A more promising architecture? Commissioners’ perspectives on the reconfiguration of personality disorder services under the Offender Personality Disorder (OPD) pathway

Publication Date28 November 2019
AuthorJulie Trebilcock,Manuela Jarrett,Tim Weaver,Colin Campbell,Andrew Forrester,Julian Walker,Paul Moran
SubjectHealth & social care
A more promising architecture?
Commissionersperspectives on the
reconfiguration of personality disorder
services under the Offender Personality
Disorder (OPD) pathway
Julie Trebilcock, Manuela Jarrett, Tim Weaver, Colin Campbell, Andrew Forrester,
Julian Walker and Paul Moran
Purpose The purposeof this paper is to explore the views of NHS England(NHSE) and Her MajestysPrison
and Probation Service (HMPPS) commissioners about the OffenderPersonality Disorder (OPD) pathway.
Design/methodology/approach A thematic analysis of four semi-structured interviews with NHSE and
HMPPS commissioners is conducted.
Findings Commissioners offere d a cautious but confident assessment of the potent ial effectiveness of
the OPD pathway, drawing p articular attention to its potent ial to enhance the confidence and compe tency
of staff, offer better va lue for money and provide en hanced progression ro utes for offenders with
personality disorde rs. Additionally, comm issioners identifie d a number of potential ri sks for the pathway
including wider system flux, funding availability, multi-agency working, offender engagement and the need
to evidence effectiveness.
Research limitations/implications The analysis is based on a small number of interviews. However,
there are only a limited number of commissioners involved with the OPD pathway.
Practical implications While the stronger focus on progression in the OPD pathway is a welcome
departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services,
the foundations of the OPD pathway ultimately lie with the DSPDprogramme and similar challenges are likely
to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably
poses significant challenges for pathway services, staff and offenders,as well as for those of us charged with
its evaluation.
Originality/value There has been limited empirical work with commissioners in the mental health field. The
paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.
Keywords Criminal justice, Rehabilitation, Prison, Probation, Commissioning, Risk
Paper type Research paper
The Dangerous and Severe Personality Disorder (DSPD) programme was introduced in 1999.
Controversially, given the poor evidence base at the time, five high security DSPD units were
opened soon after. The aim was to provide comprehensive assessment and treatment for
offenders with severe personality disorder who were thought to pose a high risk of harm to other
people. From the outset, concerns were raised about its legal, ethical and clinical legitimacy
(Mullen, 1999). Critics highlighted its considerable expense, lengthy assessment procedures,
lack of evidence for effectiveness and failure to provide step-down facilities and clear avenues for
Received 7 June 2019
Revised 9 August 2019
Accepted 23 August 2019
Julie Trebilcock is based at the
Department of Criminology and
Sociology, Middlesex
University, London, UK.
Manuela Jarrett is based at
School of Health Sciences,
City University, London, UK.
Tim Weaver is based at the
Department of Mental Health,
Social Work and Integrative
Medicine, Middlesex University,
London, UK.
Colin Campbell is based at the
Institute of Psychiatry,
Psychology and Neuroscience,
London, UK.
Andrew Forrester is based at
the Offender Health Research
Network, The University of
Manchester, Manchester, UK.
Julian Walker and Paul Moran
are both based at the Centre
for Academic Mental Health,
School of Social and
Community Medicine,
University of Bristol, Bristol, UK.
VOL. 24 NO. 4 2019, pp. 306-316, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-06-2019-0021

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