Personality disorder: prison vs community

This is a blog I wrote for CLINKS in May 2019. The exact link appears at the bottom of this blog.

Personality disorder: prison vs community

It is a sad and worrying fact that, as it stands, the best place in Derbyshire to get help for someone with a personality disorder (PD) is in HMP & YOI Foston Hall. Since 2013, the prison’s CAMEO unit has provided intervention and treatment pathways for women in prison, with all types of PD, in a therapeutic environment (Coping with complex needs, Aiming for a better understanding of self through Motivation to change, Engaging with others, and Optimism for the future). However, strict criteria mean that only those who have at least two years left on their sentence (meaning that they must have received a sentence of four years or more) can be admitted to the unit. For others, with a less serious offence, treatment must come from the over-stretched In-Reach team, who deal with the rest of the prison population. In the community, programmes exist in Approved Premises. For those who have not offended, however, specialised help for people with a PD is virtually non-existent.

Prison (specialist services)
The CAMEO service is part of the Offender Personality Disorder (OPD) Pathway, which is co-commissioned and managed by NHS England and Her Majesty’s Prison and Probation Service in response to the knowledge that approximately two-thirds of prisoners meet the criteria for at least one type of personality disorder. As well as initiatives such as the CAMEO unit, various courses have been established around the secure estate to help people in prison, including those with a PD, to interact with others in a safe and productive way. This includes the various hostels in the community, operating as Approved Premises. The Pathway Press, the newsletter of the OPD programme, offers more information.

Prison (without specialist support)
There is a serious lack of training for prison staff in the symptoms of PD. Too often, those with a personality disorder are seen as attention-seekers and/or trouble-makers. It is very often the case that an individual with a PD spends a longer time than normal locked in their cell and, as was my experience, this could be in segregation, alone for up to twenty-three hours a day. This exacerbates the condition, leading to even more time in segregation. For those lucky enough to be referred to In-Reach, there is inevitably a long waiting list and even then, treatments for personality disorders, outside the specific units, are difficult to source.

With a lack of resources, members of In-Reach face an uphill struggle to cope with the number of prisoners with a PD. In addition, making a diagnosis whilst in custody can be unreliable because the individual is away from their usual environment. People very often act differently in prison; they may be putting on a brave face or become anti-social. With regard to triggers, those in the community will merely be replaced with new or similar ones in prison. For example, a common symptom of Borderline Personality Disorder is the fear of sudden endings. This can be relationships, such as with a therapist, or situations. In prison, relocating an individual into another cell without prior knowledge can be immensely traumatic.

In-Reach may not be able to offer a tailor-made service and the individual may be left despondent, angry and potentially dangerous. However, being in a secure environment, they are more likely to see a member of the same team than if in the community.

Arguably, one of the most effective systems in prison is the Assessment, Care in Custody, and Treatment (ACCT) book. Once an individual is seen as having a mental health condition which could lead to self-harm or suicide attempts, they are supported with the ACCT book, which offers on-going monitoring during and after any treatment. Significantly, the book will not be closed until a team of healthcare professionals, prison officers and the individuals themselves agree that it should.

The Derbyshire community
As an expert by experience (I have Borderline Personality Disorder and have spent 18 months in prison) and the founder of the Derbyshire Borderline Personality Disorder Support Group, I was asked by my local NHS Clinical Commissioning Group to set up a focus group to inform and advise on the soon-to-be-established Derbyshire Personality Disorder Pathway. The pathway will be a long time in the making, and we have to be patient, but we believe it will be worth the wait because we must get it right. With one-in-ten people with Borderline Personality Disorder ending their own lives, and many more regularly self-harming and/or spending time in secure estates, lives are at stake. People in Derbyshire, and probably in other counties, have been badly let down by health services in the past. This is largely due to a lack of understanding of the disorders on the part of health and social care professionals, and this is why we need a proper community pathway.

It is not realistic to expect a service such as the CAMEO unit to be available to everyone with a PD in the community. However, at the moment, there are many out there who are subject to a poor, or even non-existent, service. PDs continue to be misunderstood and highly stigmatised. Consequently, people are more at risk of offending, and those in prison are more at risk of re-offending once released. The proposed Derbyshire Personality Disorder Pathway model addresses the issue of education and training, with the recommendation that it should include people with lived experience. It also suggests methods of assessment, referral and re-referral, treatment, and follow-up, and warns against excluding those with complex needs, who may be thought to be a potential danger to themselves or others. It focuses on bringing awareness to all professionals who are likely to come into contact with someone with a PD, with a particular emphasis on eliminating offensive terminology. Finally, it highlights the importance of a person-centred care/treatment plan and the inclusion of long-term follow-up. For more details on the proposed pathway, please email Sue at

And finally
It is, perhaps, ironic that although diagnosed with Borderline Personality Disorder in the community, the only help I received was in prison. It was refused in the community on the basis that my symptoms were too complex. However, receiving a sentence under four years meant that I could not access the services of a PD unit and I, like many others, was forced to rely on the over-stretched In-Reach team.

Nevertheless, we still felt that we were better off than those in the community, especially in Derbyshire. For this to change, it is vital that a community pathway is established.

I would like to finish this blog with a few questions for you to consider:

How much do you know about personality disorders?
Do you know anyone with a personality disorder?
What services does your county offer for people with a personality disorder?
Does this blog leave you with a need to discover more about personality disorders?

Views: 26

Add a Comment

You need to be a member of Mental Health in Higher Education Hub to add comments!

Join Mental Health in Higher Education Hub

Blog Posts

QMU launches the world's first Masters in Mad Studies

Posted by Jill Anderson on December 1, 2020 at 11:50 0 Comments

Queen Margaret University, Edinburgh is launching the world’s first master’s degree in Mad Studies. The MSc Mad Studies course is primarily a course for graduates with lived experience of mental health issues. It has been hailed by a leading international Mad Studies academic as the most exciting piece of curriculum development in the last 20 years!

Mad Studies is a recognised academic discipline that explores the knowledge and actions that have grown…


Unlearning through Mad Studies: disruptive pedagogical praxis

Posted by Jill Anderson on October 26, 2020 at 19:00 0 Comments

Medical discourse currently dominates as the defining framework for madness in educational praxis. Consequently, ideas rooted in a mental health/illness binary abound in higher learning, as both curriculum content and through institutional procedures that reinforce structures of normalcy. While madness, then, is included in university spaces, this inclusion proceeds in ways that continue to pathologize madness and disenfranchise mad people.

This paper offers Mad…


Stepchange: mentally healthy universities

Posted by Jill Anderson on October 16, 2020 at 15:48 0 Comments

Earlier this year, UUK published a refreshed version of its strategic framework, Stepchange: mentally healthy universities, calling on universities to prioritise the mental health of their students and staff by taking a whole university approach to mental health.

The Stepchange approach and shared set of principles inform the …


Think Ahead gets funding to boost its intake.

Posted by Jill Anderson on October 16, 2020 at 15:41 0 Comments

Fast-track mental health social work provider Think Ahead will expand its intake by 60% from next year following a government funding boost of at least £18m.

The Department of Health and Social Care has agreed a contract with Think Ahead to increase the number of trainees for its 2021 and 2022 cohorts from 100 to 160, with…


Transforming Mental Health Social Work videos

Posted by Jill Anderson on October 16, 2020 at 15:39 0 Comments

Health Education England has commissioned 11 videos centered on real-life experience of specialists in the social work field.

See the video playlist.

Transforming mental health social work - conference report

Posted by Jill Anderson on October 16, 2020 at 15:37 0 Comments

In February 2020 Health Education England and Skills for Care put on two major conferences about the role and development of mental health social work. 

Download the conference report.

Leadership in mental health social work - web pages

Posted by Jill Anderson on October 16, 2020 at 15:33 0 Comments

A section of the Skills for Care website has been developed for mental health social workers and AMHPs

View the web pages here.

Social work education and training in mental health, addictions and suicide: a scoping review protocol

Posted by Jill Anderson on October 16, 2020 at 15:29 1 Comment

Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this open access scoping review is to examine literature on social work education and training in mental health, addictions and…


Mental health nurse education: perceptions, access and the pandemic

Posted by Jill Anderson on October 16, 2020 at 15:25 0 Comments

With World Mental Health Day this Saturday, a new Nuffield Trust report discusses how more people might be attracted to apply to study mental health nursing, and the reasons why they might currently be less likely to do so.

Co-author Claudia Leone picks out some  key findings.

© 2022   Created by Jill Anderson.   Powered by

Badges  |  Report an Issue  |  Terms of Service