The Westgate Service and Related Referral, Assessment, and Treatment Processes

• DOI: 10.1177/0306624X14538395
• Date: 01 December 2015
• Published date: 01 December 2015
• Author: Alice L. Bennett
• Subject Matter: Articles

International Journal of

Offender Therapy and

Comparative Criminology

2015, Vol. 59(14) 1580 –1604

© The Author(s) 2014

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DOI: 10.1177/0306624X14538395

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Article

The Westgate Service and

Related Referral, Assessment,

and Treatment Processes

Alice L. Bennett1

Abstract

The formerly named “Dangerous and Severe Personality Disorder” (DSPD) units

are no longer standalone services within the criminal justice system in England and

Wales. These sites now provide personality disorder treatment services in the high-

security prison estate as part of the new national Offender Personality Disorder

(OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the

assessment, treatment, and management of offenders who are likely to have a

personality disorder and who present a high risk of re-offending (men and women)

and serious harm to others (men). Further PD treatment and progression services

are being commissioned in lower security prisons and in the community as part of

the new PD Strategy. While the suitability criteria for the two male high-security

PD treatment sites are the same, the individual units have their own assessment

and treatment methods. This article aims to communicate the referral, assessment,

and treatment methods employed within the prison-based Westgate Personality

Disorder Treatment Service, HMP Frankland.

Keywords

personality disorder, psychopathy, assessment, treatment

The Treatment of Personality Disorder and Psychopathy

Effectively treating personality disordered offenders is challenging. Service providers

are tasked with developing service-users’ skills to appropriately manage dysfunctional

aspects of their personality whilst targeting dynamic criminogenic needs that contrib-

ute to offending behaviour (Howells, Krishnan, & Daffern, 2007). A major barrier to

1Westgate Personality Disorder Treatment Service, HMP Frankland, Durham, UK

Corresponding Author:

Alice L. Bennett, Westgate Personality Disorder Treatment Service, HMP Frankland, Finchale Avenue,

Brasside, Durham DH1 5YD, UK.

Email: alice.bennett@hmps.gsi.gov.uk

538395IJOXXX10.1177/0306624X14538395International Journal of Offender Therapy and Comparative CriminologyBennett

research-article2014

Bennett 1581

achieving this aim is that high-risk personality disordered offenders have a propensity

for low treatment “readiness.” This can be due to low motivation to engage within

therapy, resistance toward treatment (Howells & Day, 2007), mistrust of others, para-

noia, and dominant interpersonal styles (Sheldon & Tennant, 2011). These factors

have led to this population being considered “untreatable” due to their historical

behaviour leading to either (a) them not being offered mainstream offending behav-

iour programmes on the basis that they were considered unable to benefit, (b) treat-

ment failing to result in clinically meaningful change, or (c) inability to fully engage

with treatment and/or attrition (Howells & Tennant, 2010).

The literature base relating to “what works” within this population is still develop-

ing meaning that it is still unknown as to which specific treatments are effective (Vollm

& Konappa, 2012). Given that it will take time for treatment completers to be released

into the community for a sufficient amount of time to evaluate the impact of treatment,

it is currently difficult to identify which treatment processes can significantly impact

upon recidivism rates. Despite the challenges of treating this population, the surround-

ing literature of “what works” with high-risk offenders with personality disorders is

developing. The literature suggests that an “eclectic array” of treatment delivered in an

integrated, systematic, coordinated way to provide a structure of generic therapy sup-

ported by specific interventions intended to target specific problems. Using phased

treatment enables the focus of that treatment to change systematically through such a

model (Livesley, 2007). Livesley’s proposed structure has been incorporated into the

treatment of psychopathic offenders (Wong, Gordon, Gu, Lewis, & Olver, 2012). This

study presents treatment for psychopathic offenders comprising two components tar-

geting interpersonal factors and criminogenic factors, reflecting Factor 1 and Factor 2

traits assessed with Hare’s Psychopathy Checklist–Revised (PCL-R). Findings from

this study provide evidence to suggest that this model provided positive treatment

outcomes, supporting the notion of treatment efficacy for this population. Skeem,

Polaschek, Patrick, & Lilienfel (2012) discuss what psychopathy is, its development,

impact upon offending, and treatment outcomes. This review provides evidence to

suggest that criminal behaviour can reduce as a result of treatment that adheres to the

risk, need, and responsivity principle. In other words, appropriate treatment is intense

to suitably match this high-risk population, targets criminogenic need, and is delivered

in a format that maximises treatment engagement (Skeem et al., 2012).

Dangerous and Severe Personality Disorder (DSPD)

Services

DSPD services were developed in England and Wales as a result of the Government

taking responsibility for high-risk offenders previously considered to be untreatable

and posing a high risk to the public. Four DSPD treatment units (two within high

secure prisons and two within high-security hospitals) were subsequently developed

with the intentions to target the following outcomes (Dangerous and Severe Personality

Disorder Programme, 2008):