A note on using mental health services

Working out when to consider a transfer from prison into mental health services can be difficult with personality disordered offenders. Health services are broadly based on a catchment area system and there is very patchy provision within medium secure hospitals for personality disordered offenders across the country. However, more specialist personality disorder services in the high secure hospitals do cover the whole country. In order to take this pathway further, you will need the cooperation and agreement of the relevant senior clinicians – usually a consultant forensic psychiatrist. This could be:

  • The visiting psychiatrist to the offender’s current prison
  • The forensic psychiatrist who works back in the offender’s home catchment area
  • The forensic psychiatrist in the specialist personality disorder provision (who in turn will liaise with the above).

Where the offender’s difficulties include both personality disorder and serious mental illness (e.g. a psychosis, where the offender has lost touch with reality), it will be more appropriate to refer the individual to the NHS mental health system (rather than a prison based intervention), whether to a mainstream mental health ward or to a specialist PD ward. Sometimes just the mental illness is treated; other times a more comprehensive package of care is provided. Specialist personality disorder units in hospital may also be important when there is a history of physical health problems, or an unusual diagnostic picture.