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Under the Radar: Women with Borderline Personality Disorder in Prison

by Matt Fossey & Georgia Black (2010).  London, UK: Center for Mental Health.  Available online at

Prison-based mental health care is problematic because of a lack of resources, the complexity of these matters, difficulties in making referrals, the paucity of good mental health care providers, and the inappropriateness of prisons as a setting for such care. For women, who are more likely to suffer from various mental health-related matters, this is an acute assortment of concerns. Borderline personality disorder (BPD) is a condition that affects approximately 20 percent of incarcerated women. Recent research suggests that being in prison makes this matter worse.

In England and Wales, the National Health Service manages prison health care services and it has mandated that these services should be equivalent to those provided in the community.  In the United Kingdom, women are twice as likely as men to have recently received mental health care. Moreover, mental health problems associated with younger women are much more multifaceted. According to the authors of this report, "this means that in order to achieve equivalence of care, women's prisons should take account of these differences in women's health problems compared to men and tailor their services accordingly."

Twelve varieties of BPD exist, but typically persons suffering BPD have unstable personal relationships, problematic self-image issues, and increased impulsivity, starting in early adulthood.  Persons with BPD self-harm, self-mutilate, and have difficulty expressing emotions. They are frequently alcohol or drug dependent, and often have past experiences with physical and sexual abuse, including domestic violence.

In this 15-page report prepared for the Center for Mental Health, a London-based research and policy group that aims to improve the lives, mental health, and wellbeing of offenders, Matt Fossey and Georgia Black review the literature on a range of issues related to BPD that are frequently overlooked with regard on women in the criminal justice system.  In particular, they examine the nature and prevalence of BPD for incarcerated women, the impact of prison on these women, and the affect of these women's incarceration on their children.

Fossey and Black also examine the following prison functions related as they relate to BPD: screening, staff training and recruitment, the transition between custody levels or between prison and community, prison-based therapeutic communities, alternatives to prisons, and parenting interventions. Fossey and Black observe that "many mental health diagnoses are identified either at the arrest, court, or prison reception stage, but many mental health problems are missed due to inadequate screening procedures."  Timely and sufficient interventions are necessary. For prison staff, specialized training, mentoring, support and supervision, and debriefing are helpful. Interventions with BPD-diagnosed persons should be based on psychotherapeutic principles.

Fossey and Black make six practice-oriented recommendations:

  • Alternatives to custody should be sought for women with a BPD diagnosis at all stages of the criminal justice system;
  • Prison staff should be aware of the relationship between BPD and self-harm;
  • Evidence-based psychological therapies should be offered BPD women;
  • Prison health care staff should routinely "meet and greet" local community mental health teams in preparing prisoner release plans;
  • Trained therapists with dialectical behavioral therapy should be available for BPD women; and
  • Family-based and parenting interventions should also be available for incarcerated BPD women.

 They also call for further research assessing "the impact of custody and family separation on women with a diagnosis of borderline personality disorder."


Posted Mon, Jun 20 2011 10:35 AM by Tracey Vessels


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