The offender personality disorder (OPD) Pathway was introduced across England and Wales from 2011 to provide a pathway of psychologically informed services across criminal justice and secure health settings for people with suspected personality disorder. It followed the controversial Dangerous and Severe Personality Disorder (DSPD) programme which ran between 2001 and 2011 and Lord Bradley’s (2009) review issues relating to mental health across the criminal justice system, which drew attention to the limited support for people with personality disorder in the criminal justice system. This chapter reviews the development of the OPD pathway since 2011, with a view to understanding what progress has been made across prison and probation settings. Attention is given to the wider politics and challenges that have surrounded its development, and the implications of these for the OPD Pathway and the future progression of people screened into it.