David Lee on the prison mental health dilemma

So this week’s column is devoted to an important service development. It may not win a competition with Great Ormond Street for who could collect the most donations from the public on a Friday lunchtime, but it is doing work of tremendous value.

Our new service supports probation officers working with high risk offenders with a personality disorder who have been subject to recall.

Studies have shown that 60 per cent of prisoners have symptoms that would meet the criteria for a diagnosis of personality disorder, compared with 5 per cent in the general population.

The concern is that a proportion of recalls to prison occur because probation officers are not equipped to assess and manage the behaviours that such offenders exhibit, which may not be criminal in themselves but create concern about the possibility of criminal behaviour. Recall is sometimes reluctant and for minor breaches, for the want of better alternatives.

The aim is to ensure greater levels of offenders’ compliance with their licences, with probation able to manage them more effectively in the community rather than needing to recall them to custody.

The project team will include a clinical psychologist based at the Oscar Hill specialist personality disorder service, who will provide outreach support and input. They will lead the project, being responsible for the development of a care pathway and service co-ordination group across voluntary, primary and secondary care services locally.

The three main elements are:

• the development of a specialist and comprehensive psychological assessment, including risk assessment. This is to support better signposting to existing services, with the aim of reducing the likelihood of prison recall;

• to provide highly structured and psychologically informed care plans;

• to provide systematic training to offender management unit officers, public protection unit officers and staff in approved premises. The training includes: recognition of personality disorder in terms of behaviour, emotions and thinking; understanding the causes and the course of personality disorder; understanding the functions of impulsive behaviours such as self-harm and angry outbursts; and strategies for managing challenging behaviours.

The proposed training is based on dialectical behaviour therapy. Studies in the US in residential settings for juvenile offenders have shown reductions in reoffending.

While this service remains small and new, few would disagree that there is a need for all agencies involved with the criminal justice system to seek innovative service improvements. If it works, it won’t get any headlines and it won’t be the centrepiece of any fundraising campaign, but it will make a positive difference to many lives.