Women’s Services

Men and women are different

It’s because of these differences that the National Offender Management Service (NOMS) and the Department of Health (DH) have produced a separate strategy for women offenders with personality disorder. This reflects the fact that:

  • The nature of personality disorder is different for women: for example, rates of borderline personality disorder are far higher for women than men
  • Rates of self-harm are four times higher among female prisoners than male prisoners
  • Female prisoners have higher lifetime incidences of trauma, including severe and repeated physical and sexual victimisation, for example one in three women in prison has suffered sexual abuse compared with just under one in ten men
  • Women prisoners have significantly higher rates of poor mental health
  • A 1992 study found that over 90% of male prisoners’ children were cared for by either their partner or the child’s mother – this compared to just 23% of the children of female prisoners being cared for by their partners.

Also, it’s a fact that women in the criminal justice system are a minority, and violent women even more so. This means that if we applied the same violence and risk criteria for men and women to access personality disorder services, only a very small number of women would be identified.

We have therefore defined the target group for the women’s strategy to focus on risk of re-offending, not just risk of harm to others.

Target group

Women in scope of the women offenders’ personality disorder strategy must meet the following criteria:

  • A current offence of violence against the person, criminal damage including arson, sexual offences (not economically motivated) and/or offences where the victim is a child; and
  • Assessed as presenting a high risk of committing another serious offence; and
  • Likely to have a severe form of personality disorder; and
  • A clinically justifiable link between the above.

The strategy’s objectives are:

  • Early identification of women who meet the entry criteria for the strategy
  • Identified women have high quality plans setting out clear treatment and intervention pathways, which take full account of their risks, needs and responsibilities
  • Where appropriate, women enter into and complete planned treatment and interventions, which are holistic, gender-responsive and trauma-informed
  • Women’s psychological health improves and they demonstrate more pro-social behaviours
  • Reduction in women’s risk of committing further offences
  • Increased effectiveness of joint working between health and criminal justice agencies with regard to women offenders with personality disorder
  • Women remain in or return to the community in a planned and safe manner, where holistic community provision continues to address ongoing risks, needs and responsibilities.
  • To develop the confidence and competence of staff in prisons, the Probation Service, local health providers, drug and alcohol agencies and the voluntary sector with responsibilities for women offenders with personality disorder.

Principles

The strategy is based on the key principle that the target group for the strategy is a shared responsibility between NOMS and the NHS, as well as others. It therefore requires joint operations, planning and delivery, butassumes that treatment services will be located mainly in the criminal justice system. Women requiring hospital treatment will access NHS high, enhanced medium secure, medium and low secure services, as appropriate; but other than in circumstances that can be clinically justified, a patient will return to the criminal justice system once their treatment objectives have been met.

Interventions must be psychologically informed, gender specific and based on the best available evidence, focussing on relationships and the social context in which people live.

The strategy will work within existing systems, pathways and processes (e.g. Offender Management, Care Programme Approach and Multi-Agency Public Protection Arrangements), but aims to improve the way women move progressively through an active pathway of appropriate interventions. It will also increase availability of and access to specialised personality disorder treatment services.

Workforce development is also a substantial part of the developing implementation plan and we are developing gender-specific personality disorder training modules.

Vision

Our vision of how this will be achieved in practice looks like this:

Offender managers will create individualised community-to-community pathway plans for every woman identified as being in the scope of the strategy. Each plan should:

  • Link together a series of appropriate interventions on a community-to-community pathway model
  • Take a whole person approach
  • Be gender-sensitive, trauma-informed, woman-centric and sensitive to any issues the individual may have around self-harm and/or caring responsibilities
  • Follow her wherever she is
  • Be defined in consultation with her
  • Aim at improvements in both health and offending behaviour outcomes
  • Include the opportunity to receive mentoring, advocacyand/or support with practical issues from a local non-statutory provider.

Staff will be supported by joint health/criminal justice community-based services offering case identification, case formulation and case consultation with regard to each woman within the target group, regardless of whether she is in prison custody, residing in approved premises or under community supervision.

Some women will require a higher level of support and will enter into treatment services.The strategy will build on existing provision, but also aims to introduce some new services.

Following treatment, women will have the opportunity to progress into a psychologically informed planned environment (PIPE). There are existing PIPE pilots at Low Newton and Send prisons. PIPEs provide offenders with progression support following (or, in future, prior to) a period of treatment in custody or in approved premises. PIPEs are specifically designed environments where staff members have additional training to develop an increased psychological understanding of their work enabling them to further develop a safe and facilitating environment.

Treatment services

  • The Primrose Unit at HMP Low Newton was established as part of the dangerous & severe personality disorder programme in 2006 and offers twelve residential spaces. Delivered jointly by staff from the prison and from Tees, Esk and Wear Valleys NHS Trust, Primrose offers comprehensive treatment to help participants reduce the impact of personality disorder, risk of re-offending and risk of harm to self. Primrose is designed for prisoners who present the highest risk of serious harm to others and have the most complex needs. For more information, please see: Planning and Delivery Guide for Women’s DSPD Services – Primrose Programme.
  • Therapeutic Community at HMP Send: The Therapeutic Community model offers a safe environment with a clear structure of boundaries and expectations. Through psychosocial therapy the aim is to encourage residents towards a better understanding of their previous behaviour and to enable them to improve their inter-personal functioning. Encouraging and reinforcing the notion of personal responsibility and sharing, members and staff meet together on a regular basis to discuss the management and activities of the community, to assess applications for admission and to support leavers. Send’s Therapeutic Community accepts women assessed as medium, high or very high risk of serious harm to others and/or a medium or high risk of reconviction; as well as deficits in two or more of the following: self-management, coping, and problem solving; relationship skills/ inter-personal relating; anti-social beliefs, values and attitudes; and/or emotional management and functioning.
  • Specialist personality disorder treatment services: The strategy aims to introduce four services at women’s prisons across England & Wales. Delivered by health and criminal justice staff, the units will offer treatment based on best-available, gender-specific evidence. The units are likely to offer a daily programme of therapeutic and learning activities, based on individual and group work. They will aim at increases in motivation to engage, psychological health and coping strategies; building staff confidence; reductions in associated behaviours such as self-harm, suicide attempts and disciplinary offences; as well as increases in motivation and engagement. The first service will (subject to financial approval) be at Foston Hall prison.
  • Choices, Actions, Relationships, Emotions (CARE):CARE is an accredited offending behaviour programme designed for women who are at medium or high risk of violent re-conviction and have three or more of the following needs: history of substance misuse problems; history of self-harming or suicidal behaviours; mental health difficulties; personality disorder diagnosis; and/or past difficulties in accessing or benefiting from help or treatment. CARE currently runs at Foston Hall prison, but the strategy aims to introduce CARE (or other programmes that address the needs and risks of the target group) at three further prisons.