The RUSH program — real understanding of self-help: a suicide and self-harm prevention initiative within a prison setting

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Abstract
As a consequence of adverse childhood experiences, offenders can develop mental health problems consistent with a diagnosis of borderline personality disorder (BPD). This is characterised by difficulties with distress tolerance, emotional and behavioural regulation, and interpersonal skills, that often manifests as recurrent suicidal ideation and self‐harm. The dynamic interaction between the prison environment, offender psychopathology and individual coping styles further elevates this risk for suicide and self‐harm. There are few treatment programs with proven efficacy in managing borderline characteristics with the exception of dialectical behaviour therapy (DBT) developed by Marsha Linehan (1993a) for clinical populations. However, the development, implementation and evaluation of forensic‐based DBT programs is in its infancy. The RUSH (Real Understanding of Self‐Help) Program is a recent Australian DBT adaptation targeting vulnerable offenders exhibiting borderline characteristics. This paper provides an in‐depth exploration of RUSH, highlighting the modifications made to the original DBT framework. Therapeutic obstacles associated with implementing RUSH in a correctional environment are discussed, together with successful strategies to overcome these difficulties. Finally, examination of quantitative and qualitative outcomes suggests that RUSH is a promising, holistic offender rehabilitation program targeting BPD characteristics and related problem areas.

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