An exploratory study of the needs of staff who care for offenders with a diagnosis of personality disorder.

People with a diagnosis of personality disorder who are considered a risk to others are a current concern for public services, government and society. Healthcare provision for this group has recently increased, making it important to begin to learn about the needs of staff working in such a challenging area. An exploratory interview study with staff working in a medium secure unit for offenders with a diagnosis of personality disorder (Unit Z) is presented. Interviews were line-coded and analysed according to the grounded theory method. A model was developed from higher order categories. This related key contextual factors to areas of concern for staff. The key contextual factors were: 'complexity of the task' and 'tension in the relationship with outside'. The areas of concern were: 'desire for more meaningful contact', 'contradictory attitude towards openness', 'feeling physically safe but emotionally vulnerable', 'ambivalence towards structure and control' and 'emphasis on staff relationships'. 'Risk of isolation' formed a core category and described Unit Z staff's pervading sense of distance from the outside world. These categories are described with supporting quotations and discussed in relation to the existing literature. Their implications for clinical practice and the development of services are considered.