The Impact on Staff of Working with Personality Disordered Offenders: A Systematic Review

Abstract

BackgroundPersonality disordered offenders (PDOs) are generally considered difficult to manage and to have a negative impact on staff working with them.AimsThis study aimed to provide an overview of studies examining the impact on staff of working with PDOs, identify impact areas associated with working with PDOs, identify gaps in existing research,and direct future research efforts.MethodsThe authors conducted a systematic review of the English-language literature from 1964–2014 across 20 databases in the medical and social sciences.Results27 papers were included in the review. Studies identified negative impacts upon staff including: negative attitudes, burnout, stress, negative counter-transferential experiences; two studies found positive impacts of job excitement and satisfaction, and the evidence related to perceived risk of violence from PDOs was equivocal. Studies demonstrated considerable heterogeneity and meta-analysis was not possible. The overall level of identified evidence was low: 23 studies (85%) were descriptive only, and only one adequately powered cohort study was found.ConclusionsThe review identified a significant amount of descriptive literature, but only one cohort study and no trials or previous systematic reviews of literatures. Clinicians and managers working with PDOs should be aware of the potential impacts identified, but there is an urgent need for further research focusing on the robust evaluation of interventions to minimise harm to staff working with offenders who suffer from personality disorder.

An integrative review of nursing staff experiences in high secure forensic mental health settings: Implications for recruitment and retention strategies

“…Employers may also wish to ensure that HSH nurses have an adequate support network outside work and that teams are well supported because these factors appear to counter the effect of the work on the well‐being of the nurse. Such recommendations accord with those of the recent reviews of forensic nurses' well‐being; however, like those reviews (Brown et al., 2017; Dickinson & Wright, 2008; Freestone et al., 2015), we found that there remains a lack of empirical research testing the effectiveness of specific modes of staff support or supervision.…”

“…Previous systematic reviews on FMH nursing have focused on the well‐being of forensic staff, finding the empirical research to be heterogeneous, site‐specific, and of limited generalizability (Brown, Igoumenou, Mortlock, Gupta, & Das, 2017; Dickinson & Wright, 2008; Freestone et al., 2015). While some studies (Elliott & Daley, 2013; Jones, Janman, Payne, & L., & Rick, J. T., 1987; Kriakous, Elliott, & Owen, 2019) found more mental distress or burnout in forensic healthcare professionals versus other professionals, others found lower or comparable prevalence of stress and burnout compared with nurses working in other settings (Berry & Robertson, 2019; Chalder & Nolan, 2002; Dickinson & Wright, 2008; Elliott & Daley, 2013; Happell, Martin, & Pinikahana, 2003; Lee, Ogloff, Daffern, & Martin, 2015).…”

The role of emotion regulation, coping, self‐reflection and insight in staff interaction with patients with a diagnosis of personality disorder in forensic settings

“…In clinical practice, adequate emotion regulation has been shown to reduce the negative emotional impact on nurses of mistreatment by patients (Goussinsky & Livne, ). As aggression towards staff by patients in forensic settings is common (Broderick, Azizian, Kornbluh, & Warburton, ; Freestone et al, ; Nicholls, Brink, Greaves, Lussier, & Verdun‐Jones, ), these findings suggest that emotion regulation may influence the way in which staff working with patients with a diagnosis of personality disorder in forensic settings cope with the challenging behaviour of their patients. In the study by Willems et al (), emotion regulation was missing, and possibly therefore, no relation was found between task‐focused coping style and interpersonal staff behaviour, while the results for avoidance‐focused coping style were ambiguous.…”

If you want to change the world you have to start with yourself: The impact of staff reflective practice within the Offender Personality Disorder pathway

“…The importance of a competent workforce is emphasised. However the emotional challenges of working with people with personality difficulties are well documented and may result in negative attitudes towards service users, boundary issues, staff mirroring defence mechanisms employed by service users and burnout, if emotions and thoughts are not recognised, reflected on and contained (Adshead, 2012; Bowers et al, 2003; Freestone et al, 2015; Hamilton, 2010; Main, 1989; Murphy and McVey, 2003). Availability of a space for reflection and containment of staff anxieties can positively impact on the quality of relationships between staff and service users and consequently on the service user’s ability to engage.…”