The needs of staff who care for offenders with a diagnosis of personality disorder: an organisational case study

Individuals with a diagnosis of personality disorder who are considered a risk to others are a current concern for healthcare providers, the government and society. Service provision for this group has recently increased, making it especially important to learn about the needs of staff who care for these demanding and complex individuals. Little research has been done in this area to date. The theoretical and empirical literature relevant to a consideration of the topic is reviewed. An in-depth interview study with staff working in a unit for offenders with a diagnosis of personality disorder (Unit Z) is presented. Its purpose was to develop understanding of the needs of staff who work with individuals with a diagnosis of personality disorder who are judged to be a risk to others. An eventual aim was to inform an intervention with staff, which could then be evaluated. Twelve in-depth interviews were carried out with multi-disciplinary staff from Unit Z. These were analysed according to the grounded theory method (Strauss & Corbin, 1998; Charmaz, 2003). An interview with a community practitioner from a different service was carried out to enhance thinking about the effects of setting. Four Unit Z patients were randomly selected to participate in a group discussion to test initial findings and integrate their perspectives into the study. Main categories were generated from analysis of the data, and a core category was identified entitled `Risk of Isolation'. Further categories were divided into `Areas of Concern' and `Key Contextual Factors' and a model was developed. This is discussed in relation to the existing literature. Implications for an understanding of the needs of staff who care for this patient group are outlined. Recommendations include: the provision of individual and group supervision to help staff reflect on the personal impact of the work, and the way in which staff relationships are affected by contact with the patient group; a focus by service heads on recruiting staff who are able to offer stability and understanding to patients and on retaining experienced workers; and the development of links with agencies for onward referral. Suggestions are made for future research and practice, with particular reference to the profession of clinical psychology. The importance of investigating the influence of changes in practice on long-term therapeutic outcome is emphasized.