Development of the Offender Personality Disorder Pathway: A summary of the underpinning evidence

Abstract

The Offender Personality Disorder Pathway programme is a jointly commissioned initiative between NHS England and Her Majesty’s Prison & Probation Service (HMPPS), the aim of which is to provide a pathway of psychologically informed services for offenders who are likely to be diagnosed with personality disorder. This paper aims to describe the underpinning evidence behind the principles and expectations of services that make up the OPD pathway programme. Evidence of personality disorder treatments from mental health settings, as well as the evidence base from the criminal justice system and the Ministry of Justice’s ‘What Works?’ literature, is considered and draws together the evidence underlying critical elements of the programme. Research shows that there is no one treatment shown to be successful for the treatment of personality disorder. As such, a holistic approach is taken, with key components including trauma-informed approaches, a focus on relationship building, early identification and sentence planning, and the importance of workforce development and relationships.

Offender personality disorder pathway Intensive Intervention Risk Management Service (IIRMS): Barriers to engagement and a vision for the future

“…It is possible that the identified offender barriers within the current study are likely to be related to the very nature of the difficulties facing the service users IIRMS attempts to engage with. In order for personality disorder to be considered present a range of psychological, emotional and social issues must be persistent, problematic and pervasive (the ‘3Ps) (Skett and Lewis, 2019). These traits may be expected to result in the difficulties we have identified to accessing psychological services to some extent.…”

“…It concluded that there was not a clear pathway of care for offenders presenting with personality disorder and that there was a limited focus on early identification and community integration within the programme. The OPD pathway aimed to address this by recognising the need for offenders to be managed across a pathway that starts and ends in the community, and which understands the nature of the complex needs of offenders with personality disorder (Skett and Lewis, 2019). Additionally, the pathway recognises that times of transition between services may be particularly difficult for offenders with complex needs who may also suffer with mental health difficulties (O’Meara et al, 2019).…”

“…Following early identification, the OPD pathway aims to support practitioners through consultation and formulation of the complex needs of the offender, and to help inform sentence and treatment planning. Additionally, within community services, the pathway offers the opportunity for some offenders to access additional individual intervention to support their identified treatment needs (Skett and Lewis, 2019).…”

Authors' Responses to Peer Review of “Offenders With Personality Disorder Who Fail to Progress: A Case-Control Study Using Partial Least Squares Structural Equation Modeling Path Analysis”

“…Response: This has been addressed in the revised manuscript; details on the standardized root mean square residual, acceptable loadings, and average variance extracted has been removed. 8. P values should be reported as exact numbers (ie, to 3 decimal points), and P values of P=.000 should be reported as P<.001.…”

Are prison-based therapeutic communities effective? Challenges and considerations

“…DTCs now form part of the OPD pathway as they incorporate the principles of treatment which are considered to be effective when working with complex personality traits (Skett and Lewis, 2019). At the core of DTCs is a relational approach to workingfocusing on therapeutic relationships, which allow the offender to feel safe, contained and which model pro-social behaviour.…”