Summary of women’s strategy and plan
Offender personalit y disorder (PD) strategy for w omen
S u m m ar y o f st r a t eg y an d i m p l em en t at i o n p l a n
Latest developments
The offender personality disorder strategy for women was completed in October 2011 and
was open for consultation until 31st January 2012. Respondents to the consultation
stressed the need for a strong community element, a holistic approach to women’s needs
and better transitions between the criminal justice system and Health. The implementation
team is currently working on drafting an overarching service specification for women,
designing the first new treatment service for women at Foston Hall prison and working with
sector-based NOMS and NHS co-commissioners to plan integrated care pathways across
the country.
Updated 1 May 2012
Key elements of the women’s strategy
Who?
Women in scope of the strategy must meet the following criteria:

A current offence of violence against the person, criminal damage including arson,
sexual (not economically motivated) offences and/or where the victim is a child; and

Assessed as presenting a high risk of committing another serious offence; and

Likely to have a severe form of PD; and

A clinically justifiable link between the above.
Given that the prevalence of PD for women in prison is between 50 and 60%, we estimate
that this definition will include approximately 2,000 women – of whom 40% will be in prison
and 60% will be under community supervision at any one time.
What?
The strategy is based on the key principle that this population is a shared responsibility
between NOMS and the NHS, as well as others. It therefore requires joint operations,
planning and delivery, but assumes that services will be located mainly in the criminal
justice system. Interventions must be psychologically informed, gender specific and
based on the best available evidence, focussing on relationships and the social context in
which people live. The strategy will work within existing systems, pathways and
processes (e.g. Offender Management, Care Programme Approach and MAPPA), but
aims to improve the way women move progressively through an active pathway of
appropriate interventions. It will also increase availability of and access to specialised PD
services. Workforce development is also a substantial part of the developing
implementation plan.
The objectives of the strategy are to:

Identify women in scope for this strategy as early as possible following conviction using
a gender-specific approach
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Summary of women’s strategy and plan

Expand the range of health- and offence-related community-based options for inclusion
in women’s pathway plans, such that sentencers’ take-up of alternatives to custody for
the target group is increased

Deliver high quality plans setting out clear intervention and treatment pathways

Enable women to enter into and complete planned treatment interventions

Increase effectiveness of joint working between Health and criminal justice agencies

Achieve evidenced psychological health improvements and pro-social behaviours

Enable women to remain in or return to the community in a planned and safe manner

Reduce the risk of further offences of violence against the person, criminal damage
including arson, sexual (not economically motivated offences) and/or where the victim
is a child

For the workforce, by 2015:
o Develop a gender specific workforce development programme
o Have in place a three year plan for delivering gender specific personality disorder
awareness training to staff working directly or indirectly on the pathway.
How ?
By the realignment of existing financial resources currently invested in the DSPD
programme, specialised NHS and NOMS commissioners will co-commission care
pathways within prisons and the community to deliver enhanced offender PD services.
Each co-commissioning plan must include a minimum set of criteria for women (to be
defined centrally). This will be supported by workforce plans to improve capability and
leadership. Our delivery approach is a community-to-community pathway with four key
elements:
1. Early identification and pathway planning. A gender-specific approach to identifying
women likely to meet the entry criteria will be applied by offender managers and court
based staff in the community; and by staff in healthcare, discipline and offender
management in prisons. A multi-profession team, working across prisons and
probation, will then produce individualised pathway plans, stitching together
sequences of appropriate interventions.
2. Treatment (if applicable – it is recognised that some women will not be ready or
motivated for treatment). The strategy will build on existing provision, but also aims to
introduce some new services.

NHS high, enhanced medium secure, medium and low secure services:
existing NHS care for women will continue. Other than in circumstances that can be
clinically justified, a patient will return to prison once their treatment objectives have
been met.

Primrose Unit at HMP Low Newton: offers comprehensive treatment (12 places)
to help participants reduce the impact of personality disorder and risk of reoffending.

Democratic therapeutic community (DTC) at HMP Send: DTCs are an
accredited offending behaviour programme. Send’s DTC accepts offenders
assessed as medium, high or very high risk of serious harm to others and/or a
medium or high risk of reconviction; as well as deficits in two or more of the
following: self-management, coping, and problem solving; relationship skills/ inter2
Summary of women’s strategy and plan
personal relating; anti-social beliefs, values and attitudes; emotional management
and functioning.

CARE (Choices Actions Relationships Emotions): CARE is an accredited
offending behaviour programme designed for women who are at medium or high
risk of violent re-conviction and have three or more of the following needs: history of
substance misuse problems; history of self-harming or suicidal behaviours; mental
health difficulties; PD diagnosis; past difficulties in accessing or benefiting from help
or treatment. CARE currently runs at Foston Hall, but the strategy aims to introduce
CARE (or other programmes relevant to the target group) at three further prisons
(in the South, North and London sectors).

Specialist PD treatment service at HMP Foston Hall: HMP Foston Hall will
(subject to financial approval) develop a suitable physical environment to deliver a
day centre type model. A flexible programme will include focus on relationships,
motivation and engagement. It is hoped that the unit will be operational by August
2013. In time, up to three further services may be introduced in other areas.
3. Psychologically informed planned environments (PIPEs): PIPEs provide offenders
with progression support following (or, in future, prior to) a period of treatment in
custody or in approved premises. PIPEs are specifically designed environments where
staff members have additional training to develop an increased psychological
understanding of their work enabling them to further develop a safe and facilitating
environment. There are currently two women’s PIPE pilot sites at HMPs Low Newton
and Send. The women’s strategy seeks to develop all six of the women’s approved
premises into PIPEs (or PIEs – psychologically informed environments) and HMP
Drake Hall into a whole prison PIE.
4. Community provision: The community part of the pathway will consist of a number of
specialist offender managers with a reduced caseload working with a health-based
psychologist to provide: case consultation; gender-specific workforce development;
joint casework; and deliver, where there are sufficient numbers, a group based
programme, including in approved premises. Each woman identified will also have the
opportunity to receive mentoring, advocacy and/or support with practical issues from
a local non-statutory provider, e.g. a women’s centre, Women in Prison, or other
appropriate women’s organisation.
Why?
We believe a gender specific strategy is necessary because:

A different definition is required for the target population. If we applied the same entry
criteria for men and women, only a very small number of women would be identified,
thus presenting challenges in terms of having sufficient numbers of participants in the
right place, at the right time, to deliver a pathway. We have therefore defined the target
group to focus on risk of re-offending, not just risk of harm to others.

Managing women offenders with PD presents significant challenges to staff, who
require gender specific training, guidance and treatment/referral options.

It is likely that women will experience a significant degree of trauma as a result of
domestic violence, separation from children and sexual abuse. Further, whilst 7% of
men in prison self-harm, it is 30% for women with about 12,000 incidents a year.
Trauma and self-harm will, therefore, be considered more strongly in the women’s
strategy.
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Summary of women’s strategy and plan
Annex A – the pathway diagram
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