Personality disorder: Complexity, countertransference and co-production

The early identification of people with personality disorder in the criminal justice system

“…There are, however, inherent limitations with screening tools, and within the context of personality disorder it is likely that it will not fully identify personality difficulties that often develop in adolescence or early adulthood. 34 There is also the concern that screening tools for personality disorder can over-diagnose personality disorder. 53 Additionally, screening tools are not comprehensive enough to adequately assess the cognitive, affective, interpersonal and behavioural features typical of narcissistic personality disorder 54 or the presence of conduct disorder prior to age 15 years for anti-social personality disorder.…”

“…33 To address these issues of stigma and marginalisation, there needs to be a good level of understanding of the comorbidity of personality disorder and other mental illnesses and a willingness to work with the associated complexities. 34 Almost 20 years ago, in 2001, the Dangerous and Severe Personality Disorder programme was established in England as a government response to the challenges posed by people who have offended and present as high risk. It was a novel but contentious approach to the management of personality disorder within the CJS and was established across four units – Broadmoor and Rampton high-secure hospitals and Frankland and Whitemoor high secure prisons – for people who met the criteria for DSPD, with the broad aim of reducing re-offending behaviour.…”

“…41 In general terms, early identification is considered beneficial for people with both mental and physical disorders, whether they are located within the community or the CJS, and personality disorder is no exception, particularly given the established difficulties with service access, marginalisation and stigma that exists for this group. 33,34 For people with a wide range of health conditions, early identification through screening and triage can promote full assessment as early as possible, leading to timely engagement within the appropriate clinical pathway. 42…”

A qualitative evaluation of staff experience in the delivery of a co-produced consultation service for personality disorder

“…the incorporation of practitioners explicitly used because of a lived experience, within MDTs, is considered a crucial element in the delivery of personality disorder services (Lamb et al, 2018;Crawford et al, 2007). Co-production is considered to help challenge stigma and negative staff perceptions through greater understanding of the patient's needs (Yakeley, 2019). A prominent example of co-production is the co-developed and co-facilitated personality disorder training package the "Knowledge and Understanding Framework" (KUF).…”

Advancing research in adult secure mental health services in England

“… 11 Despite barriers to their participation, co-production with patients, and their famies and carers, is very important and they must also be involved in developing and implementing research in this field, to ensure that it aligns with the priorities of the people who use services. 12 , 13 Furthermore, academic psychiatry in the UK has witnessed a substantial decline in capacity over recent years. The Medical Schools Council identified a reduction of 84.4 full time equivalent academic posts in psychiatry between 2007 and 2018.…”