Institutional performance of male ‘psychopaths’ in a high-security hospital

Abstract

In England and Wales most patients with the legal classification of psychopathic disorder who are compulsorily detained in hospital receive treatment in one of the three high-security ‘Special Hospitals’. The aim of this study was to describe their psychopathology and examine its relationship with institutional performance. The sample consisted of 89 young male patients with this legal classification who had received treatment in Broadmoor Hospital. All subjects' hospital medical records were examined and the data used to calculate scores on Hare's Revised Psychopathy Checklist (PCL-R), to diagnose DSM-III-R personality disorders, and to quantify aspects of behaviour whilst in hospital. A score of 25 or above on the PCL-R was found to be associated with the diagnoses of borderline, antisocial and narcissistic personality disorder, lack of improvement in social functioning, continued need for seclusion or special care, and discharge to a resource in the community rather than to a hospital. The findings raise questions concerning the provision of therapeutic resources to criminal ‘psychopaths’.

Key Words:

• mentally disordered offenders
• Mental Health Act
• psychopathic disorder
• high-security hospital
• PCL-R
• personality disorder