Evaluating effectiveness of open prison services within the OPD pathway: What drives success and failure in open prison services for high risk offende

人格障碍是一种复杂的心理健康状况，可能涉及严重的人际关系技能缺陷、识别功能障碍，在极端情况下，还可能对他人造成身体伤害(1)。人格障碍在英国是一种普遍的诊断。据估计，4.4%到13%的总人口可以达到任何人格障碍的诊断标准(3)。在刑事司法系统(CJS)中，人格障碍的比例过高，估计有65%的男性囚犯符合标准(4)。由于普遍存在，人格障碍是CJS的一个突出问题。由于人格障碍的挑战性和复杂性，专业人士通常不愿意与人群(5，6，7)一起工作，或通过与人群(5，6，7)的工作来体验疲惫。然而，针对这一人群的治疗和干预是可能的，但该领域的研究通常方法很差(8，9)。罪犯人格障碍路径(OPD Path)罪犯人格障碍路径(OPD Path)是英国司法部和NHS England联合发起的一项倡议，旨在为可能被诊断为人格障碍的高危罪犯提供跨CJS的心理咨询服务(10)。该途径基于一个完整的系统方法，认识到罪犯从服刑到监狱和/或国民健康保险制度拘留到基于社区的监督和重新解决的不同阶段。OPD路径的目的是减少再犯罪，改善罪犯的心理健康和福祉，并提高人格障碍工作人员的信心、技能和态度(10)。OPD路径覆盖全国缓刑，采用以公式为基础的方法，以及从A类监狱到社区的专业心理干预服务，例如，民主治疗社区和跨监管和社区的心理知情监狱环境(PIPE)。以前的危险和严重人格障碍(DSPD)政府策略不具成本效益，因此重新分配资金，形成目前的OPD Path，旨在满足更多人格障碍患者的需求(11)。目前，HMP Stanford Hill只有一所OPD Path开放式监狱(男性)。这项名为Path Enhanced Reletation Service(PERS)的服务重点关注那些在短期内很有可能“失败”的高危罪犯，要么是再次犯罪，要么是被送回安全的监狱环境。PERS服务的目的是将心理危险转移到实际危险中，尽可能地模拟社区环境。服务用户可以在服务中使用长达两年的时间，目的是将服务发布到社区。在三年的时间里，OPD Path成功地根据PERS模式(其中两个将接受性犯罪者)成功地获得了额外三个开放式监狱地点的资金。研究问题为了我的博士研究，我将对所有四个OPD Path开放式监狱服务进行混合方法评估，包括先进的量化模型。这项研究旨在回答最重要的问题：开放式监狱(男性)门诊服务有效吗？有四个具体的研究问题：1)接受专业开放式监狱服务(SOP)的囚犯与被转移到标准开放式监狱的罪犯的对照组有何不同？2)哪些因素将那些成功地从SOP中进步的人与那些被送回封闭状态和/或重新犯罪的人区分开来？3)罪犯使用什么叙事来解释：a.从SOPS成功地进步？B.失败？4)我们如何因果地模拟SOPS结果的关键驱动因素

Personality disorder is a complex mental health conditionthat can involve severe deficiencies in relationship skills,identify dysfunction and, in extreme cases, a risk of physicalharm to others (1). Personality disorder is a prevalentdiagnosis in the UK (2). Estimates suggest between 4.4 and13 percent of the general population could meet the criteriafor any personality disorder diagnosis (3). Within the criminaljustice system (CJS), personality disorder is overrepresentedwith estimates suggesting 65% of male prisoners meetingthe criteria (4). Due to the prevalence, personality disorder isa prominent issue with the CJS. Stemming from thechallenging and complex nature of personality disorder,professionals are often unwilling to work with or experienceburnout through working with the population (5,6,7).However, treatment and intervention with this population ispossible but research in the area is generallymethodologically poor (8,9).The Offender Personality Disorder Pathway (OPD Pathway)The Offender Personality Disorder Pathway (OPD Pathway) isa joint initiative between the UK Ministry of Justice and NHSEngland to provide psychologically informed services acrossthe CJS for high risk offenders who are likely to have adiagnosis of 'personality disorder' (10). The pathway is basedon a whole systems approach, recognising the variousstages of an offender's journey from sentence throughprison and/or NHS detention to community-based7 / 11supervision and re-settlement. The aims of the OPD Pathwayare to reduce re-offending, improve offender psychologicalhealth and wellbeing as well as improve the confidence, skillsand attitudes of staff working with personality disorderedoffenders (10).The OPD pathway has a national coverage across probationand adopts a formulation-based approach, as well asspecialist psychologically informed, intervention servicesfrom Category A prisons through to the community forexample, democratic therapeutic communities andPsychologically Informed Prison Environments (PIPEs) acrosscustody and community Approved Premises. The previousDangerous and Severe Personality Disorder (DSPD)government strategy was not cost-effective and so thefunding was redistributed to form the current OPD Pathway,aiming to cover more of the needs of personality disorderedoffenders (11).There is currently only one OPD Pathway open prison (male),at HMP Standford Hill. The service, known as PathwaysEnhanced Resettlement Service (PERS), has a focus on highrisk offenders who have a high likelihood of 'failing' in theshort-term, either reoffending or being returned to a secureprison environment. The aim of the PERS service is to shiftpsychological to practical hazards, modelling communitysettings as much as possible. Service users can spend up totwo years in service with the aim of release into thecommunity. The OPD Pathway has been successful inobtaining funding for an additional three open prison sites, inaccordance with the PERS model (two of which will take onsex offenders) over a period of three years.The Research QuestionFor my PhD research, I will undertake a mixed-methodevaluation, including advanced quantitative modelling,across all four OPD pathway open prison services. Theresearch will aim to answer the overarching question; areopen prison (male) OPD services effective? There are fourspecific research questions:1) How do prisoners accepted into specialist open prisonservices (SOPS) differ from a comparison group of offenderstransferred to standard open prisons?2) What factors differentiate those who successfully progressfrom SOPS from those who are returned to closed conditionsand/or reoffend?3) What narratives do offenders use to account for:a. Successful progression from SOPS?b. Failure to progress?4) How can we causally model the key drivers for outcomesfrom SOPS