Personality disorder units and therapeutic communities provide a safe, respectful and purposeful environment which allows prisoners to confront their offending behaviour.

In recognition of the special nature of work in units for men with personality disorders and therapeutic communities, we augment our standard expectations to take account of some of the differences we expect to see.

Offender personality disorder units including psychologically informed planned environments

90. Prisoners undergo assessment and treatment in an environment that is psychologically, emotionally and physically safe, and have a clear understanding of the treatment process.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Prisoners receive advice and full information about the unit and treatment.
  • Assessment results are communicated to prisoners in a timely manner and in a form they can understand.
  • Prisoners receive ongoing support to manage the impact of change as they progress through treatment.
  • All staff on the unit support its ethos, have an understanding and awareness of the specific needs of prisoners with personality disorders, and receive adequate training, supervision and support.
  • There is a clear clinical governance structure in place and regular clinical audits.
  • The assessment and treatment models used are evidence-based (for example, National Institute for Health and Clinical Excellence (NICE) guidance linked to research into personality disorders) and have a clear rationale for their inclusion in the process.
  • Prisoners can negotiate temporary periods of withdrawal from the programme.

91. Prisoners can access a full regime and their individual rights are not in conflict with the workings of the unit.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Prisoners in treatment have equitable access to the regime and services available in the mainstream population, including appointments, education, work and leisure opportunities.
  • Prisoners in treatment are included in routine prisoner consultative groups or have their own consultative process.
  • Prisoners are not prevented from using the official complaints procedures.
  • There is no pressure on prisoners to forgo parole.
  • Prisoners’ rights to medical confidentiality are respected.

92. Prisoners on offender personality disorder units can progress and work towards mainstream reintegration and release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • The treatment aims to reduce risk of harm.
  • Prisoners can contribute to their care and treatment plan, which is reviewed regularly. The family and/or legal representatives are encouraged to participate.
  • There are established pathways of progression to environments which support the changes that have been made in treatment.
  • Prisoners receive clear information about the likely duration of assessments and treatment phases.
  • Data is used well to scrutinise outcomes for those applying for or undertaking the programme.
  • Prisoners who are excluded or who withdraw consent are reintegrated back into the mainstream as quickly as possible.
  • Planning for progression starts in time for release or for a progressive move to be available when appropriate.

Therapeutic communities

93. Prisoners know they are entering a therapeutic community and understand what that entails.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Prisoners receive advice and full information in writing about the unit and treatment, prior to arrival.
  • Prisoners understand the distinct differences between the therapeutic community (TC) and more traditional regimes.
  • Prisoners are introduced to the community after their arrival at the TC, following an appropriate assessment and induction period.
  • The rules and expectations of the TC are understood by prisoners.
  • Prisoners understand how infringements of the rules will be dealt with.

94. Prisoners undergo assessment and treatment in an environment that is psychologically, emotionally and physically safe, and have a clear understanding of the treatment process.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • The TC has a structured and supportive assessment process, delivered in accordance with the requirements described in the treatment manuals.
  • Assessment results are communicated to prisoners in a timely manner and in a form they can understand.
  • Prisoners receive ongoing support to manage the impact of change as they progress through the TC.
  • Staff support the unit’s ethos, understand the approach adopted and receive adequate training, supervision and support.
  • There is a clear clinical governance structure in place and regular clinical audits.
  • Assessment and treatment models are evidence-based and have a clear purpose.
  • Prisoners can negotiate temporary periods of withdrawal from the programme.

95. Prisoners can access a full regime and their individual rights are not in conflict with the workings of the therapeutic community.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Prisoners have equitable access to the regime and services available to the mainstream population, including appointments, education, work and leisure opportunities.
  • Prisoners are included in routine prisoner consultative groups or have their own consultative process and are expected to contribute.
  • Prisoners are not prevented from using the official complaints procedures.
  • There is no pressure on any members of the TC to forgo parole.
  • Prisoners’ rights to medical confidentiality are respected.

96. Prisoners benefit from the distinct features of a therapeutic community.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Sufficient resources are available, including suitable rooms to ensure group and individual-based work can take place according to the published programme.
  • Prisoners, together with staff, resolve all community issues.
  • Prisoners are encouraged and able to make a contribution to the community.
  • Prisoners have access to interventions that meet their identified needs.
  • The TC is suitably accredited.

97. Prisoners in therapeutic communities can progress and work towards mainstream reintegration and release.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

  • Treatment aims are related to a reduction in the risk of harm.
  • Prisoners can contribute to their care and treatment plan, which is reviewed regularly. The family and/or legal representatives are encouraged to participate.
  • There are established pathways of progression to environments which support the changes that have been made in treatment.
  • Prisoners receive clear information about the likely duration of assessments and stay in the TC.
  • Data is used effectively to scrutinise outcomes for those applying to or undertaking the programme.
  • Prisoners who are excluded or who withdraw consent are reintegrated back into the mainstream population as quickly as possible.
  • Planning for progression starts in time for release, or a progressive move to be available when appropriate.

Human rights standards

Although human rights standards do not specify these types of specialist units, there is clear indication that the development of specialist facilities can be useful in some circumstances. Staff working in such facilities must receive specialised training. See SMR 109.2, 76.2 and Recommendation of the Committee of Ministers to member States concerning dangerous offenders (CM/Rec(2014)3).