Assessments and admissions during the first 6 years of a UK medium secure DSPD service.

BACKGROUND: Offenders with personality disorder represent a considerable burden on mental health and criminal justice services. Millfields Unit was one of the pilot medium secure units (MSUs) established by the UK Department of Health and Ministry of Justice to provide dedicated services for such individuals. AIMS: Our study aimed to describe a complete cohort of referrals made to the service and to explore decisions on admissions to the Unit. METHODS: File review was used to collect a structured data set of information on the first 158 referrals. These were then analysed descriptively and inferentially. RESULTS: Previous psychological treatment in prison and evidence of motivation for further treatment were the strongest predictors of admission to the service. People admitted showed evidence of more extensive criminal histories, prior treatment failure and higher level of risk than those accepted into conventional medium secure units. Despite the stated purpose of the units being for people with personality disorder, a high number of patients with a primary diagnosis of psychotic illness were referred. CONCLUSION: The new service accepted a high-risk group of people with personality disorder whose needs would not otherwise have been met.

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

BACKGROUND: Personality disordered offenders (PDOs) are generally considered difficult to manage and to have a negative impact on staff working with them. AIMS: This 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. METHODS: The authors conducted a systematic review of the English-language literature from 1964-2014 across 20 databases in the medical and social sciences. RESULTS: 27 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. CONCLUSIONS: The 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.