Engaging the mistrusted: an exploration of selfhood and the lived experiences of men receiving a forensic community personality disorder service

Abstract

Personality disorder (PD) has been characterised as an ill-fitting description of a complex and debilitating disorder, affecting at least 10% of the general population, over 35% of psychiatric populations and over 75% of prison populations. Historically, mental health services have actively excluded and rejected people with PD, deeming them untreatable, manipulative and blameworthy of their own distress. Consequently, there is paucity of knowledge in relation to treatment effectiveness, and even less known about what it is like to experience this condition first hand. Following a high-profile murder by someone with a PD diagnosis, the UK Government developed and piloted a range of forensic and generic mental health services to establish ‘what works’ for this group of marginalised individuals.
This is a qualitative enquiry into the experiences of men using one of the forensic community pilot services, in particular their understanding of the diagnosis and experience of being labelled, the impact of the disorder on their lives and their engagement with different aspects of the intervention. The participants in this study derive from a population often deemed the most disliked and manipulative of the entire mental health and offender communities. Not only are they disliked by mental health professionals based on their PD diagnosis, but also their history of extreme violence and aggression results in therapeutic pessimism, and even moral objections to therapeutic intervention. An interpretive phenomenological analysis (IPA) methodological approach was utilised with data generated from semi-structured interviews with six male participants. The participants were able to give insightful and powerful accounts of their experiences in a safe and entirely appropriate manner. The findings indicate that living with the disorder is typically isolating, shameful, chronic and all encompassing, with a particular devastating impact upon relationships. However, receiving the diagnosis of PD from a dedicated PD service was not only informative and helpful, but also great relief and the basis of hope. Participants reported that receiving the service had been life changing and that both clinical and personal gains were significant. Formulation, collaboration and a warm, trusting, validating and containing relationship appeared to be the essential basis for therapeutic intervention. Ascertaining and attending to previously unheard opinions has identified significant implications in terms of improving service user experiences within the service from which the data was generated. Moreover, it is suggested that the findings of this study may also provide the basis for moderatum generalisations to the wider forensic, mental health and offender communities in respect to the validity and usefulness of engaging this historically mistrusted population.

Date of Award	11 Jun 2015
Original language	English
Awarding Institution	Northumbria University
Supervisor	Michael Hill (Supervisor)