Search results

This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disordered (DSPD) NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 DSPD admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. There is a high risk of violent/sexual recidivism as measured by the Static‐99, Violence Risk Scale, and the Historical, Clinical and Risk Management Scale.

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.

This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality disorder. It raises the question: is personality disorder related to dangerousness, and (if so) what mediates the relationship? It then reviews recent findings suggesting that patients deemed to be dangerous and severely personality disordered are characterised by a combination of antisocial and borderline traits, and as such are a source of distress both to themselves and to others. It remains for future research to determine how this particular constellation of personality disorders is functionally linked to dangerousness, and whether the link is mediated by neuropsychological impairment resulting from early‐onset alcohol abuse, as recently proposed by Howard (2006). It is recommended that the current criteria for ‘dangerous and severe personality disorder’ be dispensed with.

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.

This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.

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.

Although support exists for the effectiveness of treatment for personality disordered offenders there is limited knowledge about the processes underlying the therapeutic change. The purpose of this paper is to explore the treatment experiences of six male psychopathic offenders who attended a social skills treatment component implemented within a high-secure personality disorder treatment service.

Interview transcripts were analysed by the lead researcher (first author) using interpretative phenomenological analysis (IPA) who compared and contrasted findings to develop superordinate themes across the group. External auditing analysis was conducted by the second author.

Several themes were identified that may indicate the unique ways this client group experienced treatment. These related to the importance of “group cohesion” with treatment progression and shared learning experiences, the significance of “therapeutic alliance” with treatment providers and perceived effectiveness of treatment, and the conflict participants experienced when acquiring and applying skills from their engagement in treatment. Participants identified aspects of the treatment component that facilitated the effectiveness of treatment and were effective in meeting their needs and some that would benefit from improvement.

Positive group dynamics are important. Operational staff inclusion within the facilitation team is beneficial. Attentiveness to participants’ specific responsivity needs is required. Supporting skill application post-treatment is important.

These findings add to the evidence base in relation to factors that support personality disordered offenders’ engagement within treatment. Areas that validate treatment delivery are highlighted, as are suggestions for change to maximise treatment gain for psychopathic and personality disordered offenders.

Positive professional attitudes towards personality‐disordered clients have been linked with extensive clinical and strategic benefits. The largest influences upon such attitudes are associated with staff training, supervision and support. This preliminary evaluation seeks to consider the effect of an introductory personality disorder awareness workshop upon trainees' attitudes towards personality disordered prisoners.

The attitude towards personality disorder questionnaire (APDQ) was administered to prison staff (predominantly prison officers) immediately before the workshop and then re‐tested, on average, two months later.

The study sample (n=26) showed significant improvements on the “security versus vulnerability” APDQ sub‐scale. The remaining four sub‐scales and overall APDQ scores showed no significant change.

The findings indicate that personality disorder awareness training should initially engage with trainees' perceptions of their personal security and vulnerability when working with this client group, rather than aiming to increase liking, enjoyment and acceptance of such offenders.

This study marks a preliminary analysis of a new personality disorder awareness training programme.

ABSTRACT Providing nursing care for patients with personality disorders is seen by many nursing staff as a highly undesirable job. This paper reviews the available literature and attempts to explore why the task of providing nursing care to these clients is so unpopular. Five core areas of difficulty are identified in the literature and each of these will be elaborated upon within the paper: i) these patients are perceived as less reinforcing and more demanding than mentally ill patients, ii) nurse training is inadequate preparation for this type of work, iii) the role of nursing personality‐disordered patients is high in conflict, iv) this type of nursing is traumatising and v) this type of nursing requires specific skills and qualities.The paper will then outline the implications that these challenges have for a nursing service that provides care for personality‐disordered patients. These include the impact upon i) the retention of staff, ii) the recruitment of staff, iii) the patients and iii) an organisation. The paper will also suggest some potential solutions to these challenges.

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.