Borderline personality disorder (BPD) is a severe, complex, and costly disorder requiring comprehensive treatment. Correctional settings commonly include mental health treatment and on-site mental health clinicians providing psychosocial and psychopharmacological treatment; however, the mandate of prison settings in particular often conflicts directly with providing clinical care to those with complex mental health needs. The necessary emphasis on security, safety, and, in some cases, retribution, can create invalidating environments that both elicit and reinforce the serious behavioral problems often observed among those with BPD, such as self-injury and suicidal behavior. When effective treatments are available, considerable challenges emerge with regard to the training and preparation of clinical staff to treat and line staff to manage inmates with BPD. This chapter discusses these and other issues and provides suggestions for continued work to better understand and treat individuals with BPD in forensic settings.
