People living with borderline personality disorder (BPD) who become involved with the criminal justice system often experience a complex set of difficulties associated with mental health, social exclusion and criminogenic needs. For services, these complexities can present significant challenges. Characteristics associated with BPD, including emotional dysregulation, impulsivity and interpersonal difficulties, may interact with offending and rehabilitation needs for some individuals. At the same time, the systems designed to respond to offending behaviour do not always have access to specialist knowledge about personality disorder and evidence-based treatment. People with BPD involved with the justice system may also experience barriers to accessing diagnosis, psychoeducation and appropriate treatment.
It was against this background that the criminal justice role at South Australia’s Borderline Personality Disorder Collaborative (BPD Co) was developed. BPD Co opened in 2019 as a specialist statewide service with the aim of improving access to evidence-based care for people with BPD, while also building the capacity of the broader systems through training, research and service development. The model of care specifically identified a criminal justice program as one component of this statewide approach.
When I first heard about the development of BPD Co, the criminal justice role immediately sparked my interest. It represented an opportunity to bring together two areas I was passionate about: forensic practice and supporting people with BPD. At that time, I had worked for the South Australian Department for Correctional Services (DCS) for 11 years in various custodial roles, including delivering criminogenic and therapeutic programs and working with people at risk of suicide. The criminal justice role presented an opportunity to draw on all my existing experience, knowledge and partnerships while delving further into the specialist area of personality disorder.
Since stepping into the criminal justice role when it was first established in 2020, it has become clear to me that this is much more than a clinical position. It involves consultation and liaison across correctional, youth, courts and forensic mental health services; development of therapeutic initiatives; workforce training; and research designed to better understand the needs of people with BPD involved with the justice system. Underpinning the role has been a central target: improving the capacity of forensic systems to respond to BPD in ways that are effective, evidence-informed and relevant to people with justice involvement.
From Concept to Implementation
From the outset, it was clear that the criminal justice program needed to operate at several levels. Providing individual clinical support was important, but a single clinician could never meet the needs of an entire forensic population. If the role was going to have a broader impact, it also needed to focus on system development.
There were several needs that shaped our early priorities. We were aware that people with BPD and offending histories could experience difficulties accessing appropriate treatment due to concerns about risk, complexity or the impact of their behaviour on other participants. Additionally, clinicians experienced in treating BPD sometimes felt less confident working with people with significant offending histories, particularly where antisocial traits or other complexities were also present.
This created something of a service gap: people with the greatest complexity could also be the people least likely to receive evidence-informed services.
Our first priorities were to increase opportunities for access to evidence-based intervention and increase the capacity of the systems surrounding consumers. Prison officers, allied health clinicians, medical staff and other professionals encounter people with BPD in very different circumstances and we needed to support them to better understand BPD.
There were practical barriers. At the time, approximately 9,000 people were either imprisoned or subject to community-based correctional orders in South Australia. A specialist service could not provide direct intervention to everyone with BPD. To achieve a broader impact, we needed to consider how we could support the wider justice system.
There was also very little research to guide us. Although personality disorder was known to be over-represented in forensic populations, estimates of BPD prevalence varied considerably and Australian research was limited. Additionally, entering established correctional and forensic systems required trust, approvals and an understanding of operations. Research presented similar challenges; conducting research within busy operational environments can be difficult with limited personnel and resources.
However, these challenges ultimately helped define the role. Rather than developing a single intervention, we built the criminal justice program around four interconnected areas: treatment, consultation, workforce development and research.
Creating Pathways to Treatment
One of the first initiatives established was the Road Maps: In the Driver’s Seat group. The 12-week therapeutic program was adapted from BPD Co’s existing Road Maps program.
The short-term intervention uses a generalist common-characteristics approach rather than relying on a specialist treatment model. Using a generalist model also created potential for the program to one day be delivered outside of BPD Co. In the group, participants develop an understanding of patterns associated with emotional dysregulation and personality difficulties as well as the relationships between thoughts, feelings and behaviour. The program emphasises structure, consumer agency, and active engagement between clinicians and participants. The forensic program was entitled In the Driver’s Seat to reflect the importance of fostering personal agency and ownership in the process of behavioural change.
In developing the program, it was recognised that forensic participants may have additional complexities and needs. Written language and program delivery were adapted to improve accessibility for people with lower literacy. Although the program is not intended to be criminogenic in nature, it was noted that BPD and criminogenic factors sometimes overlap. As such, content addressing substance use and impulsivity was incorporated, and participants were provided opportunities to reflect on the possible links between BPD-related problems and offending behaviour.
Alongside group intervention, we established a consultation and complex-care pathway. This allows DCS clinicians to seek specialist input for people presenting with severe and complex personality difficulties where additional formulation, treatment planning or longer term treatment may be helpful.
Building Capability Across the System
Perhaps the greatest opportunity for system-wide impact has been workforce training and supervision. We developed a suite of training for staff, with content tailored to different roles. Half-day workshops are delivered to trainee correctional officers, while full-day workshops are provided to clinicians, nurses and other staff working directly with people in custody and the community.
The training workshops cover the conceptualisation of personality disorder, challenging stigma and misconceptions, and provide practical strategies for responding to behaviours associated with personality disorder. An essential component of our full-day training is lived experience. Workshops are delivered by two clinicians alongside a lived-experience educator, who shares their experience of BPD and their recovery journey. This adds an important perspective beyond clinical information, providing insight into how BPD can be experienced and how interactions with services and providers can support engagement and recovery.
Over the past five years, we have trained approximately 550 clinical and mental-health-adjacent staff and almost 200 trainee correctional officers with more training yet to come. We see this training as an important step towards a broader goal of culture change, increased confidence and capability of staff, and improved awareness of BPD-related concerns.
Additionally, mental health clinicians are able to access regular group and individual supervision focused on BPD-related issues. This provides opportunities to strengthen clinical formulation and practice, reflect on complex presentations, and support clinicians to approach their work with greater confidence and consistency.
Building the Evidence Base
Research has become another important component of the criminal justice role.
In collaboration with researchers from the University of Adelaide, we conducted a systematic review and meta-analysis examining both diagnosed BPD and self-reported BPD symptoms amongst people in prison (Dahlenburg et al., 2024). The review included 48 studies and more than 20,000 participants and demonstrated higher than expected rates of BPD amongst incarcerated males and females.
We then set out to get a better understanding of what was occurring locally through establishing a research partnership with DCS to retrospectively examine routine assessment data from people entering moderate- to high-risk rehabilitation programs (Bartsch et al., 2025). The results again showed high levels of borderline symptoms. These findings were important in reinforcing the need for ongoing education, capacity building and treatment opportunities for forensic consumers with BPD.
Where to From Here?
Six years into the criminal justice role, there is still much to do.
One continuing priority is to strengthen the evidence base. In particular, we need to better understand how personality difficulties interact with criminogenic needs and responsivity factors, and whether interventions targeting these difficulties can improve both wellbeing and justice outcomes.
Evaluating treatment outcomes is another important step. We are evaluating the Road Maps: In the Driver’s Seat program to better understand the potential effectiveness of short-term therapeutic interventions for this population. At a systems level, workforce development must also remain ongoing. As workforces change and evidence develops, we need to continue to offer staff opportunities to build knowledge and confidence in working with people with BPD.
Future goals also include extending our reach into earlier stages of the criminal justice system. To date, much of our work has focused on adult forensic services; however, we intend to work more closely with youth justice services to improve early identification and intervention services for young people with BPD. Additionally, building awareness of BPD among lawyers, judicial officers and other court-based staff may create opportunities to improve interactions and outcomes early in the judicial process.
Reflections
When I first heard about BPD Co in 2018, I saw the proposed criminal justice role as an opportunity to bring together my experience in corrections with my interest in improving care for people with BPD. What I probably did not appreciate then was how much of the role would involve establishing links — between mental health and correctional services, research and practice, specialist services and frontline staff, and clinical knowledge and lived experience. The past six years in this role has reinforced that supporting people with BPD in the criminal justice system cannot sit solely with one clinician, one program or even one service. Sustainable change requires partnerships and for systems to be willing to create opportunities for improved services and intervention.
Upon hearing that I was presenting at an international conference earlier this year, one forensic client said to me:
“I hope that they [conference attendees] are inspired to open a BPD Co in every country.”
For me, I think that statement was a clear reminder of why this work matters – to create hope for recovery and support the people who may otherwise miss out on the help they need.
Kimberley Gilson
Borderline Personality Disorder Collaborative
Barossa Hills Fleurieu LHN, Mental Health Services
Questions? Contact kimberley.gilson2@sa.gov.au
References
Bartsch, D. R., Ransom, S., & Gilson, K. J. (2025). Screening for borderline personality symptoms amongst adult offenders attending rehabilitation programmes. Psychiatry, Psychology and Law, 33(2), 466–478. https://doi.org/10.1080/13218719.2024.2444304
Dahlenburg, S. C., Bartsch, D. R., & Gilson, K. J. (2024). Global prevalence of borderline personality disorder and self-reported symptoms of adults in prison: A systematic review and meta-analysis. International Journal of Law and Psychiatry, 97, 102032. https://doi.org/10.1016/j.ijlp.2024.102032
