-->PONE-D-25-20906-->-->Exploring staff and service user experiences of personality disorder services in open prisons: A qualitative study of Pathways Enhanced Resettlement Support-->-->PLOS One

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Overall, this was a well written, novel, and informative study on staff and service user experiences of OPD Pathway PERS. A clear rationale was evident for the current study, and sound justification for various research methods. The findings were well presented, and nicely contextualised. Below are some quite specific thoughts and minor recommendations.

Thanks, and best wishes!

1. Some typos – 36 (should ‘service’ be ‘service users’ here?); very occasional and minor grammatical errors (141, 355).

2. 52-53 – I’d be interested in knowing immediately from reading this how many papers/interventions were covered in this meta-analysis. Think important here to note albeit important but equally quite limited/blunt measurements of success. Have there been any qualitative studies? Worth mentioning here?

3. 59-61 – Does inequality here reflect the differential quality of resettlement services? Not quite sure of the point here.

4. 80-84 – I have no doubt you will have debated such an issue, but current thinking is moving towards conceptualising PD as more difficulties in self and interpersonal functioning (on a spectrum) rather than a fixed mental health condition. I would also provide some more explicit reasoning around why staff burnout is associated with working with PD, for example ‘due to the particular emotional and relational demands of this work...’.

5. 87-88 – This ‘with a likely diagnosis of pd’ is a bit vague.... perhaps ‘assessed as meeting criteria for a PD’.

6. A wider point about PD is that you are referring to PD very broadly; we know, of course, that certain PDs are more prominent in the CJS and in men (albeit potentially due to gendered diagnostic criteria). I do appreciate your aim for conciseness in this introduction, but I also wonder, given the variety of symptoms/presentations across various PDs, whether it might be worth just noting more particular prevalence and symptomatology of certain PDs in the male custodial setting.

7. 85-92 – Worth just noting briefly the state of the evidence base for OPD?

8. 90 – ‘Using an algorithm’.....‘designed to assess presence of PD traits and risk’?

9. 175-179 – If CL was involved in analysis, would her OPD experience not also be relevant here?

10. 186 – Is a mental health nurse really considered operational, rather than clinical, staff? Obviously, this would also change your results section, and how you denote participants.

11. The overarching theme title for theme two feels geared towards staff actions/experience/attitudes, but this theme also seems to encapsulate how service-users see and approach staff differently in PERS services. This may work as a kind of virtuous circle (whereby the more trusting staff appear, the more service users meaningfully engage, thereby increasing how trusting staff appear....). I just wonder if the theme heading could more explicitly acknowledge this change in behaviour/attitude from SUs as well as staff.

12. Just wonder, in the reflective statement, if there were any differences in the attitudes between service users still within PERS, and ex-service users, now in the community.

13. 335 – ‘In others’......‘and in systems more widely!’

14. 336 - Indeed. I felt the themes were, to some extent, presented in chronological order, with seemingly initial mistrust towards PERS mitigated by development of trust, with this then influencing engagement in later stages of the ‘rehabilitation’ and ‘release’ process (e.g., parole). Again, can’t help but consider the idea of a ‘virtuous cycle’ here. Just a reflection!

15. Limitations – While I appreciate why additional demographic data were not collected, it would be helpful to acknowledge the absence of ethnicity information, particularly for SUs. Due to this omission, obviously the paper cannot comment on known demographic skews within OPD service user populations (typically over-representing white individuals) or consider potential differences in experiences across ethnic groups.

16. 387-388 – Whilst I agree, I do think it would be important to caveat that this paper looked at quite a specific part of the prison estate.

Reviewer #2: Thank you for the opportunity to review this paper, and my congratulations to the authors on this novel work to explore the experiences of staff and service users of supports for people in open prisons with personality disorders. Below I have included some thoughts for your consideration, I hope they are helpful.

Overall

1. Acknowledging the exception for the name of programs (such as the OPD pathway), I strongly recommend the authors replace the word “offender(s)” throughout the paper and instead use a person-centred alternative, consistent with practices for reducing stigma, prejudice and harm in research and healthcare. (for example, in the abstract, first line of the introduction, page 4 line 78…) The papers below may be helpful resources.

Tran NT, Baggio S, Dawson A, et al. Words matter: a call for humanizing and respectful language to describe people who experience incarceration. BMC International Health and Human Rights. 2018.

Bedell PS, Spaulding AC. The Names Have Been Changed to Protect the . . . Humanity: Person-First Language in Correctional Health Epidemiology. American Journal of Epidemiology. 2018.

Introduction

2. P5L96 This sentence uses “high-risk” twice, it’s not clear to me what the first use to label people means. If the authors could please revise to clarify who the program is meant to serve (“high risk” individuals is also used on P4L87, if the authors could please clarify, high risk of/for what?).

Methods

3. More details on participants selection and the process of conducting interviews and informed consent are needed (Please see COREQ items 9-23). A few key examples of needed details:

- How were staff members selected and approached to participate? How many were invited and how many declined to participate?

- How were potential participants selected and invited to participate? How many people declined to participate? How was informed consent ensured (was the consent form reviewed verbally?). How was confidentiality protected during the interviews?

- Were people compensated for their participation?

4. (L154) The data analysis section is written in the plural first person, but there is no stage that describes any author besides GM being engaged in the work. Multiple coders are not required by RTA but suggest revising to be more explicit that there was no other input or review.

5. (L171) I think it would be helpful for authors to include why member checking was conducted only with staff and not program participants.

6. The section on researcher positionality requires more details to be consistent with COREQ guidelines:

- Specifically more details are required about what it means that co-authors “previously worked’ in OPD pathway services (as staff or care providers?)

- Key details about interviewer positionality and potential dynamics (such as gender, occupation, experience with qualitative research and relationship to correctional authorities) would also be important to include, particularly given that the authors report later that participants viewed the interviewer as an authority figure.

Results

7. The results section is missing description of how many programs were represented by current and former service users

8. Theme three (L273) is focused on the idea of progression which is a different framing from the binary (fail/succeed in open prison) used throughout the rest of the paper. I might suggest either revising the introduction to expand on the idea of progression or to contextualize the idea of progressing within the fail/succeed framework in the results section.

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Reviewer #1: Yes: Anya Frude

Reviewer #2: No

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Exploring staff and service user experiences of personality disorder services in open prisons: A qualitative study of Pathways Enhanced Resettlement Support

PONE-D-25-20906R1

Dear Dr. Mathlin,

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Steph Scott

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PLOS One

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