Treating dangerous and severe personality disorder in high security: lessons from the Regional Psychiatric Centre, Saskatoon, Canada

Abstract

We describe the approach to risk reduction at the Regional Psychiatric Centre (RPC) in Saskatoon, Canada, making legal and institutional comparisons with the new Dangerous and Severe Personality Disorder (DSPD) Service to be established in high security hospitals in England and Wales. The RPC applies cognitive behavioural techniques to reduce recidivism, and current evidence suggests the same approach should form the core of the treatment regime in DSPD units. The key to success is the strict management of programme integrity, to deliver intensive treatment that is tailored to the individual's abilities and readiness to accept change. The Stages of Change model, derived from addictions, allows the planning, monitoring and evaluation of treatment. It plays an important role in maintaining staff morale by providing an objective measure of success within a reasonable time frame. The DSPD service will require effective management and sophisticated information systems to support these developments. The RPC has the advantage of clear pathways through the service. Patients are able to return to an ordinary prison whenever they wish, and the average length of stay is about 2 years. The DSPD service will have to guard against beds becoming blocked by long-stay patients who have no way out of the service. Long term incarceration in hospital is an expensive and inefficient way of protecting the public, and a unit with a high proportion of long-stay patients would find it hard to sustain a therapeutic ethos, with a consequent threat to staff morale.