If you want to change the world you have to start with yourself: The impact of staff reflective practice within the Offender Personality Disorder pathway

Abstract

The offender personality disorder (OPD) pathway was implemented in 2012 to help improve services for people with personality difficulties within the criminal justice system. The OPD pathway acknowledges the importance of supervision, training and reflective practice for staff working with this client group and such activities have therefore been embedded within this initiative. Despite the research from this pathway identifying benefits to both staff and service users, there is a gap in knowledge about the impact of reflective practice. This study aims, therefore, to increase this knowledge base by exploring staff’s experience and perception of reflective practice as part of the OPD pathway programme. Focus groups and semi-structured interviews were completed with 32 members of National Health Service and National Probation Service staff within offender management teams and approved premises in the North East of England. Thematic analysis was used to analyse the data, resulting in the emergence of four key themes relating to the utility of reflective practice sessions. The findings suggest that reflective practice is useful, however, there are some barriers to attending sessions. The findings have implications for service delivery and workforce development within the OPD pathway programme and more widely within NPS.

Keywords

reflective practice Offender Personality Disorder Pathway partnerships practitioners

Introduction

The publication of ‘Personality Disorder: No Longer a Diagnosis of Exclusion’ (NIMHE, 2003a) highlighted concerns about the treatment of people with personality disorder and the often unhelpful responses from organisations working with this client group. The Personality Disorder Capabilities Framework (NIMHE, 2003b) sought to create more responsive services, alongside reducing stigma, negative attitudes, and social exclusion to help end the cycle of rejection commonly experienced by individuals with personality disorder. It acknowledged a need for a ‘whole systems’ approach, a culture change, for staff to have the required skills and knowledge, alongside a commitment to reflective practice and lifelong learning (NIMHE, 2003b). These guidance documents marked important steps towards improving services for those with personality disorder.

While thought to affect between 4% and 11% of the population in the United Kingdom, personality disorder is highly prevalent among prisoners and in probation service caseloads with estimations of around 60% (Brooker et al, 2011; HMPPS/NHSE, 2020; Pluck et al., 2012). In the criminal justice system, personality disorder is associated with faster reconviction rates, increased violence, higher numbers of adjudications, and increased drop out from treatment (Cooke, 2010; McMurran, 2012; Minoudis et al., 2011).

Given the prevalence of personality difficulties in the criminal justice system and the negative impact on rates of re-offending and individuals’ pathway progression, the Bradley Report recommended an interdepartmental strategy, with joint working between the National Health and Criminal Justice systems (Bradley, 2009). Following this, a joint proposal was made in 2011 by the Department of Health (DOH) and what was then the National Offender Management Service (NOMS), to develop an innovative new pathway of services to improve outcomes for offenders with personality difficulties in the criminal justice system. The offender personality disorder (OPD) pathway aimed to improve services for a greater number of offenders in both custody and the community than previous initiatives such as the Dangerous and Severe Personality Disorder programme.

The OPD national strategy sought to enhance offender management by introducing a psychologically informed approach, with case formulation at the heart (DOH/NOMS, 2011; Joseph and Benefield, 2010 , 2012). The main aims of the strategy include: to reduce risk of harm to others and further offending; to improve the psychological well-being of offenders; to use resources efficiently; and to develop a competent workforce with the appropriate attitudes, skills, and confidence to work with personality disorder (Skett et al., 2017). Evidence-based recommendations for the management of personality disorder were embedded within this new strategy (NIMHE, 2003a, 2003b; NICE, 2009a, 2009b).

The importance of a competent workforce is emphasised. However the emotional challenges of working with people with personality difficulties are well documented and may result in negative attitudes towards service users, boundary issues, staff mirroring defence mechanisms employed by service users and burnout, if emotions and thoughts are not recognised, reflected on and contained (Adshead, 2012; Bowers et al, 2003; Freestone et al, 2015; Hamilton, 2010; Main, 1989; Murphy and McVey, 2003). Availability of a space for reflection and containment of staff anxieties can positively impact on the quality of relationships between staff and service users and consequently on the service user’s ability to engage.

The National Institute for Mental Health in England (NIMHE, 2003b) advocates the importance of continuing professional development, specifically that staff have access to adequate support, education, training and supervision to help them to work effectively with this client group. Similarly, Milligan and Gordon (2011) highlight the need for workforce development and creating a learning organisation, helping all staff become critically reflective about their practice to develop knowledge and skills and promote the engagement of service users. Ramsden et al. (2016) suggest that the pressures of work have left probation service staff feeling less safe to reflect and emphasise the importance of attending to the emotional needs of staff to ensure they can effectively work with service users.

Earlier this year, new guidance was published for practitioners working with people showing personality difficulties in the criminal justice system (HMPPS/NHSE, 2020). This further highlighted the importance of practitioner skills and resilience when working with this client group, and the impact of this on both the well-being of the workforce and the effectiveness of practice. The guidance emphasised the benefits of being a reflective practitioner; that is staff recognising and reflecting on how they respond to their emotional reactions, how they work together as a team and with their clients (HMPPS/NHSE, 2020).

Given the emphasis on the importance of reflective practice, National Health Service (NHS) staff working within the OPD pathway have facilitated group reflective practice sessions within both offender management teams and approved premises in the North and South of Tyne clusters of the National Probation Service (NPS). These are not mandatory sessions and can be accessed by any staff member in each office who wants to participate, therefore, numbers of participants in each group can vary. Group reflective sessions within offender management teams have been facilitated by two multidisciplinary team staff members (including Nurse Practitioners, Social Workers, Occupational Therapist, Psychologists, and Probation Officers (POs)), once each month in each site, lasting one hour. Group reflective practice sessions within approved premises have been facilitated by a senior Clinical Psychologist, bi-weekly, lasting approximately one hour. These group sessions have allowed probation service staff to set their own agenda; discuss team or individual issues; consider their emotional reactions, thoughts and ways in which they could adapt; and develop their clinical practice. While reflective practice sessions in each area were facilitated by different members of staff, they followed a similar model of reflection with a view to help improve practice (Gibbs, 1988).

Research following the implementation of the OPD pathway has demonstrated a beneficial impact for both probation service staff and service users, however, this has mainly focused on consultation, training and formulation, rather than the impact specifically of reflective practice (Brown et al., 2018; Clark and Chuan, 2016; Davies and O’Meara, 2018; Mapplebeck et al., 2017; McMullan et al., 2014; Ramsden et al., 2014; Shaw et al., 2012). This study aims to explore NPS and NHS staff experience and perception of reflective practice sessions, in the North and South of Tyne clusters and to consider the future allocation of resources within the OPD pathway in this area.

Methodology

Information relating to staff experience and perception of reflective practice sessions was collected through focus groups and semi-structured interviews, as part of a wider service evaluation with a specific focus on workforce development.

Participants consisted of a volunteer sample of both Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) staff working within the OPD national strategy, and NPS staff members based within offender management teams and approved premises in the North and South of Tyne clusters.

To enable participants to give informed consent, the lead researcher attended team meetings within the NPS local delivery units and approved premises, across the region, to raise awareness of the purpose of the service evaluation being undertaken. Potential participants were advised that the researchers would return at a set date and time to gather data from those who wished to participate. All participants were advised that their participation was voluntary and informed that their feedback would be treated as confidential and anonymised.

At the time of data collection, there were eight staff employed within the CNTW NHS team, 116 staff within the offender management team (including Senior Probation Officers, PO, and Probation Service Officers (PSO)), and approximately 80 staff within the approved premises (including PSO and Residential Workers) in the region. Of the total 204 staff, 191 were eligible to participate as reflective practice sessions were available to them at that time. Thirty-two participants volunteered to participate in focus groups and semi-structured interviews relating to their experience of reflective practice. This is a representative of 16–17% of the total potential participants available.

Seven CNTW staff took part in a focus group, a further 13 approved premises staff participated in one of five further focus groups and 12 staff from the offender management team took part in individual semi-structured interviews. Table 1 demonstrates the roles of participants within the study. All participants had experience of facilitating or participating in a reflective practice session, as part of the OPD pathway programme within the region.

Table 1.

Breakdown of participant’s job roles.

CNTW staff	Seven participants
Senior Probation Officers	One participant
Probation Officers	Eleven participants
Probation Support Officer	Four participants
Residential Workers	Nine participants

This project was registered with the Her Majesty’s Prison and Probation Service (HMPPS) National Research Committee, who considered ethical issues and approved the project. All participants’ answers were kept confidential. Any identifying features have been removed and all participants were assigned a participant code to maintain anonymity.

Semi-structured interviews and focus groups were completed, between August 2018 and January 2019, using an interview schedule including questions about the reflective practice sessions facilitated by NHS OPD pathway team members. As much as possible, participants were encouraged to elaborate on their answers and give a detailed account of their experience. Focus groups and individual semi-structured interviews took place in the participant’s place of work and lasted approximately 30 minutes.

Thematic analysis was utilised to identify emerging themes relating to staff perception and experience of accessing the staff reflective practice sessions. All the data were initially coded, prior to being further examined and organised into initial themes. Initial themes identified were then compared and revised in line with the thematic analysis procedure by the researcher. The most frequent emergent themes were taken to be the most significant. Data credibility was ensured by a second researcher independently analysing a portion of the raw data to identify emergent themes. This was compared to the initial analysis and determined to be accurate.

Results

Throughout the thematic analysis, four key themes emerged in relation to participant’s experience and perception of the reflective practice sessions facilitated in the North and South of Tyne clusters. These were:

Staff reflective practice sessions are useful.

Potential impact of reflective practice sessions on direct work with offenders.

Staff reflective practice sessions help to manage job pressures.

Barriers to attending reflective practice sessions.

Theme one: Staff reflective practice sessions are useful

The theme ‘Staff reflective sessions are useful’ was the most prevalent emergent theme throughout the analysis, emerging a total of 82 times. Participants stated that:

The concept is good as it is useful to offload. (Participant 21, Offender Management Team, Semi-Structured Interview)

Participants working within offender management teams reported that sessions were useful in that they:

support staff to manage stress and challenges within their role,

allow opportunity to reflect on client issues, their own emotional responses and team dynamics or issues,

provide a safe space to offload and reflect on practice,

allow opportunity to seek advice and support from peers and OPD pathway team members,

allow opportunity to take time to reflect on their individual practice and

consider how they will both manage the pressures of their role and the emotional impact of working with offenders with personality disorder.

Similarly, staff within the Approved Premises, reported that reflective sessions were useful in that they:

provide an opportunity to reflect on personal practice,

provide an opportunity to reflect on arising team and resident issues and presentations,

consider the support being offered to residents within the Approved Premises,

consolidate relevant Personality Disorder Training previously completed,

are an opportunity to offload,

provide a forum for teams to discuss issues openly and honestly and

improve understanding of different roles and pressures within the staff team.

Participants also stated that the staff reflective sessions provide the only opportunity at present to reflect on their experiences working with offenders and the emotions that they might experience associated with their job roles. One participant stated:

It is helpful to offload and talk about how others feel. Supervision in this way is not offered by managers in NPS at this time/for years. Sessions are an opportunity to vent, with people that you know. (Participant 8, Approved Premises Staff Member, Focus Group 2)

While another participant stated:

Sessions are effective in letting off steam, not many other opportunities to do this. (Participant 15, Approved Premises Staff Member, Focus Group 4)

Theme two: Potential impact of reflective practice sessions on direct work with offenders

The theme ‘Potential impact of reflective practice sessions on direct work with offenders’ emerged a total of 16 times. Participants reported that reflective practice sessions, although relatively new within the OPD pathway partnership in the region, had the potential to positively impact on direct work with offenders over time. More significantly, participants expressed a sense that reflective practice was a resource for them to support their practice and well-being, rather than a resource which sets out to impact directly on direct work with offenders. Participant’s stated:

It can inform the work we do with offenders. It opens you up to different possibilities. We don’t always focus on work with the offenders though. (Participant 29, Offender Management Team, Semi-Structured Interview)

At the moment I don’t think sessions inform the work we do with offenders. It’s more about understanding that it is difficult to work with PD and allow space to think it through and process our own emotions. (Participant 32, Offender Management Team, Semi-Structured Interview)

I think if you want to change the world you have to start with yourself. If you think about yourself this impacts on the work you do with the residents. (Participant 9, Approved Premises, Focus Group 2)

Theme three: Staff reflective practice sessions help to manage job pressures

The theme ‘Staff reflective sessions help to manage job pressures’ emerged a total of 13 times. Participants identified that the sessions support them to take time to reflect on their individual practice and consider how they will both manage the pressures of their role and the emotional impact of working with offenders with personality disorder. One participant working within an Approved Premises stated:

There is no rest now, being pulled everywhere. Never get a chance just to get away, eating on the go, phone and window constantly going. There is going to be burnout with the current shift patterns and constant turnover/emergency beds. Having this space to reflect and get away helps release the pressure. (Participant 11, Approved Premises, Focus Group 3)

While another participant stated:

I find it very useful. I used to be livid with this place, having opportunity to be open and honest and vent has worked for me. It is helpful that there is no judgement…I can be as open and honest as I need to be, vent and take a look at where we can start improving, especially when lots of people are in the group. It increases awareness of others job roles and workload…Group allows for greater understanding of pressures others have and the opportunity to address team issues. (Participant 12, Approved Premises, Focus Group 3)

Theme four: Barriers to attending reflective practice sessions

Some ‘Barriers to attending reflective practice sessions’ were also identified including; staff not being able to attend reflective practice due to their shift patterns or working hours, feeling unclear about what to expect within sessions, not valuing the sessions and busy workloads.

I find it difficult at times to discuss personal stuff within a group. Sometimes sense of unknown is off-putting for some people. (Participant 24, Offender Management Team, Semi-Structured Interview)

They are always on a Wednesday and I don’t work Wednesdays. (Participant 26, Offender Management Team, Semi-Structured Interview)

It is entirely possible that this may impact negatively on staff engagement in reflective practice sessions and this may have been evident within difficulties initially establishing reflective practice groups.

I still think it is early days, cos they are like slow open groups aren’t they? They need time to develop and to get an identity so I think we are still very much in the formative stages of the group developing. (Participant 5, NHS Staff, Focus Group 1)

Findings and discussion

The benefits of reflective practice identified from this study may have significant implications for service delivery and outcomes with regards to working with people with personality disorder in the criminal justice system. Specifically, the findings of the current study suggest that it is both useful and within the capacity of reflective practice sessions to provide a forum to offload, share and develop practice, process individual emotions relating to working with offenders, relieve pressures associated with work and support staff development and well-being. The findings offer support to the aim of developing reflective practitioner’s, as outlined within the national guidance (HMPPS/NHSE, 2020).

Further, the findings may offer a response to the growing body of research that warns of the potential negative impact on staff of working with people with personality difficulties, if emotions and thoughts are not recognised, reflected on and contained. Specifically, the potential for emerging negative attitudes, blurring of boundaries, staff mirroring of defence mechanisms employed by service users, an unthinking response and staff burnout (Adshead, 2012; Bowers et al, 2003; Freestone et al, 2015; Main, 1989; Murphy and McVey, 2003). Similarly, feedback from participants working within Approved Premises supported previous findings that emphasised the need for reflection and containment of anxiety to ensure that staff can deliver effective and appropriate services for people with personality disorder and further supports recommendations that reflective practice is a crucial part of ongoing workforce development and training (Barrett, 2011; Milligan and Gordon, 2011; Simpson and French, 2005; Stokoe, 2011).

The results of the current study may indicate that staff who make regular use of reflective practice sessions are better able to manage the pressures of their role. This, in turn, may act to reduce or prevent staff burnout over time, however, further research would be required to investigate this conclusively and to fully understand the barriers to attending the sessions and the perspective of staff who do not find the sessions useful.

Opinion in relation to the impact of staff reflective practice sessions on work with the offenders was generally mixed. Some participants expressed the view that reflective practice sessions had the potential to directly impact on work with the offender and that this would be of benefit, while others expressed the sense that the benefits of the sessions may only indirectly inform their work with offenders, however useful they may be. It is possible that some participants held the view that reflective practice sessions should be perceived as a helpful and important resource for staff well-being, regardless of the direct impact on work with the offender. This may support Ansbro’s (2019) findings that over theorising service user’s presentation and approaches to working with them was not always necessary or relevant. Rather it is the core principles of a therapeutic rapport, that is, empathy and maintaining appropriate boundaries that are the most important factors in supporting the development of effective working relationships (Ansbro, 2019). Reflective practice may support staff to maintain empathy and boundaries within their working relationships with service users and it is this that supports the development of trusting therapeutic relationships indirectly, within which lasting changes can be achieved.

Fellows (2014) noted that staff may avoid relational work as a means of protection at times, while Ramsden et al. (2016) suggested that work pressures within the probation service may result in staff feeling less safe to reflect. Apart from logistical barriers to attending sessions such as not working the days or hours that sessions are facilitated, it is possible that on busy or overloaded days, attendance at reflective practice comes second to process-driven tasks, if not actively promoted, valued and supported. These factors may compound barriers to attending reflective practice sessions at times of high pressure, when staff may be feeling burdened or overloaded. It is, therefore, likely that the full benefits of reflective practice sessions may only be truly realised when well embedded within the team and wider organisational culture. It is, therefore, key that the OPD pathway programme and NPS continue to maintain a key focus on reflective practice and develop increased awareness into the potential barriers to engagement in these sessions.

Limitations of this study and recommendations for future research

It is important to acknowledge however that the current study represents a relatively small sample of staff within the OPD pathway programme and therefore further research may be required to ensure the results are generalisable. There may also be limitations relating to feedback received within the focus groups, as these forums can often result in some staff finding it more difficult to offer their views in a group or to disagree with others. A larger sample size may have helped obtain different views about the experience and perception of reflective practice sessions.

It is also possible that the request for volunteers attracted those more interested in reflective practice and who valued the reflective practice sessions within their role. The study may not represent the views of staff who do not value reflective practice or are not comfortable within a reflective practice setting, as staff that did not have experience of the sessions were not sufficiently represented within the study to draw conclusions in relation to their experiences. Further research may be required in order to adequately explore the views of those who do not attend reflective practice.

It is possible that reflective practice sessions were not accessible to everyone and may have excluded part-time staff or shift workers within the Approved Premises, as they were facilitated between the hours of 9–5 pm and on the same day each week. Group reflective sessions were also conducted on-site in offender management teams and approved premises to make it easier for staff to access them, however, there are differences between offices in the spaces available where reflective practice could occur. Whilst some sites have large rooms to enable reflective practice to take place comfortably, others particularly in Approved Premises have had to take place at times within reception offices where there were often interruptions, which may negatively impact on staff experience.

Different members of staff facilitated group reflective practice sessions in each site, and there may be confounding variables in the way that sessions were ran and in the individual differences of facilitators. It is possible that differences in therapeutic/academic training of facilitators may have impacted on their facilitation of sessions and consequently how these were experienced by staff.

The interviews and focus groups were conducted soon after the implementation of group reflective practice sessions and so were a new concept for most staff and it is possible that only a small number of staff at that time had experience of them. Further research into the impact of such sessions on staff, after a longer period of implementation, when more staff have had the opportunity to experience them would be helpful to obtain more detail about their impact and usefulness. A further study could look more specifically at the impact of reflective practice on burnout, boundary issues and how participation in reflective practice impacts on the work with services users and the quality of relationships between staff and service users.

Finally, it is acknowledged that there may be differences in staff’s experience of reflective practice depending on their range of experiences and length of time qualified, as training has likely changed its focus over time. Further research would be required to determine whether experience of reflective practice is affected by range and length of experience within the role.

Conclusions

The literature suggests that reflective practice is important for staff working with people with personality difficulties to avoid burnout, boundary issues and staff acting in an unhelpful way based on their emotional responses (Freestone et al, 2015; Hamilton, 2010; Murphy and McVey, 2003). The current study set out to determine staff’s experience and perception of reflective practice sessions within the OPD pathway programme. The findings indicate that the majority of staff who have accessed this service within the North and South of Tyne clusters have found it to be a valuable and helpful resource. Specifically, the current study indicates that reflective practice is particularly helpful in supporting staff to manage stress and challenges within their role; allow an opportunity to reflect on client issues; personal emotional responses; team dynamics; provide a safe space to offload and reflect on practice; allow opportunity to seek advice and support from peers and OPD pathway team members; allow opportunity to take time to reflect on their individual practice and to consider how they will both manage the pressures of their role and the emotional impact of working with offenders with personality difficulties. The current findings suggest that to not have access to reflective practice sessions may leave staff vulnerable to the potential negative impacts of working with offenders with personality disorder outlined in the prior research (Adshead, 2012; Bowers et al, 2003; Freestone et al, 2015; Main, 1989; Murphy and McVey, 2003) and suggest a whole host of potential benefits of accessing regular group reflective practice sessions.

However, feedback from participants highlights the importance of ensuring a protected space for reflective practice and promoting awareness of the benefits of these sessions among staff teams and within NPS more widely. It is indicated that the provision of reflective practice holds a range of positive benefits for staff, which may provide additional benefits to service users. However, it is imperative that sessions are adequately promoted, resourced, prioritised and valued within teams in order for them to reap the potential benefits. It is also important that reflective practice is supported within a wider systemic and cultural framework as advocated in the literature (Milligan and Gordon, 2011; NIMHE, 2003b) and that staff can feel safe to reflect at times of work pressures and stress (Fellows, 2014; Ramsden et al., 2016).

Implications for future practice

The findings of the current study suggest that group reflective practice sessions should be widely promoted and made available for all staff, with consideration for how to ensure that part-time staff and those working shifts can attend. Consideration may also be need to be given to the physical space and environment in which group reflective practice takes place, to ensure that staff can participate effectively, free from interruptions and within a protected, safe and supportive space.

The findings support the continued allocation of resources to allow group reflective practice sessions to take place. However, commitment from senior management is crucial to protect time for staff to reflect and promote the importance of these sessions, allowing staff to attend even at times of increased workloads and pressures, when perhaps the benefits of reflective practice will be most keenly felt. That being said, reflective practice sessions should remain optional as to enforce a mandatory element may only serve to remove the key components of reflective practice and add additional pressures on top of an already busy workload.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Nicole Webster

References

Adshead

(2012) Mirror, mirror: parallel processes in forensic institutions. In Adlam

Aiyegbusi

Kleinot

, et al. (2012) The Therapeutic Milieu under Fire: Security and Insecurity in Forensic Mental Health (pp.97–115). London: Jessica Kingsley Publications.

Ansbro

(2019) A qualitative examination of attachment-based concepts in probation supervision. Probation Journal 66(2): 181–200.

Barrett

(2011) Sustainable organisations in health and social care: developing a team mind. In: Rubitel

Reiss

(2011). Containment in the Community: Supportive Frameworks for Thinking about Antisocial Behaviour and Mental Health (pp.89–121). London: Karnac.

Bowers

Callaghan

Nijman

, et al. (2003) The right people for the job: choosing staff that will adjust positively and productively to working in the new personality disorder (PD) services. Retrieved June 28th, 2020. Available at: https://www.kcl.ac.uk/ioppn/depts/hspr/archive/mhn/projects/personalitydisorderdocs/rightpeople.pdf.

Bradley

(2009) The Bradley Report. London: Department of Health.

Brooker

Sirdifield

Blizard

, et al. (2011) An Investigation into the Prevalence of Mental Health Disorder and Patterns of Health Service Access in a Probation Population. Retrieved June 28th, 2020. Available at: https://pdfs.semanticscholar.org/28d8/e7306862aa5c7ea4b85e493bf0fe0ac6c427.pdf?_ga=2.26749565.1180255622.1593348839-154996827.1585657543.

Brown

Beeley

Patel

, et al. (2018) Training probation officers in case formulation for personality disordered offenders. Criminal Behaviour and Mental Health 28(1): 50–60.

Clark

Chuan

(2016) Evaluation of the impact personality disorder project – a psychologically informed consultation, training and mental health collaboration approach to probation offender management. Criminal Behaviour and Mental Health 26: 186–195.

Cooke

(2010) Personality disorder and violence: understand violence risk: an introduction to the special section personality disorder and violence. Journal of Personality Disorders 24(5): 539–550.

10.

Davies

O’Meara

(2018) Routine practice in staffed community accommodation (approved premises) in England and Wales: quantitative benchmarking from the first year of a longitudinal study. Criminal Behaviour and Mental Health 28(3): 227–238.

11.

Department of Health and National Offender Management Service (2011) Consultation on the Offender Personality Disorder Pathway Implementation Plan. Available at: http://cipn.org.uk/wp-content/uploads/2017/05/personality_disorder_pathway_feb_11.pdf (accessed 28 June 2020).

12.

Fellows

(2014) ‘What’s needed as part of probation practice when working with personality disordered offenders? The importance of avoiding errors of logic’ – a practitioners response. Probation Journal 61(2): 192–199.

13.

Freestone

Wilson

Jones

, et al. (2015) The impact on staff working with personality disordered offenders: a systematic review. PLoS One 10(8): 1–18.

14.

Gibbs

(1988) Learning by Doing: A Guide to Teaching and Learning Methods . Oxford: Oxford Polytechnic.

15.

Hamilton

(2010) Boundary seesaw model: good fences make for good neighbours. In: Tennant

Howells

(eds) Using Time. Not Doing Time: Practitioner Perspectives on Personality Disorder and Risk. Chichester: Wiley Blackwell, pp. 181–194.

16.

HMPPS/NHSE (2020) Practitioner guide. Working with people in the criminal justice system showing personality difficulties. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/869843/6.5151_HMPPS_Working_with_Offenders_with_Personality_Disorder_v17_WEB.pdf (accessed 7 May 2020).

17.

Joseph

Benefield

(2010) The development of an offender personality strategy. Mental Health Review Journal 15(4): 10–15.

18.

Joseph

Benefield

(2012) A joint offender personality disorder pathway strategy: an outline summary. Criminal Behaviour and Mental Health 22: 210–217.

19.

Main

(1989) The Ailment and Other Psychoanalytic Essays. London: Free Association Books.

20.

Mapplebeck

Ramsden

Lowton

, et al. (2017) Embedding psychological thinking: an evaluation of a regional training model for probation staff. Journal of Forensic Practice 19 (1): 37–46.

21.

McMullan

Ramsden

Lowton

(2014) Offender personality disorder pathway: evaluation of team consultation. Mental Health Review Journal 3: 185–195.

22.

McMurran

(2012) Readiness to engage in treatments for personality disorder. International Journal of Forensic Mental Health 11: 289–298.

23.

Milligan

Gordon

(2011) The importance of systemic workforce development in high secure settings. In: Willmot

Gordon

(eds) Working Positively With Personality Disorder in Secure Settings: A Practitioner Perspective. West Sussex: John Wiley & Sons, pp. 188–199.

24.

Minoudis

Shaw

Bannerman

, et al. (2011) Identifying personality disturbance in a London probation sample. Probation Journal 59(1): 23–38.

25.

Murphy

McVey

(2003) The challenges of nursing personality-disordered patients. The British Journal of Forensic Practice 5(1): 3–19.

26.

National Institute for Mental Health in England (NIMHE) (2003) Personality Disorder: No Longer a Diagnosis of Exclusion. Available at: http://personalitydisorder.org.uk/wp-content/uploads/2015/04/PD-No-longer-a-diagnosis-of-exclusion.pdf (accessed 7 May 2020).

27.

National Institute for Mental Health in England (NIMHE) (2003b) Breaking the Cycle of Rejection: The Personality Disorder Capabilities Framework. Available at: http://personalitydisorder.org.uk/wp-content/uploads/2015/06/personalitydisorders-capabilities-framework.pdf (accessed 7 May 2020).

28.

National Institute of Health and Clinical Excellence (NICE) (2009a) Borderline Personality Disorder: Treatment and Management, Quick Reference Guide. London: NICE.

29.

National Institute of Health and Clinical Excellence (NICE) (2009b) Antisocial Personality Disorder: Treatment and Management, Quick Reference Guide. London: NICE.

30.

Pluck

Sirdifield

Brooker

, et al. (2012) Screening for personality disorder in probationers validation of the standardised assessment of personality – abbreviated scale (SAPAS). Personality and Mental Health 6(1): 61–68.

31.

Ramsden

Joyes

Gordon

, et al. (2016) How working with psychologists has influenced probation practice: attempting to capture some of the impact and the learning from the offender personality disorder pathway project. Probation Journal 63(1): 54–71.

32.

Ramsden

Lowton

Joyes

(2014) The impact of case formulation focussed consultation on criminal justice staff and their attitudes to work with personality disorder. Mental Health Review Journal 19 (2): 124–130.

33.

Shaw

Minoudis

Craissati

, et al. (2012) Developing probation staff competency for working with high risk of harm offenders with personality disorder: an evaluation of the pathway’s project. Personality and Mental Health 6: 87–96.

34.

Simpson

French

(2005) Thoughtful leadership: lessons from Bion. Organisational & Social Dynamics 5(2): 280–297.

35.

Skett

Goode

Barton

(2017) A joint NHS and NOMS offender personality disorder pathway strategy: a perspective from 5 years of operation. Criminal Behaviour and Mental Health 27: 214–221.

36.

Stokoe

(2011) The healthy and unhealthy organisation: how can we help teams remain effective? In: Rubitel

Reiss

(eds) Containment in the Community: Supportive Frameworks for Thinking about Antisocial Behaviour and Mental Health. London: Karnac, pp.353–385.