Mentalization based treatment for violent offenders project shortlisted for HSJ Awards 2017

12 September 2017

We are delighted to announce that our Mentalization Based Treatment for violent offenders with antisocial personality disorder (ASPD) project has been shortlisted for HSJ Awards 2017, in the innovation in mental health category. The awards are one of largest celebrations of healthcare excellence in the world, recognising and promoting the finest achievements in the NHS, and showcasing them to the service’s most influential leaders.

People with a diagnosis of antisocial personality disorder (ASPD) remain on the periphery of mental health, with limited access to treatment. ASPD carries high rates of comorbidity and mortality, and harmful consequences for families and society. Despite the publication of NICE guidelines, the evidence base and provision of effective treatments remain inadequate and the belief that the condition is untreatable remains widespread.

Our treatment pilot demonstrated preliminary results indicating a reduction in aggression and violence, and improvement in health outcomes.

In 2014, we received joint criminal justice and NHS England funding to roll out MBT services within the National Probation Service in 13 sites across England and Wales. The service offered 12 months of weekly group therapy for high-risk violent offenders with ASPD.

The services are now part of an NIHR-funded randomised controlled trial (RCT) led by Professor Peter Fonagy at UCL, the largest RCT to date evaluating treatment for ASPD. Reviewers of our bid for NIHR funding noted: “Findings are likely to be of international significance, with potentially enormous implications for how this condition is managed and treated”.

MBT was developed by Professor Fonagy and Professor Anthony Bateman (Anna Freud Centre) and has shown to be highly effective in treating Borderline Personality Disorder. The treatment we have developed is a result of very close work with our partners UCL, who are running the research trial, and also with the Anna Freud Centre, which developed the intervention and are leading on training and supervision. Together we have adapted and piloted MBT for use with violent offenders with ASPD.

Since the service rolled out, there have been a number of innovations:

  • Each team’s probation officer has been trained to co-facilitate the group alongside MBT Therapists. This has improved the project’s link with the probation system, the average banding and cost of facilitators has dropped, and will contribute to the sustainability of the provision of MBT services within probation.
  • The role of service users or Experts by Experience (EbE) has been critical to the success of the project. The EbEs are ex-offenders with personality disorder who have benefitted from treatment. They provide a crucial role in engaging offenders and preventing drop out by participating in their assessment and treatment. Following recommendations from the EbEs, we changed the service model to allow them to co-facilitate the group and attend clinical supervision, which has significantly improved attendance rates. Service users were also involved in the project design, and service users trained in research methods are collecting measures from the offenders as part of the RCT.
  • As well as offenders under probation supervision, offenders can be recruited from Category D (lowest security) prison to the MBT services, offering a rare continuation of a service from prison to the community.

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