1. Personality Disorder: A prison perspective
James Taylor
Mental Health & Suicide Risk Management Co-ordinator. SPS

2. Yes, daily. And that’s just the staff!!!
At work do you come into contact with people who have personality disorders?

3. overview What are our obligations and aims Prevalence in prisons
A little bit of History
What about today in Scotland’s prisons
Needs v’s diagnosis
Where do we go next?

4. "The degree of civilization in a society is revealed by entering its prisons.”
Dostoyevsky, 19th C

5. Perspectives
Attitudes
Values
Culture
Environment
Context

6. SPS –Mission Statement
Custody
Order
Care
Opportunity

7. Prevalence of personality disorder (from clinical interviews) Singleton et al 1998
Male remand Male sentenced Female
Percentage of the population with each type of disorder
Type of personality disorder
Avoidant
Dependent
Obsessive-Compulsive
Paranoid
Schizotypal
Schizoid
Histrionic
Narcissistic
Borderline
Antisocial
Antisocial only
Antisocial and other
Other only
Any personality disorder

8. Fazel & Danesh 2002 Large scale systematic review covering
28 survey examined for PD = prisoners
65% male prisoners with PD
47% ASPD
42% female prisoners with PD
21% ASPD

9. Black et al 2007 Small study – 220 newly convicted
Nearly 30 % of 220 meet BPD diagnosis
27% male,
55% of female (low numbers)
Nearly 57% also ASPD

10. Darke et al 1998 2/3 prisoner on Methadone met diagnosis for ASPD
< 10% diagnosis for Psychopathy
?Over emphasis on criminal act & related behaviours
The over inclusiveness problem & the under inclusiveness problem

11. Small/ Special Units Barlinnie SU, 1973 – 1994
“A special unit should be provided within the Scottish Penal system for the treatment of known violent inmates, those considered to be violent and selected long term inmates” and
“the traditional officer / inmate relationship should be modified more closely to a therapist / patient basis, while retaining a fair discipline systems”

12. Historical Management
Between
SPS GiCs noted 100 prisoners unmanageable in mainstream – would suit small unit environment
Jan 1997, 55 prisoner - By 1998, between
1998 Executive Committee for the Management of Difficulty Prisoners formed – continuous assessment for Rule 80 prisoners
2000 closure of Shotts SU –> management in segregation with individualised regimes

13. Present Day- ASPD GPASS 8 records PD unspecified type
From Healthcare 10 in paper records & less than 10 ?Diagnosis
“there are many but nobody likes to document this”
We really don’t know……
ECMDP – focuses on most challenging

14. BPD
BPD
“ a pervasive pattern of instability of interpersonal relationships, self image and affects as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts.” DSM-IV-TR

15. Females in Scottish Prisons
380 females in custody – 163 (42%) have been managed on ACT2CARE (27% of all males)
135 recordable incidents of self harm in 2007 (& rising)
Many have evidence of scarring from past lacerations
almost all test positive on admission for substance use
108 (29%) prescribed methadone. Almost the same again detoxing &

16. Females in Scottish Prisons
80% history of mental health problems
High proportion have history of physical psychological and sexual abuse
Significant proportion involved in prostitutions and sex industry
Many place little value on their own health needs

17. Females in custody - BPD
Electronic records = ? 2
Paper records 11 confirmed diagnosis. 2 with ? Diagnosis
All +++ self harm
10 substance misuse
10 comorbid other mental illness
Another 16 - revolving door – same presentation

18. Females in custody But why small numbers?
Just not recorded in clinical records
Only recall most serious examples
? Is it because they are staff intensive
2 requiring 24hr direct 1:1 contact to minimise risk of Self Harm

19. Need v Diagnosis “ We just get on with it”, “work with the behaviour”
Management in context
Dynamic risk & needs assessment helps understand behaviour
Behaviour & needs help define the prison ethos, regime & practices

20. However, diagnosis can matter…
Common terminology
Framework to understand prisoner presentation
Differentiate & define criminogenic and health needs
Obligation to “treat”
Reshaping/enhancing of prison regime
Healthcare (esp. MH) & addictions

21. Where next for SPS? Better data collation of current diagnosis
? Clarification of prevalence
BPD project Cornton Vale
Continue to develop partnerships

22. So - Why does PD matter?
Impact of the running of the whole prison system.
The need to ensure effective services.
To achieve SPS aims - Rehabilitation, re-integration, care & protection