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The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway.

A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted.

Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness.

The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway.

While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation.

There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.

The purpose of this paper is to highlight the findings of a service evaluation project assessing the impact of team consultation to criminal justice staff working with personality disordered offenders.

A qualitative design using content analysis of focus groups and individual semi-structured interviews.

Criminal justice staff report increased awareness and understanding, use of a person-centred approach, development of formulation skills and defensible practice following team consultation.

This paper will be of interest to practitioners who offer and/or receive consultation for work with offenders with personality disorder. Suggested changes to team consultation formats may be of interest to services involved with the Offender Personality Disorder Pathway.

This paper contributes towards the emerging literature on the role of consultation and formulation on workforce development for individuals with personality disorder. It also contributes to the evaluation of the services offered by this specialist team as they support probation Trusts across Yorkshire/Humber to support the community specification of the national Offender Personality Disorder Pathway.

This article explores the development of an offender personality disorder strategy for the Department of Health (DH) and National Offender Management Service (NOMS). The strategy has two strands: offenders who present a high risk of serious harm to others, and workforce development. This article primarily considers the first of these. The strategy builds upon the learning so far from the Dangerous and Severe Personality Disorder (DSPD) programme and democratic therapeutic communities in prisons. This indicates the need for NOMS and the NHS to take joint responsibility for the assessment, treatment and management of this population and to deliver services, where appropriate, through joint operations. A greater focus is required on the early identification of personality disordered offenders who present a high risk of serious harm to others, leading to an active pathway of intervention predominately based in the criminal justice system (CJS).

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.

The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.

The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.

Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.

There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.

The purpose of this paper was to examine the impact of a highly structured, formulation focused consultation process on knowledge and attitudes towards personality disorder and on perceived practice with personality disordered offenders. Consultation was delivered by the Yorkshire/Humber regional Pathway Development Service (PDS). This pilot study sought to inform the development of this service and the support offered to probation Trusts across Yorkshire/Humber to implement the national Personality Disorder Offender Pathway.

Consultation was offered to a number of offender managers working in the Yorkshire/Humber region. The impact of the consultation on their knowledge and understanding of personality disorder in general was examined as was their attitudes to working with this population and their perceived confidence and competence in delivering supervision to each individual.

The findings from this small pilot study would suggest that the structured format used by the Yorkshire PDS was helpful in enhancing the probation officers’ knowledge and understanding of personality disorder as well as their perceived confidence in and attitudes towards working with individuals with a personality disorder.

The study indicates that the structured format used by the PDS is of value and may be applied to the support offered to probation Trusts across Yorkshire/Humber as they implement the community specification of the national Personality Disorder Offender Pathway.

The offender personality disorder (OPD) pathway faces the difficult task of identifying individuals who are eligible for their service from the entire probation caseload. The offender assessment system personality disorder (OASys PD) screen is a national screening tool used by the pathway to help with this task. This paper aims to describe an evaluation of the effectiveness of this plus an additional screening tool currently used to identify eligible individuals for the OPD service in the South of England. Recommendations for improvements were made as necessary.

A mixed methods design used a quantitative analysis of data on the effectiveness of the OASys PD for correctly identifying individuals and a thematic analysis of a focus-group conducted with clinicians within the service.

The analysis revealed a positive predictive value of the OASys PD screen of 72% and a negative predictive value of 91%. Key themes from the focus-group revealed what worked well about the screening process, what was difficult and what needed to be improved.

The OASys PD performed better than the clinicians had expected. It was recommended that the service continued to use the combination of the screening tool and the interviews with minor adjustments.

This is the first research study of its kind on the effectiveness of the OASys Personality Disorder Screening tool. Using such a tool with some caution (the addition of consultation) creates a useful and effective process for tackling the very difficult task of identifying people for the community component of the Offender Personality Disorder Service. This research provides some evidence for the validity of such a process that is currently used throughout the National Probation Service in England and Wales.

The profile of personality disorder in forensic clinical practice has been raised by key developments over the last decade, although services remain in the large part piecemeal and disconnected. This paper aims to describe the lessons learnt from the development of one specialist service for personality disordered offenders.

The policy context in which the service was developed, the challenges of working in this area, and data relating to the clinical and risk profile of referred cases are presented.

Data demonstrate extensive comorbidity and heterogeneity amongst those referred to the service. With reference to the experience gained in the first four years of the service, it is suggested that a systematic and formalised model of “understanding” the psychology of the individual should be the core process of future developments for this group of offenders, and subsequently recommendations are made to enhance the practical utility of such formulations rate.

Conclusions are mostly based on expert opinion and upon one particular service provision, and therefore care should be exercised in generalising the results of this study to existing services. The need for further research in order to enhance knowledge and understanding of this complex group is highlighted.

The heterogeneity and comorbidity within this group of offenders emphasises the need for services to offer a range of assessment methods and interventions to meet individuals' requirements.

The experiences and recommendations in this paper are valuable to professionals working with personality disordered offenders and to the development of more extensive services for such individuals.

This paper aims to describe: the need for substance misuse treatment with high risk, personality disordered prisoners, and the implementation of two evidence-based psychological interventions aimed at addressing substance misuse within a high secure, personality disorder treatment unit and potential future evaluation options.

In addition to the literature base evidencing the need for substance misuse treatment with this population, the Iceberg and ‘InsideOut’ interventions are presented. These interventions adopt a risk reduction and health intervention approach respectively. This includes explanations of how they came to be implemented within a prison based personality disorder treatment service and potential ways to evaluate these services.

Evidence-based psychological interventions can be implemented for this population whilst being responsive to changing government priorities for substance misuse treatment. The organisation’s research strategy includes an intention to evaluate these interventions in order to inform future delivery.

The high levels of co-morbidity between personality disorder and substance misuse disorders in the high security prison estate highlights the need for substance related treatment for this population. Given the responsivity issues relevant to personality disordered offenders, the format of delivery of evidence-based psychological interventions has to be considered.

This paper discusses the application of evidence-based psychological interventions for substance use within a high secure, personality disordered population which has developed as a result of ministerial changes within the treatment of both substance misuse and personality disorder.

In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service.

The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015.

Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ² analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample.

In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders.

The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.

The Yorkshire and Humber Personality Disorder Partnership (YHPDP) provides psychological consultation and formulation to offender managers (OMs) within the National Probation Service as part of the offender personality disorder (OPD) pathway. The pathway highlights the importance of formulation-led case management to develop pathways for offenders with personality difficulties at high risk of causing serious harm to others. This study aims to ask what is the experience of psychological consultation/formulation on the relationship between a sample of service users (SUs) and their OMs.

Semi-structured interviews were undertaken with five OMs who had engaged in at least three consultations with YHPDP psychologists/psychotherapists within the OPD pathway. Qualitative methods were used to analyse the data, specifically interpretative phenomenological analysis, which is useful when dealing with complexity, process or novelty.

OMs experienced the consultation/formulation process to be containing and reflective. They found complex, emotionally demanding clients who have offended and have personality disorder traits could be responded to differently as a result of this process. From an OM perspective, this improved the relationship between themselves and their SUs and supported risk management. These conclusions must be tentative, as they are drawn from a small-scale qualitative study, but provides the basis for further research.

Although there is increasing research into the outcomes of the OPD pathway, little has been done regarding the experience of the relationship between OMs and SUs. This research takes a qualitative perspective to explore this area.