have:

  • Improved targeting of resources for screening and early identification;
  • A focus on assessment, case formulation and sentence planning;
  • Access to the high security prison PD treatment services;
  • Access to secure psychiatric hospitals for offenders with co-morbid severe mental health problems where the requirements of the mental health act are met and the NHS pathway is the most appropriate for the individual;
  • PD treatment units in category B and C prisons for men and closed prisons for women;
  • Access to existing accredited offending behaviour programmes, including democratic therapeutic communities in prisons;
  • Access to psychologically informed planned environments (PIPEs) in prisons and approved premises, which will provide offenders with progression support following a period of treatment or period in custody;
  • Increased support for offender managers working in the community using established MAPPA (multi agency public protection agreement) procedures.

The pathway will be co-commissioned by the Commissioning and Commercial Directorate in the National Offender Management Service and NHS Specialised Commissioners. Four sectors will each develop a business plan for delivery of the pathway investing resources available through a re-configuration of the dangerous and severe personality disorder programme:

  • North – Northeast, Northwest, Yorkshire & Humberside, North Wales;
  • Mid – East Midlands, West Midlands, East of England;
  • South – Southeast, South central, Southwest, South Wales;
  • London

A pilot pathway specifically for women offenders with personality disorder is also being developed.

Who is the pathway for?

The target population for the pathway:

  • Personality disorder: Are likely to have a severe personality disorder; and
  • Risk:
    • For men – are assessed as presenting a high likelihood of violent or sexual offence repetition and a high or very high risk of serious harm to others;
    • For women – A current offence of violence against the person, criminal damage including arson, sexual (not economically motivated offences) and/or where the victim is a child; and assessed as presenting a high risk of committing another serious offence;
  • Link: there is a clinically justifiable link between the personality disorder and the risk.

The link between personality disorder and offending

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.