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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 report highlights the current understanding of personality disorders with specific emphasis on service provision in the context of recent policies and guidelines issued by the Department of Health. It gives an overview of the wide range of perspectives of various stakeholders. It explores the key aspects of collaboration and the implications of a collaborative approach to delivering services for people with personality disorders. It also makes recommendations for implementation and identifies the organisations involved in the process of collaboration.

People with personality disorders often present with interpersonal difficulties which affect their relationship with significant others but also with staff involved in their care. Administrators work in “frontline positions” where they are required to face challenging situations yet their role has not been studied. This study aims to describe the role and contribution of an administrator in a personality disorder service.

A mixed-methods design was used. All incoming calls to a specialist personality disorder service over three months were documented. A semi-structured focus group (n = 7) with clinicians working in the service was conducted. The data was analysed using thematic analysis. Clinical vignettes are presented to highlight typical interactions.

The qualitative results highlighted that the administrator is key in psychological preparations, managing pressure and maintaining clinical boundaries. Traits identified as useful in an administrator working in a personality disorder service are flexibility, consistency and assertiveness. Tensions between administrators and clinicians were related to the role definition of the administrator, boundaries, countertransference and process interaction. The majority of incoming calls were from patients scheduling and cancelling appointments. Only 3% of calls evoked negative feelings in the administrator such as feeling “annoyed” or “drained”.

Results highlight a need for careful selection, training and supervision of staff. A key recommendation is the need for integration and close coordination of the administrator within the clinical team.

This study represents one of the first efforts to explore the contribution of administrators within personality disorder services. It explores the impact of the administrator on the team.

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.

A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.

The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.

This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

The purpose of this paper pertains to the implementation of an occupational therapy service within a newly‐established medium secure service for 16 men with intellectual disabilities and additional diagnosis of personality disorder located in the North West of England.

This is a general review, providing a descriptive account of the development and implementation of an occupational therapeutic provision for men residing in a medium secure unit with a dual diagnosis of intellectual disability and personality disorder and a service user account of its efficacy.

The paper seeks to illustrate the efficacy of occupational therapy implemented by a specifically recruited and trained staff team, describing engagement in meaningful, bespoke programmes of occupation used to assist service users to address deficit areas via mutual engagement in activities, serving to facilitate the formation and development of positive and trusting relationships between service users and staff. The impact of the service is described from a service user's perspective.

There is very little literature relating to those with intellectual disability also diagnosed with personality disorder. There appears to be no specific study of occupational therapy amongst those with dual diagnosis of intellectual disability and personality disorder. This paper is therefore unique in its approach and provides an overview of both the process and method used to implement occupational therapy, as well as a service user perspective and an illustration of its efficacy in a medium secure setting.

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 explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) associated with treatment discontinuation in a sample of adult male prisoners.

Data from 92 male offenders in a high secure prison personality disorder treatment unit was analysed. PCL-R and personality disorder diagnoses were predicted as being related to increased treatment dropout.

Having a diagnosis of narcissistic personality disorder was related to treatment dropout, but PCL-R total scores were not. There was a trend for a diagnosis of antisocial personality disorder being associated with remaining in treatment.

The current study highlights that narcissistic personality disorder can be associated with treatment dropout, warranting further exploration as to why this is the case.

Managing responsivity issues for those presenting with a personality disorder diagnosis could be effective in maximising treatment engagement from this specific offender group.

Although treatment dropout has been explored previously, this is the first study to explore treatment dropout at a specialised unit designed specifically to provide treatment for this client group.

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.

Personality disorders manifest themselves in a variety of ways and there is also debate about the extent to which these conditions can be treated. The author debates the definition of personality disorder and considers the stigma that this diagnosis can attach to individuals. A new approach to the treatment of people with personality disorders is proposed, using the person‐centred approach and placing the individual at the centre of services. With regards to personality disorder, this person‐centred approach is able to treat the condition as well as addressing the negative effects of how it manifests itself.