The needs of staff who care for people with a diagnosis of personality disorder who are considered a risk to others

Abstract

In recent years much attention has been given to the question of how to manage individuals with a diagnosis of personality disorder who are judged to be a risk to others. This review is part of a corresponding attempt to understand the needs of those who work in healthcare settings with such a challenging group. Current political and service developments are described and the potential effects of these on staff are outlined. The patient group is briefly defined to inform discussion of the impact on staff of the work situation at both individual and organisational levels. The needs of staff in dealing therapeutically with the patient group are considered, drawing on ideas from psychoanalytic, organisational, and attachment theories. Staff needs are discussed in the light of the findings of research evaluating interventions with offenders and individuals with a diagnosis of personality disorder. Studies of ward atmosphere and team functioning are reviewed in order to enhance understanding of the environmental needs of staff. Research into the associations between job satisfaction, occupational stress, and burnout is considered. The implications of the review for developing understanding of the needs of staff are summarised. A table is presented describing these. The main areas identified are: the importance of staff receiving regular clinical supervision which incorporates the opportunity to reflect on the personal impact of therapeutic work; the value of group supervision aimed at building awareness of the way in which patients influence staff members' relationships with each other; the need for help from managers and senior clinicians in developing an integrated sense of a complex and potentially contradictory task; and the usefulness of training staff with regard to research into the effectiveness of different interventions to counter therapeutic pessimism and encourage evidence-based practice.

Keywords:

• Staff needs
• personality disorder
• forensic mental health
• risk

Acknowledgements

The author wishes to thank Nikki Jeffcote, Keith Turner and Heather Wood for their comments on earlier drafts of this paper.