NHS England London Region Specialised Commissioning is currently undertaking a tabletop review of Tier 4 (T4) Personality Disorder inpatient provision within the London footprint. This review is being led by the Nursing and Quality and Mental Health teams and covers all units providing national T4 Personality Disorder inpatient services, which are all located in London.

The review has been initiated in response to a number of quality and environmental concerns identified within the provision. It will also consider how the current T4 Personality Disorder pathway aligns with national mental health policy, including the NHS Long Term Plan, with a particular focus on the strategic shift from inpatient care towards community-based, multidisciplinary models of support.

The review is assessing the effectiveness of the current service model, its clinical distinctiveness, equity of access, and its alignment with national policy objectives.

This information is not held in the format requested, as the recording of diagnoses within the Mental Health Services Data Set is not mandatory.

This information is not held in the format requested, as the recording of diagnoses within the Mental Health Services Data Set is not mandatory.

It is for individual integrated care boards to commission mental health services, including those for people with borderline personality disorder, to meet the needs of their local population.

We are investing at least £2.3 billion of extra funding a year in expanding and transforming mental health services in England by March 2024. Through the NHS Long Term Plan, we are investing almost £1 billion of this extra funding in integrated community mental health support for people with serious mental illnesses. This will give an additional 370,000 adults and older adults greater choice and control over their care.

I am grateful to my hon. Friend and predecessor. I see no evidence that people are being misdiagnosed or mismanaged. This is, of course, a matter for healthcare professionals and consultant psychiatrists in particular, and I cannot really interfere with their diagnoses, but I have noted my hon. Friend’s concerns, and I will certainly look into the issue.

The charity Salute Her has reported that 133 women—a third of its caseload —presented themselves to it last year having suffered a sexual assault. They also presented themselves to defence community mental health services, but were subsequently discharged from the military owing to their having a personality disorder. I wrote to the Minister asking for further information, but none was available. Will the Minister look into the service to ensure that due clinical rigour is applied before people are discharged with a personality disorder?

This information is not held. The Ministry of Defence (MOD) does not routinely record a Veteran's discharge reason to this level of detail.

The National Evaluation of the Offender Personality Disorder Pathway was published on 13 October 2022.

No specific assessment has been made. The ‘Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014’ records the prevalence of and trends in personality disorders in those aged 18 to 64 years old. The Survey is available at the following link:

Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. - NHS Digital

The next Adult Psychiatric Morbidity Survey is expected to commence in 2022, with the final report to be published in 2024.

The ‘Mental Health of Children and Young People in England, 2017’ survey provides estimates of the prevalence of specific disorders, including behavioural disorders for children and young people. These disorders are generally only diagnosed in children and young people and the presence in childhood is required for certain adult psychiatric diagnoses, such as antisocial personality disorder. The survey is available at the following link:

Mental Health of Children and Young People in England, 2017 [PAS] - NHS Digital

Through the National Institute for Health Research (NIHR) we have funded or supported studies into the causes and treatments of personality disorder. This includes a study to evaluate dialectical behavioural therapy skills for employment for individuals with a personality disorder and a randomised controlled trial of structured psychological support for people with a personality disorder. The NIHR welcomes funding applications for research into any aspect of human health, including personality disorder. The NIHR’s funding is available through open competition and we encourage researchers to submit applications in this area.

We will invest an additional £1 billion in community mental health care for adults with severe mental illness by 2023/24. This will allow a further 370,000 adults and older adults with severe mental illnesses, including personality disorders, greater choice and control over their care and to live well in their communities.

The IPP Action Plan is regularly reviewed to ensure that it is responsive to the needs of those serving IPP sentences, whether in prison or in the community. During the COVID-19 pandemic, and in accordance with measures mandated in the interests of public health, HM Prison and Probation Service (HMPPS) implemented exceptional delivery models which inevitably had some impact on all operational work. A large number of IPP prisoners have been released each year since the IPP Action Plan was first introduced in 2016, and the Plan will be refreshed, reviewed and republished after careful consideration of the forthcoming Justice Select Committee’s Report and recommendations.

HL7157 & HL7158:

HMPPS operate four Progression Regimes in closed, adult male category C prisons which provide opportunities for parole-eligible prisoners who are not making anticipated progress, and particularly prioritise places for those serving an IPP sentence. The first Progression Regime opened at HMP Warren Hill in December 2014. Following the success of the Regime at HMP Warren Hill, a further three Progression Regimes were opened in 2018 at HMP The Humber, Erlestoke and Buckley Hall.

The following table shows the number of prisoners in England and Wales subject to Imprisonment for Public Protection (IPP) sentences that have been (1) received into, and (2) released from, Progression Regimes in each year since 2017.

* Progression Regimes opened at HMPs Erlestoke, Humber and Buckley Hall.

These data have been drawn from local spreadsheets and databases held by the Progression Regimes, as national data systems can only capture movement for a whole prison, rather than individual units within a prison. As with any large scale recording systems, the figures are subject to possible errors with data migration and processing.

The total capacity of the Progression Regimes was 202 in 2017, with only the Progression Regime at HMP Warren Hill operational at that time. This number rose to 350 spaces (202 in HMP Warren Hill, 40 in HMP Erlestoke, 48 in HMP Humber and 60 in HMP Buckley Hall) with the opening of the three additional Progression Regime sites by the end of 2018. In 2019 a further 40 places were opened in HMP Erlestoke, however last year one of their Progression Regime units closed, affecting their number of places. This unit is being replaced with a new one later this year.

HL7160:

Psychology reviews for IPP prisoners commenced in 2016 and targeted those serving IPP sentences where no progress had been made to either open conditions or release despite 2 or more post tariff parole reviews. In 2019, the cohort was widened to incorporate IPP prisoners with tariffs of fewerless than 2 years. In 2021, the cohort was again expanded to include all those 5 or more years post tariff irrespective of whether they had been to open prison previously, those serving IPP sentences for non-sexual and non-violent offences, and those serving IPP sentences for robbery.

The following table shows the number of IPP psychology reviews completed for eligible IPP prisoners, as described above, each year since 2016. The high figure in 2016 reflects the fact that a large proportion of those eligible had their reviews in the first year the central reviews were introduced:

HL7161:

HMPPS Women’s Estate Psychology Services have implemented an indeterminate sentence prisoners strategy which includes the IPP cohort. The overarching goal of the strategy is to ensure that all are supported to progress through their prison sentences as quickly as possible. Psychologists regularly review cases and work with prison and probation colleagues to remove barriers to progression and expedite completion of interventions and services.

HL7216:

The following table shows the number of prisoners subject to IPP sentences that have had two or more post-tariff parole reviews with no progression to (1) open conditions, or (2) release, in each year since 2017:

*Caveats:

1. The figures in these tables have been drawn from administrative IT systems which, as with any large scale recording system, are subject to possible errors with data entry and processing.

2. These figures include both the recalled and unreleased IPP populations.

HL7217 & HL7218:

The following data are produced from service provider returns and, whilst quality assured, are subject to reporter error. As of 31 December 2021 there were 4,869 people with IPP sentences who had been identified as meeting the screening criteria for the Offender Personality Disorder Pathway. OPD pathway screening is an administrative activity which does not necessarily mean someone needs a specific intervention to address a personality disorder. Such a need would be identified when the prisoner’s probation officer reviews the prisoner’s sentence plan to take account of the OPD pathway screening.

Of those identified as meeting the screening criteria, 2,780 are currently in custody (with 1,200 of these in custody on recall).

From 1st January 2017 to 31st December 2021, a total of 1,892 offenders serving IPP sentences have been referred to OPD Services as follows:

To note: in the breakdown of protected characteristics below, some categories have been merged where necessary to avoid the risk of identifying individual offenders.

By Age:

By Ethnicity:

By Sex:

The IPP Action Plan is regularly reviewed to ensure that it is responsive to the needs of those serving IPP sentences, whether in prison or in the community. During the COVID-19 pandemic, and in accordance with measures mandated in the interests of public health, HM Prison and Probation Service (HMPPS) implemented exceptional delivery models which inevitably had some impact on all operational work. A large number of IPP prisoners have been released each year since the IPP Action Plan was first introduced in 2016, and the Plan will be refreshed, reviewed and republished after careful consideration of the forthcoming Justice Select Committee’s Report and recommendations.

HL7157 & HL7158:

HMPPS operate four Progression Regimes in closed, adult male category C prisons which provide opportunities for parole-eligible prisoners who are not making anticipated progress, and particularly prioritise places for those serving an IPP sentence. The first Progression Regime opened at HMP Warren Hill in December 2014. Following the success of the Regime at HMP Warren Hill, a further three Progression Regimes were opened in 2018 at HMP The Humber, Erlestoke and Buckley Hall.

The following table shows the number of prisoners in England and Wales subject to Imprisonment for Public Protection (IPP) sentences that have been (1) received into, and (2) released from, Progression Regimes in each year since 2017.

* Progression Regimes opened at HMPs Erlestoke, Humber and Buckley Hall.

These data have been drawn from local spreadsheets and databases held by the Progression Regimes, as national data systems can only capture movement for a whole prison, rather than individual units within a prison. As with any large scale recording systems, the figures are subject to possible errors with data migration and processing.

The total capacity of the Progression Regimes was 202 in 2017, with only the Progression Regime at HMP Warren Hill operational at that time. This number rose to 350 spaces (202 in HMP Warren Hill, 40 in HMP Erlestoke, 48 in HMP Humber and 60 in HMP Buckley Hall) with the opening of the three additional Progression Regime sites by the end of 2018. In 2019 a further 40 places were opened in HMP Erlestoke, however last year one of their Progression Regime units closed, affecting their number of places. This unit is being replaced with a new one later this year.

HL7160:

Psychology reviews for IPP prisoners commenced in 2016 and targeted those serving IPP sentences where no progress had been made to either open conditions or release despite 2 or more post tariff parole reviews. In 2019, the cohort was widened to incorporate IPP prisoners with tariffs of fewerless than 2 years. In 2021, the cohort was again expanded to include all those 5 or more years post tariff irrespective of whether they had been to open prison previously, those serving IPP sentences for non-sexual and non-violent offences, and those serving IPP sentences for robbery.

The following table shows the number of IPP psychology reviews completed for eligible IPP prisoners, as described above, each year since 2016. The high figure in 2016 reflects the fact that a large proportion of those eligible had their reviews in the first year the central reviews were introduced:

HL7161:

HMPPS Women’s Estate Psychology Services have implemented an indeterminate sentence prisoners strategy which includes the IPP cohort. The overarching goal of the strategy is to ensure that all are supported to progress through their prison sentences as quickly as possible. Psychologists regularly review cases and work with prison and probation colleagues to remove barriers to progression and expedite completion of interventions and services.

HL7216:

The following table shows the number of prisoners subject to IPP sentences that have had two or more post-tariff parole reviews with no progression to (1) open conditions, or (2) release, in each year since 2017:

*Caveats:

1. The figures in these tables have been drawn from administrative IT systems which, as with any large scale recording system, are subject to possible errors with data entry and processing.

2. These figures include both the recalled and unreleased IPP populations.

HL7217 & HL7218:

The following data are produced from service provider returns and, whilst quality assured, are subject to reporter error. As of 31 December 2021 there were 4,869 people with IPP sentences who had been identified as meeting the screening criteria for the Offender Personality Disorder Pathway. OPD pathway screening is an administrative activity which does not necessarily mean someone needs a specific intervention to address a personality disorder. Such a need would be identified when the prisoner’s probation officer reviews the prisoner’s sentence plan to take account of the OPD pathway screening.

Of those identified as meeting the screening criteria, 2,780 are currently in custody (with 1,200 of these in custody on recall).

From 1st January 2017 to 31st December 2021, a total of 1,892 offenders serving IPP sentences have been referred to OPD Services as follows:

To note: in the breakdown of protected characteristics below, some categories have been merged where necessary to avoid the risk of identifying individual offenders.

By Age:

By Ethnicity:

By Sex:

The OPD national evaluation report was completed in Autumn 2020 having been subject to standard MoJ analytical review processes. These processes include internal quality assurance and sending a draft of the report to two external independent reviewers for comment. Once the report is finalised and signed off by MoJ Head of Profession for social research, communication plans are put up to ministers for approval to publish on www.gov.uk. Since this time, which has included changes to ministers at the MOJ, the evaluation report has been working through standard clearance processes for publication.

The timeline for finalising a research report varies as it is dependent on a number of factors, including length, complexity and drafting styles of reports along with the time and resource required to review, quality assure, revise drafts and finalise the report. It is also important to note that since the start of the pandemic, MoJ staff, including Offender Personality Disorder Pathway staff, have been redeployed to support the operational response to COVID-19 impacts in custody and in probation.

We hope to be able to publish the commissioned national evaluation of the OPD pathway, led by Professor Moran, once it has completed progressing through standard MoJ/HMPPS clearance and publication procedures.

The Department publishes a range of detailed statistics for PIP on Stat-Xplore: https://stat-xplore.dwp.gov.uk .Guidance on how to use Stat-Xplore can be found here: https://sw.stat-xplore.dwp.gov.uk/webapi/online-help/index.html.

These statistics include monthly clearances (decisions) since PIP was introduced in April 2013. Clearance figures can be broken down by clearance type (e.g. whether the claim was awarded, disallowed pre-referral to an assessment provider, disallowed at assessment or withdrawn), by reassessment type (i.e. whether the claimant was making a new claim or was undergoing a Disability Living Allowance (DLA) to PIP reassessment) and by main disabling condition.

Note that main disabling condition is only recorded for claims which reach the assessment stage. Claimants may often have multiple disabling conditions upon which their entitlement decision is based but only the main disabling condition is recorded and shown in these statistics. Main disabling condition is the disability recorded on the PIP administrative system. It is possible that a reassessment claim could have a different main disabling condition recorded on the DLA and PIP systems.

With regard to your question relating to “Behavioural Disorders” we advise that you group together the Disability Subgroups, “Conduct disorder (including oppositional defiant disorder)” and “Hyperkinetic Disorder – ADHD/ADD.” For the question relating to borderline personality disorder select Personality Disorder.

Having a personality disorder can have a big effect on the person's life, as well as their family and friends. We expect clinicians to use their professional training and judgement in diagnosing people with personality disorders and providing appropriate support and treatment thereafter.

Treatment for personality disorders may involve talking therapy, group therapy and medication. Further advice and support is also available from the Royal College of Psychiatrists and the voluntary and charitable sector.

We do not collect this data centrally

We hold the following information, which is of relevance:

A data matching exercise between DfE and MoJ found that, of children sentenced in 2014, around 45% of children with short custodial sentences, and 46% with a high-end community sentence have Special Education Needs without a statement (compared with 17% of pupils in state-funded secondary schools).

There are high numbers of young people with special educational needs including speech, language and communication needs in youth custody. Data collected to inform the custody placement decision for young people shows that 32% were recorded as having ‘learning disability or difficulty concerns’ between April 2014 and March 2016.

The information requested is not collected centrally.

The information requested is not collected centrally.