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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.

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.

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.

This is a discussion paper describing the reflections of clinical leads within well-established intensive intervention and risk management services (IIRMS). IIRMS has developed in the past five years, with a small number of services leading in the development of a psychologically informed case management approach to working with individuals released from prison on probation licence, who have a history of high risk, high harm violent convictions linked to pervasive psychological and interpersonal problems.

Clinical leads of three services considered a period of 23 months up to December 2019, in which the outcomes for all individuals on their caseload at that time were reviewed. Reflections on the themes included the reasons for a premature return to prison and emerging themes for those who appeared to be successfully resettled.

Approximately one-third of the individuals were returned to prison, and for most, this occurred within the first 18 months of release. There was considerable unanimity between clinical leads regarding the themes, and problems with relative youth, substance misuse, relationship difficulties, managing transitions and complacency featured. There were four themes identified in those who appeared to have settled successfully in the community.

The identified themes provide key learning that will be enshrined in an updated version of the guidance for all IIRMS, with the overall aim of reaching out and engaging with a group of individuals who are most at risk of exclusion from services.

Although there are limitations associated with the informal approach of this paper, the reflections of the clinical leads have provided a valuable addition to the very limited empirical literature in this field.

The 2011 Offender Personality Disorder Strategy promoted formulation-led approaches to offender management. The purpose of this paper is to demonstrate how formulation can inform partnership-working with women offenders, specifically those with complex needs including personality difficulties.

Learning from partnership case-work is shared to highlight a psychological understanding of the needs of one female offender, and the organisational system operating around her.

The paper describes the development of a “volcano metaphor” as a conceptual framework to assist workers, without psychological training, to better understand the complexity of a client’s intense emotional world. It also reflects the impact of an individualised formulation for through-the-gate working.

The challenges and advantages of “joined-up” inter-agency working are highlighted, including some ideas on how to promote consistency. These include the use of formulation as the basis for decision making and to help “contain” strong emotions attached to working with complex women offenders. Importance is attached to stable and appropriate housing for such women by anticipating their resettlement needs prior to points of transition, and coordinating provision through multi-agency public protection arrangements.

The paper’s originality lies with the development of the volcano diagram as an accessible format for considering individualised formulation and risk assessment. The paper also offers detailed reflections on wider systemic processes attached to working with complex women offenders. It is particularly relevant to psychological practitioners working within probation and prisons, and also to offender managers.

The Millfields unit is one of three medium secure hospital services on the Offender Personality Disorder (OPD) pathway, for the assessment and treatment of high-risk offenders who are likely to meet criteria for this diagnosis. This study has designed an audit to examine influencers of patient engagement within Millfields, whose treatment approach is that of an adapted therapeutic community (TC). The purpose of this study was to explore themes raised by patients in relation to engagement, drivers for and barriers to engagement and to make recommendations for improvement.

The first author engaged in ward and group observations, a review of each patient’s medical records, unstructured discussions with staff and semi-structured interviews with each patient exploring their experiences of therapy, relationships with staff, understanding of and engagement with the treatment model, attitudes towards peers and aspirations for the future. Themes were generated from the transcription of interviews and subsequent mind mapping.

In total, 12 of the 13 patients engaged in the semi-structured interviews. Six main themes were identified as being important influencers of engagement: the ward atmosphere, authenticity of engagement, perception of staff investment in the treatment, preferential treatment of senior residents, responses to boundary crosses and violations and the level of understanding a patient had of his treatment.

Research into engagement with psychosocial therapies in patients who have personality disorders has recently been published by Tetley et al. (2012) and Jinks et al. (2012). This study specifically focusses on TC engagement and male offenders with personality disorders.

The purpose of this paper is to gain an in-depth view into how participants perceived their experience of engaging in an enhanced Intensive Intervention and Risk Management Service (IIRMS), which is a part of the Offender Personality Disorder (OPD) pathway based within the community.

Five participants were interviewed. They were at different points of engagement with the service. Interviews were taped, transcribed and analysed using the grounded theory methodology.

Participants were able to provide in-depth reflections about their experiences at the service. The main issues centred upon “managing fragile relationships” and “an emerging self”. Subcategories linked to managing fragile relationships were: “letting people in and keeping them away”; “surviving the ruptures”; and “treating me like a person”. Subcategories linked to an emerging self were: “readiness to change” and “making new connections”.

This study focused upon one enhanced IIRMS and findings are not necessarily generalisable to other services within the OPD pathway, although themes are likely to resonate for those leaving custody with complex interpersonal difficulties.

This study has provided access to participants’ perspectives on engaging with an IIRMS. Many factors impact upon the individual’s journey, which is central to the relational approach underpinning the pathway.

The findings have important messages for service providers and commissioners and crucially service user perspectives have been obtained that are integral to future development of the OPD pathway. The findings are also relevant for released prisoners attempting to reintegrate within the community.

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 purpose of this study is to investigate the experiences of adult male prisoners presenting with personality difficulties in an open (Category D) prison in the UK and their experience of a pilot offender personality disorder (OPD) pathway Psychologically Enhanced Resettlement Service (PERS) in the prison.

Thirteen participants who had engaged with PERS were interviewed about their experiences of open conditions and the service. The interviews were transcribed verbatim and analysed using thematic analysis.

Two superordinate themes were identified relating to participants’ experience of open conditions, highlighting the challenges they faced. These were “the impact of institutionalization” and “relational barriers”. Two superordinate themes were identified relating to participants’ experiences of PERS; these were “relationships with staff” and “service structure”. Each superordinate theme had subordinate themes.

Analysis is based on a small number of interviews in one male prison, and only qualitative data were collected. A mixed-methods approach would enable the triangulation of results.

Clinical importance for the pilot service is established, and there should be consideration for the rollout of PERS to other open establishments.

To the best of the authors’ knowledge, this study is the first to explore the experiences of Category D prisoners within the open estate engaging with a pilot OPD pathway service. Findings illustrate the difficulties OPD service users encounter managing the transition into open prison conditions and highlight elements of the PERS model that can support this process. Clinical and research implications are identified.

The purpose of this paper is to explore the different clinical features of pathological demand avoidance (PDA) and antisocial personality disorder (ASPD) presented in the form of a single case study. The study highlights the potential of misdiagnosis and conceptual confusions to practitioners in forensic settings between the two conditions when working with offenders with personality disorders.

A case formulation using the “five Ps” method based on the personal history of an incarcerated male is presented and the clinical similarities and differences between PDA and ASPD are delineated. These differences and similarities are evaluated and applied to offender management including intervention options.

There are considerable similarities between ASPD and PDA making the two conditions difficult to separate. Both diagnostic criteria identify childhood behavioural problems, aggression, destructiveness, conduct disorder (CD), manipulation and non-compliance as indications of the disorder. For example, the criteria for later adult ASPD are the presence of childhood antisocial behaviour and CD. However, these behaviours may also be suggestive of the attention deficit hyperactivity disorder and non-compliance that are part of PDA. Violent behaviours and aggression can also be perceived in a similar way. Misdiagnosis of PDA as ASPD reduces the efficiency of treatment programmes.

The implications of these findings could prove useful in the successful risk management of offenders with PDA. Given the similar behavioural characteristics between PDA and ASPD, the prevalence of PDA among offenders may be higher than observed. The aim of this study is to raise awareness of potential conceptual complications and clinical confusions between the two conditions with a view to aid offender management through case formulation. A large scale study into offenders with PDA would draw attention to the prevalence of the condition as well as its association with offending behaviour.