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Abstract This paper examines in detail the work of two community personality disorder pilot projects whose aim is largely preventative. It will be some time before the impact of the projects can be determined but both are innovative and raise questions about the ability of services to offer early intervention to those with personality disorder.

Abstract This article summarises criteria that can lead to a diagnosis of personality disorder before considering the impact on personality disorder of specific interventions and policy initiatives designed to ensure that services respond to need.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

The purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork.

In total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis.

All participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change.

The findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.

Within the current offender personality disorder (OPD) pathway in the UK, black, Asian and minority ethnic (BAME) populations are underrepresented. Fewer BAME offenders are engaging with services despite being proportionately identified for inclusion and referred on to the pathway. The paper aims to discuss this issue.

This qualitative study explored the experiences of 11 BAME men engaged in a prison-based OPD service for young offenders to identify the highlights and challenges of engagement within the service and to what extent they experienced a sense of inclusion/belonging.

Thematic analysis was used to identify three overarching themes and sub-themes. Why am I going to be an Outcast? describes the barriers to engagement encountered by the participants; and Give it a Try and Nothing but Respect describe the process of overcoming these barriers. Barriers revolved around the experiences of judgement, alienation and hopelessness. These were overcome through peer encouragement, developing relationships with staff and freedom to regulate levels of engagement.

Practice and policy implications are considered to support similar services in addressing the barriers to engagement faced by BAME individuals. Areas for future research are also recommended.

Currently, no research has directly explored the under-representation of young BAME offenders with emerging personality disorder in the OPD pathway. The findings provided an insight into some of the difficulties these young BAME offenders faced when accessing this service, alongside aspects which maintained their engagement.

Following on from an earlier published study, the purpose of this paper is to further clarify with a larger sample and over a longer timescale of two years the effect of a therapeutic-community informed personality disorder service intervention upon psychiatric in-patient bed use. The service integrates two psychoanalytical models; a mentalization-based treatment (MBT) and a service user network (SUN) model.

The number of psychiatric bed days used by patients attending each arm of the service model (SUN and MBT) was collated using the electronic patient records system. Bed use in the six-12-18-and 24-month period before each patient started treatment was compared with bed use in the same periods after starting treatment.

There appeared no significant increase after intervention in the group of patients using no psychiatric beds prior to intervention. Bed use in the second group (those using beds prior to intervention) appeared significantly reduced by six months and the reduction continued to prove significant at 12 and 18 months post-intervention. In relation to the component arms of the service, a significant reduction in bed use was seen in each of the MBT and SUN interventions at six, 12, 18 and 24 months after commencement. However, due to the small sample sizes, these results lacked sufficient power to afford a meaningful comment upon the effect of component arms.

Intervention by the TC informed two-model integrated personality disorder service had a statistically significant effect overall on reducing bed use, which was maintained at six and 12 months.

The paper supports the finding of the authors’ previous study; a therapeutic model of care that significantly reduces psychiatric bed use. That the reduction in psychiatric bed use continues to further appear highly significant at 18 months suggest that our service has an enduring effect upon inpatient psychiatric resources.

The paper describes a unique model of care currently successfully employed in the therapeutic management of people with personality disorder. The model is replicable and effective and offers some possibilities for the development of therapeutic-community informed practice.

Borderline personality disorder (BPD) is a controversial psychiatric diagnosis. Despite an increasing amount of research looking at the BPD diagnosis when applied to young people, there is limited understanding of the key viewpoints of mental health professionals working with young people in the UK. This research aims to use Q-methodology to contribute to understanding the multiple views of the diagnosis.

Q-statements about views of the BPD diagnosis were selected from relevant journals, internet sites and social media platforms and were validated by a Q-methodology research group, the research supervisors and an online group of individuals with BPD. Q-sorts were then used to explore the viewpoints of 27 mental health professionals in the UK working with children and adolescents. Analysis of the data was completed using Q-methodology analysis software.

Three main factors emerged from the data, explaining 66% of the variance. Of the 27 participants, 24 loaded onto these three factors, defined as: harmful not helpful; language and optimism; and caution and specialist services. Three Q-sorts did not load significantly onto any one factor.

There appears to be at least three ways of understanding the BPD diagnosis for young people. It may be useful for clinicians to consider and share their own viewpoint, be open to difference and formulate difficulties from an individual perspective.

The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial personality disorder (ASPD).

A total of 79 participants were recruited from ten psychiatric inpatient wards across two hospital sites in South London. Personality disorder was assessed using the SCID‐II for DSM‐IV, the prevalence of unmet needs was assessed by The Camberwell Assessment of Need Short Assessment Schedule and substance misuse problems measured using well validated drug and alcohol use disorder identification tools.

The presence of a concurrent ASPD was independently associated with a greater number of unmet needs. ASPD was associated with lower qualifications and a greater risk of homelessness and substance misuse. Unmet need was associated with lower qualifications and substance misuse. In a stepwise linear regression model alcohol dependence and drug misuse were the most significant predictors of unmet need.

Further research is required to identify the reasons why these needs are not being met and establish reasons for these patients' high‐dropout rates from treatment.

The present findings suggest BAH psychiatric inpatients with ASPD are at greater risk of alcohol dependence and drug misuse and report a greater number of unmet needs thus requiring a greater volume of services; however, current services are not meeting these needs. Mental health teams should ensure thorough needs assessment procedures are incorporated into general psychiatric service practice ensuring effective treatment packages are tailored to these patients needs.

The research identifies a previously under‐researched sub‐group of psychiatric inpatients with a high proportion of unmet health and social needs and suggests further research to develop service improvements supporting their management.