Pathways through custody

After considering the sentence and responsivity factors, you can now make informed decisions about the custody treatment pathway.

1. Accredited prison programmes

Tip

Think creatively about total denial – select a programme that doesn’t require offence admissions – anger management or a drug programme.

The standard accredited programmes within the prison system may adequately meet the risk and needs of personality disordered offenders. These would be assigned in the usual way via a thorough risk assessment and sentence plan to identify treatment targets encompassing pro-social competencies and offending behaviours.

Although personality disorder is not assessed by mainstream programmes, the groupwork often addresses highly relevant issues such as managing impulsive behaviour, emotional self-management or social problem solving. There are also programmes – some of which have very long waiting lists – which may probe more intensively into personality development and functioning; these include the Self-Change Programme (when there is a substantive history of instrumental aggression), Chromis (specifically for high risk psychopathic offenders) and the Extended Sex Offender Treatment Programme.

In the case of accredited programmes, it is especially important to evaluate progress via the post-treatment reports. There may be problems with partial engagement, disruptive behaviours, poor attendance and shamming which give an indication of the adequacy of the basic accredited programme route and whether the individual requires referring to one of the other pathways.

The main reasons for looking beyond the standard accredited programmes are if the individual has previously failed to complete offending behaviour programmes or has completed them but this has not led to a change in behaviour. Prison psychology assessments may be available to assist with more complex sentence planning. Given the range of programmes and changing entry criteria, prison psychologists are a very useful source of advice regarding accredited programme options. The main programmes fall into four main areas:

• Thinking skills
  These are the most commonly completed short duration programmes, designed to enhance pro-social competencies including impulse control, perspective taking, reasoning skills and interpersonal problem solving.
• Violence
  These programmes tend to target either expressive violence (emotional control and anger management) or instrumental violence.
• Sex Offender Treatment Programmes
  A range of programmes designed to provide the right intensity of intervention to match risk level and treatment need.
• Substance misuse
  Includes a range individual and group work for alcohol and drug misuse.

2. Democratic therapeutic communities (DTC)

Democratic therapeutic communities provide a long-term intervention designed to address risk related to offending, whilst addressing emotional and psychological needs. The expected length of treatment is 18 months, to provide enough time to enable change and practise the use of new skills. Currently there are 12 DTCs in five prisons, one of which is for women.

DTCs are a form of social therapy and an accredited offending behaviour programme. The environment is designed to create a 24/7 ‘living-learning’ experience, where staff and prisoners contribute to the decisions of the community. The programme is structured around large and small therapy groups focussing on community issues, offending behaviour and links between current and past experiences; there may also be opportunities for educational and vocational work. The therapy plan is informed in the usual way via OASys and the sentence plan.

The DTCs largely have common entry criteria and there is a universal referral form, available on request. The prisoner should self-refer as this is regarded as an indicator of motivation. Referrals can also be made by a practitioner. Be aware that the motivation of the individual is paramount to successful referral and where a third party has referred, this should be done with the full informed consent and will of the prisoner. The standard entry requirements include:

• a willingness to work as part of a community, participate in groups and be subject to the democratic process
• a willingness to commit to staying for at least 18 months (i.e. determinate sentenced prisoners must have more than 18 months to serve)
• they should have reached the point in their lives when they say they are ready to change and their behaviour reflects this
• the offending history must include violence (including robbery) and/or sexual offences; other offending is also considered
• there must be deficits in two or more of the following:
  • self-management, coping, and problem solving
  • relationship skills/interpersonal relating
  • antisocial beliefs, values and attitudes
  • emotional management and functioning.

3. Dangerous and Severe Personality Disorder (DSPD) programme

The DSPD programme was a joint pilot venture between the Ministry of Justice and the Department of Health. The services were developed to provide intensive treatment for people who have severe personality disturbance which is directly linked to risk of serious sexual or violent offending. These individuals are at the extreme end of the personality disorder spectrum. There are two high secure units based within the prison system, and wards specialising in the treatment of personality disorder within the three high secure hospitals across the country. A smaller DSPD service for women is also available. Referrals to individual sites are made initially on geographic location, and up to date information can be obtained from the website: www.personalitydisorder.org.uk. The individual sites have referral templates available on request from the units. Referrals will usually have a minimum of three years still to serve.

The general referral criteria include:

• more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it difficult or impossible to recover.
• the individual must meet criteria for a severe personality disorder (over the cut-off for psychopathy, and/or must suffer from a range of personality problems over and above antisocial traits).
• there must be a link between the disorder and the offending.

Additional indicators which may warrant consideration include:

• An inability to acknowledge the seriousness of the offending
• A history of institutional violence
• A history of abusing trust and exploiting others
• A track record of reoffending or breaching statutory orders after completing prior programmes
• Excessively violent aspects to the offending
• Hostility and unclear motivation to engage in treatment.