The programme

The Offender Personality Disorder (OPD) Pathway programme is a jointly commissioned initiative between NHS England and Improvement and HM Prison & Probation Service aimed at supporting and managing offenders with complex mental health needs. The aim is to provide a network of psychologically informed services for high-risk high-harm offenders guided by detailed case formulation.

The research

A mixed-methods research programme was conducted consisting of three components:

1. Qualitative interviews with staff and offenders, to explore their understanding and experiences of the Pathway. 
2. A quantitative evaluation to provide more insight into potential effects of aspects of the Pathway on recorded risk, adjudications, self-harm, recalls and proven reoffending. A linked dataset was created for these analyses with a comparator group consisting of people who were screened into the OPD Pathway but did not receive the service.
3. An economic evaluation of the cost-effectiveness of the Pathway was conducted using decision modelling.

Findings

Qualitative analysis from offenders and staff interviewed reported that establishing trust and collaborative work was key to the work of the programme. Offenders felt their risk had reduced, psychological health had improved and that they felt safer. Staff spoke highly of the training and supervision provided. Most staff thought that the Pathway had led to improvements in risk assessment and management.

The quantitative analyses did not detect a statistically significant effect between treatment and comparator groups. In sub-group analysis, significantly fewer adjudications occurred in those receiving OPD intervention services. 

Costs were similar across all groups in relation to criminal justice outcomes. The comparator group was more costly than the treatment group and case formulation alone. OPD Pathway intervention service costs are substantially higher than mainstream criminal justice services: these services are for individuals with the most complex mental health needs and include residential interventions and formal therapy options. There are potential cost savings from case formulation. Case formulations are carried out by offender managers and a psychologist to inform a personalised, psychologically informed approach that feeds into pathway plans.

Conclusions

The researchers found that the OPD Pathway Programme has created new services and treatment options for a large population of offenders. The qualitative data from this study suggests the OPD programme is having positive effects on both offenders and staff. This, and the result of the economic evaluation suggest that the use of case formulation may be a particular strength. Although a beneficial effect on proven offending behaviour was not observed statistically, the research team say that this may not be indicative of Programme failure and that it is too soon to definitively conclude whether the OPD Pathway is achieving its intended outcomes. They say that a study with a longer follow-up period is needed.

The researchers conclude that building trust, instilling hope, case formulation and workforce development will be key to the future success of the Pathway. Establishing trust and working in collaboration was seen as a major part of the therapeutic work by offenders and staff alike. 

Thanks to Gerd Altmann for kind permission to use the header image in this post which was previously published on Pixabay.