Changes in attitudes to personality disorder on a DSPD unit

Background: Psychiatric professionals tend to have poor attitudes towards people who suffer from personality disorder. Previous studies suggest that such attitudes are influenced by sufferer behaviours, organizational factors and the characteristics of individual professionals, but do similar considerations apply outside health services? Aim: To identify what events, experiences and factors in the course of daily work with personality-disordered people influence the attitudes and beliefs of prison staff. Method: Semi-structured interviews were conducted with prison officers working in a pilot 'Dangerous and Severe Personality Disorder' Unit within a UK prison. Open questions were asked about any changes in their attitudes to or beliefs about personality-disordered inmates. Results: Positive influences on attitude were: development of greater understanding of personality disorder and prisoners as individuals; improvement in inmate behaviours; education; the staff counselling programme; staff sharing support and skills; the challenge and purpose of the new role and having their views listened to. Negative influences were: delays in establishing the treatment programme; some inmate behaviours; fear and concern over their new roles and negative portrayal as a profession in the media. Conclusions: In order to maintain a high overall positive attitude among staff to working with people with personality disorder, units should have: consistency of direction and timely implementation of anticipated developments; clear philosophy and treatment regime; substantial investment in staff training programmes and effective programmes for the provision of clinical supervision to frontline staff.