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The offender personality disorder (OPD) pathway provides services to people with histories of offending and traits of personality disorder (PD) who are at high risk of violent re-offending. The residential provisions have been developed as psychologically informed planned environments (PIPE), in which socially creative activities form an integral part. Ryan et al. (2018) suggest that social and creative activities offer individuals experiences to increase their understanding of themselves and others. The purpose of this study is to complete a service evaluation exploring how people who live on an OPD PIPE in a woman’s prison make sense of their experiences of a drumming, singing and ceremony group, which was offered to them as part of their provision PIPE.

Semi-structured interviews were conducted with six service users (between 19 and 42 years old).

Thematic analysis identified three themes: emotional regulation, belonging and connectedness and humanising spaces.

This study used a small sample (n = 6), and all participants were accessing the same OPD provision PIPE. Further, participation was voluntary, and results found may relate to possible biases in a self-selecting sample. The interviewer knew the participants through their clinical work, and despite being informed that participation in this research project would have no bearing on their treatment pathway, some may have participated as a way to demonstrate their compliance with the overall programme. A further limitation relates to the group being evaluated on its own without a comparison group.

This study has important implications for treatment delivery in prisons, as it demonstrates the therapeutic merit of social creative activities for one of the most complex, high-risk and challenging offender groups. The findings show that the specific combination of the physical act of drumming and the social act of drumming together may create an environment that allows people to heal and overcome both physical and emotional disconnections that have been caused by their trauma.

This study’s findings provide further understanding of the experience of people who have survived trauma.

Findings suggest that the group provides therapeutic value, offering an alternative to traditional therapy and targets specific difficulties particularly associated with emotionally unstable and antisocial PDs. We suggest that socially creative activities form an important part of the rehabilitation process of complex, high-risk groups. Future research would benefit from focusing on the extent to which experiential learning through socially creative group participation can impact on lasting behavioural change.

The aim of this paper is to provide an overview of a novel offender personality disorder (OPD) higher education programme and the research evaluation results collected over a three-year period. Data from Phase 1 was collected from a face-to-face mode of delivery, and Phase 2 data collected from the same programme was from an online mode of delivery because of the COVID-19 pandemic.

In Phase 1, three modules were developed and delivered in a fully face-to-face format before the pandemic in 2019–2020 (n = 52 student participants). In 2020–2021 (n = 66 student participants), training was adapted into a fully online mode of delivery in Phase 2. This mixed-methods study evaluated participant confidence and compassion. Pre-, post- and six-month follow-up questionnaires were completed. Qualitative interviews were conducted across both phases to gain in-depth feedback on this programme (Phase 1: N = 7 students, Phase 2: N = 2 students, N = 5 leaders). Data from Phase 1 (face-to-face) and Phase 2 (online) are synthesised for comparison.

In Phase 1 (N = 52), confidence in working with people with personality disorder or associated difficulties improved significantly, while compassion did not change. In Phase 2 (N = 66), these results were replicated, with statistically significant improvements in confidence reported. Compassion, however, was reduced in Phase 2 at the six-month follow-up. Results have been integrated and have assisted in shaping the future of modules to meet the learning needs of students.

Further research into the impact of different modes of delivery is important for the future of education in a post-pandemic digitalised society. Comparisons of blended learning approaches were not covered but would be beneficial to explore and evaluate in the future.

This comparison provided informed learning for consideration in the development of non-related educational programmes and, hence, was of use to other educational providers.

This paper provides a comparison of a student-evaluated training programme, thus providing insights into the impact of delivering a relational-focused training programme in both face-to-face and online distance learning delivery modes. From this pedagogic research evaluation, the authors were able to derive unique insights into the outcomes of this programme.

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.

Dialectical behaviour therapy (DBT) has been widely used in a number of different settings with published outcomes and literature supporting its validity and efficacy. What is less understood is DBT’s application to forensic populations. The purpose of this paper is to qualitatively explore the experiences of high risk and adult male forensic clients (diagnosed with borderline personality disorder (BPD) and antisocial personality disorder (ASPD)) in a forensic adapted version of DBT.

Six clients who had completed four modules of DBT and individual therapy engaged in semi-structured interviews which were transcribed and analysed using thematic analysis.

The findings identified emerging themes relating to group processes and treatment outcomes. Specifically, the importance of motivation, shared learning, professionalism, reinforcement and reflection in creating a positive experience of DBT were identified. In addition clients identified feeling supported, a sense of belonging, personal achievement, increased knowledge and skills application as being part of their experience of DBT.

Whilst efforts were made to manage limitations, potential confounders include the impact of the researcher’s direct involvement in the facilitation of DBT and the small sample size.

This study provides support for the use of DBT with forensic males diagnosed with ASPD and BPD and the importance of the group component to the treatment modality. It emphasises the importance of group cohesion and the development of interpersonal factors including feeling supported, sense of belonging and a sense of achievement.

This paper provides a unique contribution to the understanding of the application of DBT with forensic male clients with personality disorder. It is the first known study to use qualitative methods to explore forensic male clients’ experiences of group and individual DBT. This paper provides insight into the key themes of clients’ experiences of DBT. These identified themes lend support to the importance of motivation of clients and the experience of shared learning, reinforcement and reflection. Furthermore, feeling supported, having a sense of belonging and a sense of personal achievement were identified as key to the positive experience of clients.

The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders (PDs) within a high security prison.

A comparative quantitative case study design supported the understanding of the frequency and pattern of SH and PRB behaviour across two stages of a PD treatment programme for 74 male prisoners. Data obtained from the prison’s records were analysed using dependent t-tests, χ² test of independence and time-frequency analyses.

Inferential statistics showed that the frequency of SH and PRB behaviour statistically increased across two phases of the PD treatment programme; however, the method of SH or type of PRB behaviour engaged in did not change. Mapping the frequencies of incidents using a time-frequency analysis shows the patterns of both behaviours to be erratic, peaking in the latter phase of treatment, yet the frequency of incidents tended to decline over time.

This is the first study to explore SH and PRB behaviours in men across two phases of a PD treatment programme. This study highlights the need for continued psychological support alongside the PD treatment programme with a focus on supporting men in treatment to effectively manage their SH and PRB behaviour.

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.

The purpose of this discussion paper is to describe the transition over the past five years of a highly specialist group treatment programme to a tiered public health delivery model within the offender personality disorder (OPD) pathway. The focus of this journey of transformation has been the Challenge programme, currently the only OPD specialist service for men with sexual convictions in the community in England and Wales, and now a pan-London service.

More than 600 high-risk men with sexual convictions are screened into the OPD pathway and reside currently in the community across London. The programme leads have developed a triage model – based on the wider OPD model – that applies the principles of the least intervention necessary and the most effective use of limited resources.

Preliminary informal feedback was sought on the new consultation approach and innovative joint casework delivery models. The model of care is discussed in relation to the preliminary feedback, which was encouraging in terms of satisfaction with the consultation service and in terms of the people on probation who found that participating in the joint casework enhanced their working relationship with offender managers. The consistent use of a single model of care and a careful triage approach across the city to working with this group of individuals is still in development. Early feedback suggests that the service has to potential to be effective, but establishing this requires formal evaluation.

Practice implications include the need to address the lack of confidence that many practitioners report when working with people with sexual convictions. Virtually delivered group consultation may enhance the development of skills as it may providing a flexible toolkit for delivery.

This practice paper describes the only specialist community service for men with high-risk, high-harm sexual convictions and personality difficulties in the UK.

This study aims to explore the demographic and reconviction data of individuals who had engaged in an established Intensive Intervention and Risk Management Service, a community service within the offender personality disorder pathway (OPD).

Demographic information and reconviction data from the Police National Computer was accessed for all participants (n = 69) released to the service over a 10-year period (2008– 2018), 45 of who met criteria to be included in the study. Their intervention period spans custody to community, with an expected period of 2 years engagement upon release.

Participants in the service had experienced significant traumatic histories, with four or more adverse childhood experiences. Individuals had a mean of 17 convictions for violent and/or sexual offences and an average of 11 years in custody prior to release. The average length of intervention at Resettle in the community was almost 19 months, with an additional minimum of six months in-reach prior to release. A total of 60% of individuals were recalled back to custody at least once during their intervention, with this being more likely for those who had been convicted of a violent rather than sexual offence. Within the group who were reconvicted, the reconvictions were for less serious offences than the index offence, with only 16% being convicted of an indictable offence. Almost two-thirds (64.4%) did not receive a further conviction post-intervention in the follow-up period.

This follow-up study focused upon demographic and reconviction data from one established IIRMS. Although findings are not necessarily generalisable to other IIRMS and OPD pathway services, the demographic and reconviction data has important learning for how services may reflect upon engaging with individuals whose needs and risks had not previously been adequately met and managed upon release. This data are useful learning, for what may help individuals with complex needs upon release into the community after long sentences and how to best meet their needs. There are aspects of the Resettle IIRMS approach which could be applied to non-specialist services to encourage a holistic, compassionate and relational approach to reaching those with complex needs who pose significant risks to others.

This follow-up study has provided access to participants’ engagement with an established IIRMS. Although participants “opt in” to the service whilst in custody, engagement on release becomes a probation licence condition; a fixed boundary regarding attendance and engagement which, although enables robust risk management and reduces the likelihood of drop-out, also raises consideration about choice and control. The four day per week service provides an intensive intervention, for those with complex needs and limited prior experience of living safely (with minimal risk to self or others) in the community. Participants were previously offered little hope of release or effective support because of their risk, need, complexity and, in some cases, concern about whether their risk could be effectively managed. Although not a panacea for all, the results are suggestive of a service that is navigating the boundary between “care and control” to good effect for future resettlement and desistance.

The findings are important for service providers, commissioners and the public purse. The results are useful for the national development of IIRMS. The findings are also important for prisoners and people on probation to inform their decision-making regarding intervention choices and hope for what may be achievable.

The purpose of this paper is to explore staff and prisoner experiences of a newly implemented Personality Disorder Service (PDS) within a category B male establishment.

A semi-structured interview was used to explore the experiences of seven male category B PDS prisoners and eight PDS members of staff (four National Health Service (NHS) clinical staff and four prison service staff) from a multi-disciplinary team (MDT). Interviews were transcribed verbatim and thematic analysis was completed.

Prisoner sample: one overarching theme “environment” organised two themes: “enabling factors” and “disabling factors” which had a subtheme “integrating men who have sexually offended onto the unit”. Another theme “opportunities for self-development” was identified. Staff sample: an overarching theme “environment” organised two themes: “enabling factors” and “disabling factors”. An overarching theme “multi-disciplinary working” organised two themes: “working in partnership” and “cultural differences in working practices”. Two further themes were: “professional development” and “stressors”.

This study focused on a small sample of staff and prisoners and their experiences of a newly implemented PDS. In addition, both staff and prisoners volunteered to take part in the study, and therefore may not be a representative sample. Consequently the results cannot be generalised to other establishments or PD services.

Staff and prisoner experiences indicate that a multi-disciplinary approach to personality disorder services is desirable and can be effective. Prisoners are gaining experiences of positive therapeutic relationships with staff and hope that their experiences of the PDS will reduce their risk of reoffending. Staff experiences indicate that the integration of two services presents challenges and that they are working to overcome these. It may be advantageous for the impact of cultural differences within a MDT to be explored further.

This is the first study that explores the experiences of the MDT and prisoners of the newly implemented PDS. The PDS forms part of the new development under the National Offender personality disorder pathway.

The purpose of this paper is to explore service-users’ hopes and expectations of a psychologically informed planned environment (PIPE) located in the high-security prison estate.

A semi-structured interview was used to explore the hopes and expectations of five male Category A PIPE prisoners. Interviews were transcribed verbatim and thematic analysis was used to analyse the data.

Analysis resulted in two overall themes: “Progression” and “Being Part of a Community”. Relevant sub-themes were considered to portray processes within these two wider themes.

In applying these findings to practice, this study provides evidence that places value on the current referral process which ascertains prisoners’ motivations to attend the PIPE.

This is the first known study that explores service-users’ hopes and expectations of the pilot PIPE service. The PIPEs are included within the recently introduced Offender Personality Disorder Pathway.