Personality Disorder Unit Research Articles

Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit.

This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service. Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced. In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.

Clinical Audit Reviewing Compliance With Respective Trust-Based Physical Health Monitoring Guidelines, Amongst Inpatients Prescribed Anti-Psychotic Medication in Two Distinct Secure Care Facilities: A Low Secure Unit and a Prison Personality Disorder Unit

Aims1.To review the current level of compliance with CPFT (Cambridge & Peterborough Foundation Trust) guidelines by inpatients prescribed anti-psychotics at George Mackenzie House (GMH) low-secure unit and likewise, with NHFT (Northamptonshire Foundation Trust) guidelines by inmates prescribed anti-psychotics at HMP Whitemoor's Fens Unit.2.To identify any differences or similarities in compliance rates between both sites.3.To identify any possible areas of difficulty in ensuring full compliance with said guidelines and suggest possible solutions.MethodsA retrospective design was used, in which the electronic and hardcopy patient records of service users at both sites, covering a specified time-frame (2nd Dec 2021- 2nd Dec 2022) were screened. Data collected from eligible users included demographic information, names of anti-psychotics used and results of each individual's screening profile measured against the respective Trust's guidelines.ResultsThe demographic profiles of eligible service users at both sites were largely similar.17 out of 18 services users from GMH and 23 out of 50 service users from the Fens Unit were found eligible for the audit.The majority of eligible service users at both sites (88-100%) were compliant with measurement of relevant laboratory markers, as per Trust guidelines.However, at both sites, there were notable omissions in monitoring of certain physical parameters, especially waist circumference (100% omission in both sites) and ECG monitoring ( 60% omission in prison,14% in GMH), which is important given the significant comorbidity of cardiovascular risk factors amongst service users at both sites.ConclusionWe noted disproportionate compliance in the monitoring of different physical health parameters. While laboratory tests were on the whole, satisfactorily monitored, there were gaps in other clinical measurements like waist circumference and ECG recordings. We postulate several reasons for this discrepancy, including: •A possible lack of awareness about the importance of measuring parameters like waist circumference, which also indicates a lack of familiarity with Trust guidelines.•A lack of time/inconvenience in ensuring adequate recording of clinical parameters•Inadequate reminders to conduct relevant physical health checks.We suggest possible solutions to ensure 100% compliance: for example, creating a teaching session for staff and service users on pertinent topics, like metabolic syndrome or creating electronic aids to remind staff when physical measurements are due.This audit also engendered further questions on appropriateness of anti-psychotic prescription and importance of educating service users about physical complications of anti-psychotic use. These could be the focus of future audits.

The Impact of Stopping Risk Assessment Checklists at a Specialist Personality Disorder Unit.

Aim This study was conducted in Springbank Ward, a specialist ward for patients with emotionally unstable personality disorder, based in Cambridge, United Kingdom. We aimed to assess any change in incident frequency following the introduction of a new protocol for leaving the ward, in which patients are offered an optional conversation with staff in place of a formal risk assessment checklist. We also aimed to assess patient and staff perceptions of the change. Methods We used data routinely collected by Springbank Ward to compare incident frequency in the year before and after the change in protocol. We conducted structured interviews with patients and staff to obtain qualitative data on the new protocol and used thematic analysis to interpret the interview data. Results There were 466 incidents during the period before the change in protocol and 408 incidents in the period after. Adjusted for occupancy rate, there was no statistically significant difference in the frequency of incidents. Patients and staff were generally satisfied with the new protocol, with an average satisfaction rating of 4.1 out of 5. Thematic analysis generated five main themes: 'taking ownership', 'autonomy versus restriction', 'staff-patient interaction', 'staff expertise' and 'protocol efficiency'. Conclusions Our study reveals high satisfaction with the new way risk is assessed and managed for patients leaving Springbank Ward, with an appreciation for its holistic and minimally restrictive approach. This was achieved without significantly increasingincident frequency.

Patient and Staff Perspectives on a Non-Restrictive Leave Protocol at Springbank Ward, Specialist Personality Disorder Unit

AimsSpringbank Ward is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim was to gauge patient and staff satisfaction with the new protocol and investigate their views on the change.MethodsData were obtained through structured interviews with staff who assessed risk (nurses and psychiatrists) and patients. 9 patients and 8 members of staff were interviewed between 9–19 March 2021. Interviewees were presented with diagrams of both the new protocol and old risk assessment checklist and asked a series of questions, including: rating their satisfaction; any potential improvements; and whether they would prefer the previous or current protocol. Thematic analysis of interview answers was used to explore patient and staff perspectives. Two authors independently analysed the interview transcripts, before discussing any discrepancies to reach a unified set of themes, subthemes and codes.ResultsBoth patients and staff gave the new protocol an average satisfaction rating of 4.1/5. Thematic analysis generated five themes: “taking ownership”, “autonomy Vs restriction”, “staff-patient interaction”, “staff expertise” and “protocol efficiency”. Most interviewees agreed that the new protocol supported patients in taking responsibility for their safety, helping to prepare for life in the community. The protocol was considered minimally restrictive and more efficient than the previous system. The importance of communication and trust between patients and staff, as well as the use of staff intuition in holistically assessing risk, was emphasised. Potential disadvantages included the perceived riskiness of reducing restrictions and difficulty seeking support early in the admission.ConclusionIn general, the new protocol is rated highly by patients and staff and is considered to be minimally restrictive and more holistic, in line with the aims established by our previous evaluation. Our findings have implications regarding risk management for inpatients with EUPD.

How one specialist personality disorder unit stopped using restraints and restrictions

How one specialist personality disorder unit stopped using restraints and restrictions

Rethinking Risk Assessments in a Borderline Personality Disorder Unit: Patient and Staff Perspectives.

BackgroundThe present study was undertaken in a borderline personality disorder unit in Cambridge, UK. Our aim was to evaluate patient and staff perspectives on the current risk assessment procedure and to assemble opinions on a proposed change to this procedure.MethodologyStructured interviews were conducted with patients and risk-assessing staff. Likert-scale and open questions were asked to gather both quantitative and qualitative data on both the preexisting risk assessment procedure and the proposed change to the procedure. The qualitative data was assembled into key themes.ResultsPatients and staff were moderately satisfied with the current risk assessment process, with patients scoring it an average of 2.75 out of 5 and staff scoring it 2.5 out of 5. Six key themes emerged as relevant to the process for both staff and patients: holistic approach, autonomy and freedom, responsibility, staff-patient relationship, time taken, and chance for reflection. One theme, “triggering negativity,” emerged among patients only, while a theme exploring ideas about risk emerged only among staff.ConclusionOur study highlights the need to introduce a new risk assessment procedure that grants patients more freedom and responsibility and encourages staff to individualize the process for each patient by taking a holistic approach. This would cultivate a ward environment that is less risk-averse and more recovery-oriented.

Sex, gender and the carceral: Female staff experiences of working in forensic care with sexual offenders

English high-secure hospitals have contained individuals deemed mentally disordered, and dangerous, since the mid-nineteenth century. With the development of gender sensitive services female patients have been moved out of these institutions into smaller secure settings. Female staff continue to work in high secure hospitals, but are often in a minority in these services. Little is known about how female staff experience the everyday world of work. This paper is based on in-depth interviews with female nurses employed in a unit caring for detained male sexual offenders with a diagnosis of personality disorder. It forms part of a much larger discourse-analytic study of nine patients, with a history of sexual offending, and eighteen mental health nurses, which focused on talk about pornography and criminality. The findings from this project have been previously reported in Mercer and Perkins (2014). This paper demonstrates how patriarchy remains an enduring cultural characteristic of caring for men detained under the Mental Health Act (1983, 2007) because of sexually violent crimes against women and children. It textures the ward environment and the relationships between people who work within it, constructing women as ‘outsiders’ and producing a masculine culture which leaves female staff feeling vulnerable and at risk. The analytic focus of the paper is concerned with exploring how women experience working in the male-dominated environment of a high-security Personality Disorder Unit (PDU). Three discursive repertoires are identified: the institutional space as male, the impact of working with men detained as a result of sexual offending, and the construction of therapeutic work as a ‘job for the boys’. In this world, female staff, as a product of their gender, constructed themselves both as at risk and inviting risk.

Cost implications of treatment non‐completion in a forensic personality disorder service

BackgroundA high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive treatment at all.AimsIn this study, we sought to determine the economic consequences of non-completion of treatment, using case study data from a secure hospital sample. Both health and criminal justice service perspectives were taken into account.MethodsData were collected from a medium secure hospital personality disorder unit. A probabilistic decision-analytic model was constructed, using a Markov cohort simulation with 10,000 iterations. The expected cost differential between those who do and those who do not complete treatment was estimated, as was the probability of a cost differential over a 10-year post-admission time horizon.ResultsOn average, in the first 10 years following admission, those who do not complete treatment go on to incur £52,000 more in costs to the National Health Service and criminal justice system than those who complete treatment. The model estimates that the probability that non-completers incur greater costs than completers is 78%.ConclusionIt is possible that an improvement in treatment completion rates in secure hospital personality disorder units would lead to some cost savings. This might be achievable through better selection into treatment or improved strategies for engagement and retention. Our study highlights a financial cost to society of individuals discharged from secure hospital care when incompletely treated. We suggest that it could, therefore, be useful for secure hospitals to introduce routine monitoring of treatment completion. © 2013 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons, Ltd.

Reflections on using qualitative methods with offenders in the High Secure Prison Estate

This article reflects the experiences of using qualitative research methodologies with personality–disordered prisoners located within a high secure Dangerous and Severe Personality Disorder (DSPD) unit. The study described in this paper aimed to explore the functions that self–harming behaviour served for personality–disordered prisoners. During the planning stage of the study, quantitative methods were deemed unsuitable to answer the research question, as the hope was to ascertain participants’ insights into the functions of their self–harming behaviour. Aside from qualitative methods being more appropriate in this instance, the implementation of the study led to other benefits being observed. Qualitative methodology, incorporating a semi–structured interview and analysis using Interpretative Phenomenological Analysis, were considered valuable in exploring the research question. These qualitative factors allowed the investigation of: a sensitive subject that allowed the interviewer to be responsive to participants; participants’ ‘lived experience’ of a phenomenon; participants’ insight into their self–harming behaviour; core beliefs linked to self–harming behaviour; the functions that self–harming behaviour serves; and how the functions of self–harming behaviour can evolve over time.

Effectiveness and tolerability of long-acting intramuscular risperidone as adjuvant treatment in refractory borderline personality disorder

Dear Editor The lack of effective oral treatments for severely affected patients with borderline personality disorder (BPD) lead us to frequently use depot antipsychotic medication in our personality disorder unit. BPD is characterized by severe instability of interpersonal relationships, of self-image, and of affects resulting in marked impulsivity. The importance of the disorder is reflected in persistent functional impairment and in elevated suicide rates (Cheng et al. 1997; Paris 2005). There is no current consensus on the best treatment for BPD, and different combinations of oral medications are being prescribed by physicians (Paris 2011; Silk 2011). Furthermore low treatment compliance with oral medication is particularly described in these patients due to their characteristic personal instability which might significantly affect the efficiency of the drugs. For that reason, the possibility that lack of efficacy of oral treatments in refractory BPD patients might reflect the lack of compliance needs to be explored. In that sense, we designed a study to explore the benefits of using a depot IM medication, longacting intramuscular risperidone, in the treatment of BPD patients refractory to previous oral medication trials. A total of 49 BPD patients (30 women and 19 men) were included in the study. Inclusion criteria were the following: (1) 18–45 years of age; (2) diagnosis of borderline personality disorder (BPD) according to DSM IV criteria; (3) score equal or greater than 16 in the Zanarini Rating Scale for BPD; (4) “severely or very severely ill” as defined by a score 5 or greater in the CGI severity scale; and (5) refractory to a combination of oral medications commonly used for BPD treatment. Exclusion criteria were (1) current substance use dependence disorder; (2) life history of schizophrenia, schizophreniform disorder, bipolar disorder, or neurological disorders; (3) unstable medical disease or pregnancy; and (4) demonstrated intolerance to oral risperidone. The sample mean age was 27 years (SD±4.5) and the average duration of the disease was 7 years (SD±3.3). Patients were regularly treated in the day-care hospital due to severe behavioral dyscontrol causing markedly functional impairment. The study was approved by the Institutional Ethical Committee, and all patients signed informed consent. Treatment was started with an initial dose of 37.5 mg IM injection of LA risperidone repeated every 2 weeks, which could be raised to 50 mg as to clinical consideration. Patients were evaluated at months 1, 3, and 6 with clinical scales including the Zanarini Rating Scale for BPD, the Hamilton Anxiety Rating Scale, the Brief Psychiatry Rating Scale (BPRS), the Overt Aggression Scale (OAS), the Clinical Global Impression scale (CGI), and the Global Assessment of Functioning (GAF). Gradual significant improvement of severity ratings was observed from the first month and during the first 3 months of treatment (p<0.001), but no significant changes in the CGI scale were observed between the third and sixth J. L. Carrasco (*) :N. Palomares :M. D. Marsa Institute of Psychiatry and Mental Health, Hospital Clinico San Carlos, C/ Martin Lagos s/n, 28040 Madrid, Spain e-mail: jcarrasco.hcsc@salud.madrid.org

‘Enabling Environments’: The lived experience of Category A prisoners on a Dangerous and Severe Personality Disorder unit

The study explores the lived experience of Category A prisoners on a Dangerous and Severe Personality Disorder (DSPD) unit. Specifically the focus was on exploring what core environmental qualities Category A prisoners residing on a DSPD unit consider to be necessary for the unit to be an ‘enabling environment’ based on their actual experience of engaging and residing on the Westgate DSPD unit. A secondary aim of exploring the congruence between participants’ responses and the nine core elements of an ‘enabling environment’ proposed by Johnson and Haigh (2011) was also considered. An Interpretative Phenomenological Analysis (IPA) method was chosen for this study as it focused on understanding the meaning attributed by participants to their particular lived experience. Four participants (Category A prisoners post-DSPD treatment) were interviewed using semi-structured questions based on existing research. Interviews lasted an hour and were analysed using IPA (Smith, Flowers &amp; Larkin, 2009), an idiographic method that allows an in-depth analysis of the transcripts. Analysis of the four interviews produced three superordinate themes: identity within a social world, embracing change and maintaining stability throughout change. Participants found the DSPD unit environment provided opportunity, choice and the chance to take personal responsibility for change. Inconsistent rules and lack of transparent decision making were highlighted by participants as factors that imbalanced the overall positive experience of the DSPD unit environment. Additionally, the nine core elements of an ‘enabling environment’ as proposed by Johnson and Haigh (2011) appeared to map onto the emerged three superordinate themes. This is indicative that the actual lived experience of Category A prisoners, meeting criteria for DSPD services, supports that the Westgate DSPD unit has elements of an ‘enabling environment.’ Furthermore, there are implications that the core elements of an ‘enabling environment’ could be considered within the context of three broader themes: encourage identity within a social world, embrace change, and maintain stability throughout change.

Investigating changes in anger and aggression in offenders with high levels of psychopathic traits attending the Chromis violence reduction programme

Chromis was accredited by the Correction Services Accreditation Panel in 2005 as an intervention designed to reduce violence in offenders whose level or combination of psychopathic traits disrupts their ability to engage in treatment and change. It runs as part of the regime in the dangerous and severe personality disorder unit in HM Prison Frankland (Westgate). A multiple case study investigation into changes over time in participants is currently underway, part of which is reported here. This paper reports on information relating to changes in anger and aggression in Chromis completers. Change in psychometrics and observed incidents of verbal and physical aggression are considered for five case study participants who have completed Chromis and progressed from Westgate to a different location. Findings suggest that cases experienced a reduction in self-reported anger, and expected incidents of physical aggression but had higher than expected levels of verbal aggression after leaving Westgate. These findings offer cautious optimism for the effectiveness of Chromis, although methodological limitations must also be considered. Findings may be seen as positive indicators of Chromis, or at least the approach to working with these offenders across Westgate, in reducing violence. Findings support the continued delivery and evaluation of Chromis. There may be benefit in exploring ways to further understand and address verbal aggression in participants.

‘Everything contradicts in your mind’: A qualitative study of experiences of forensic mental health staff in two contrasting services

In the theoretical literature, there is growing recognition of the psychological impact on staff of working in challenging healthcare settings. In forensic mental health (FMH) services, powerful transference and counter-transference reactions in staff-patient relationships may emerge and may even play a role in contributing to incidents of malpractice, but there is little empirical research here. The exploration of the experiences of FMH staff in two contrasting services. Thirteen in-depth interviews were carried out with staff from a range of clinical disciplines in a mainstream National Health Service (NHS) medium secure unit (MSU), and 12 interviews were undertaken with such staff from a Personality Disorder Unit (PDU) in an MSU. All interview data were analysed independently using the grounded theory method. To synthesise the two separate analyses, a thematic analysis of both data sets was carried out, in which 'thematic units' were defined as significant points of comparison between the analyses of the two sets of interviews. The combined analysis yielded six main themes under two main headings. Themes under the first heading Experience of the Clinical Task were: 'difficulty in achieving task integration'; 'motivation to build relationships, work through difficulty and bring about change'; and 'minimal sense of risk and anxiety at the centre'. Themes under the second heading Experience of the Organisation were: 'a distant and difficult relationship with outside'; 'preoccupation with staff relationships'; and 'feeling unsafe'. The overarching concept of the combined analysis was encapsulated in the quotation: 'Everything contradicts in your mind'. Clinical and organisational aspects of work seemed separate in the minds of staff, with the latter reported to be more stressful; staff support came in the form of close relationships with colleagues, who saw themselves as isolated in the context of the wider environment. Promotion of the well-being and effectiveness of FMH staff should therefore take account of clinical, organisational and societal aspects of their situation.

An exploratory analysis of the NEO‐FFI and DSM personality disorders using multivariate canonical correlation

AbstractIt has been argued that some of the difficulties in the Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorders might be overcome by examining their association with measures of general personality such as the Neuroticism, Extroversion and other Five‐Factor Inventory (NEO‐FFI) model. The study explored associations between the NEO‐FFI and DSM personality disorder in 85 male offenders referred to a personality disorder unit. Although simple correlation showed the expected associations, multivariate canonical correlation revealed more complex and novel associations such as the finding that borderline personality disorder has a more robust conceptual relationship than antisocial personality disorder with the NEO‐FFI. Overall, the NEO‐FFI can be used to conceptualize most DSM personality disorders. Copyright © 2010 John Wiley &amp; Sons, Ltd.

An empirical evaluation of reasons for non‐completion of treatment in a dangerous and severe personality disorder unit

Individuals deemed to be of high risk to others, and diagnosed with severe personality disorders have become the focus for developing clinical services in England. Such services often require highly secure accommodation and labour-intensive therapeutic interventions. There is, however, uncertainty about the capacity to engage such patients effectively in therapies. Here, we examine service evaluation monitoring data to identify the level of completion of therapeutic programmes in a high secure severe personality disordered population, and analyse reasons for failure to complete. Guidelines for classifying reasons for non-completion were developed, based on the multifactorial offender readiness model (MORM). Electronic case notes were searched for references to non-completion, and recorded reasons for non-completion were classified. Non-completion was at a relatively modest level. The main reasons for non-completion were: (1) affective: general distress of the patient or specific emotional reactions to previous offending, e.g. shame; (2) volitional: pursuing goals other than treatment; and (3) cognitive: negative self-efficacy beliefs and negative evaluations (low trust) of staff and the programme. External factors included exclusion from treatment and transfer to another unit. This study identifies specific readiness areas that might need to be addressed in efforts to improve engagement and retention in treatment. A wider range of methodologies is required for future studies.

P02-247 - Assessing the functions of self-harm behaviours in a high secure hospital setting for patients deemed dangerous and severely personality disordered

ObjectivesThe present research aims to investigate what purpose[s] self-harm serves for male patients in a dangerous and severe personality disorder unit in Rampton high secure hospital. It is proposed that existing functional models of self-harm should be modified to suit this group due to environmental constraints and features of their diagnoses.MethodsA model of self-harm was devised from interviews with patients, literature reviews and a pilot review of daily nursing notes, therapy notes and incident reports. The ten proposed functions for self-harm in this population were affect regulation, interpersonal influence, control, sensation seeking, psychosis, feeling generation, self-punishment, anti-suicide, revenge and the expression of aggressive intent. This was applied to data collected from incident reports and daily nursing notes on all incidents (n=386) of self-harm for all current patients (n=53) in the unit in December 2008, in order to establish the nature and context of the incidents, i.e. the location, time and method of self-harm, as well as the function of the behaviour.ResultsThe nature and context of self-harm was similar to that in other inpatient and secure settings, except the number of incidents, which did not vary according to time of day. The functions of self-harm were diverse, and there was evidence for those unique to this population.ConclusionsFuture research intends to develop a behavioural classification system for the assessment of motivations for self-harm that can be administered to staff and patients. The clinical impact of this work is discussed.

The clinical and risk characteristics of patients admitted to a secure hospital‐based Dangerous and Severe Personality Disorder unit

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.

An exploratory study of the needs of staff who care for offenders with a diagnosis of personality disorder

People with a diagnosis of personality disorder who are considered a risk to others are a current concern for public services, government and society. Healthcare provision for this group has recently increased, making it important to begin to learn about the needs of staff working in such a challenging area. An exploratory interview study with staff working in a medium secure unit for offenders with a diagnosis of personality disorder (Unit Z) is presented. Interviews were line-coded and analysed according to the grounded theory method. A model was developed from higher order categories. This related key contextual factors to areas of concern for staff. The key contextual factors were: 'complexity of the task' and 'tension in the relationship with outside'. The areas of concern were: 'desire for more meaningful contact', 'contradictory attitude towards openness', 'feeling physically safe but emotionally vulnerable', 'ambivalence towards structure and control' and 'emphasis on staff relationships'. 'Risk of isolation' formed a core category and described Unit Z staff's pervading sense of distance from the outside world. These categories are described with supporting quotations and discussed in relation to the existing literature. Their implications for clinical practice and the development of services are considered.

‘Sentenced to hospital’—A cause for concern?

Personality and Mental HealthVolume 1, Issue 1 p. 74-79 Complex CaseFree Access ‘Sentenced to hospital’—A cause for concern? Adrian Morris, Adrian Morris Nottinghamshire Healthcare NHS Trust, UKSearch for more papers by this authorSimon Gibbon, Simon Gibbon Nottinghamshire Healthcare NHS Trust, UK Section of Forensic Mental Health, University of Nottingham, UKSearch for more papers by this authorConor Duggan, Corresponding Author Conor Duggan [email protected] Nottinghamshire Healthcare NHS Trust, UK Section of Forensic Mental Health, University of Nottingham, UKUniversity of Nottingham, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA, UKSearch for more papers by this author Adrian Morris, Adrian Morris Nottinghamshire Healthcare NHS Trust, UKSearch for more papers by this authorSimon Gibbon, Simon Gibbon Nottinghamshire Healthcare NHS Trust, UK Section of Forensic Mental Health, University of Nottingham, UKSearch for more papers by this authorConor Duggan, Corresponding Author Conor Duggan [email protected] Nottinghamshire Healthcare NHS Trust, UK Section of Forensic Mental Health, University of Nottingham, UKUniversity of Nottingham, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA, UKSearch for more papers by this author First published: 06 August 2007 https://doi.org/10.1002/pmh.10Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL REFERENCES Fallon, P., Bluglass, R., Edwards, B., & Daniels, G. (1999). Report of the committee of inquiry into the personality disorder unit, Ashworth Special Hospital. London: HMSO. Retrieved from: http://www.archive.official-documents.co.uk/document/cm41/4194/ash4194.htm Grieg, D. N. (2002). Neither bad nor mad: The competing discourses of psychiatry, law and politics. London & Philadelphia: Jessica Kingsley Publishers. Citing Literature Volume1, Issue1June 2007Pages 74-79 ReferencesRelatedInformation

Attitude to personality disorder among prison officers working in a dangerous and severe personality disorder unit

Background It is well established that staff attitudes to personality disordered patients are commonly negative, characterised by pessimism and rejection. A recent study in forensic psychiatric hospitals has described the psychological and social factors underlying positive attitudes, and suggested that staff with more positive attitudes perform better and are less stressed. Aim To assess whether it is possible to predict which staff will adjust positively to working with personality disordered people. More specifically to confirm links between attitude to personality disorder and: job performance; perception of managers; personal well-being; burnout; and interaction rates with inmates. Methods The opening of a new Dangerous and Severe Personality Disorder unit within a UK prison allowed a longitudinal study of prison officers to be performed, in which a number of measures, including the Attitude to Personality Disorder Questionnaire (APDQ), were collected at three fixed points (at baseline, eight and sixteen months after the opening of the unit). Results Attitude to Personality Disorder varied over the course of the study, and changes in attitude were linked to events experienced by individual officers. More positive attitude to personality disorder was associated with improved general health and job performance, decreased burnout, and favourable perception of managers. Conclusions Attitude to Personality Disorder has important outcomes, and is responsive to the psychosocial environment. Its measurement is not useful for staff selection, because of low stability over lengthy time periods. The APDQ has been demonstrated to be valid measure of attitude to PD, and potentially useful for outcome studies, or benchmarking between units.