Dangerous Severe Personality Disordered (DSPD) Patients: Characteristics and Comparison with Other High-Risk Offenders

Abstract

England and Wales introduced the administrative category of Dangerous Severe Personality Disorder (DSPD) and established special units in prisons and high-secure psychiatric hospitals for their treatment. To examine their characteristics, we approached 202 patients admitted to DSPD units; 174 consented to participate in research. All were male, and the median age was 38 years. Most were white and born in the UK. Most patients (75%) met full DSPD criteria as suffering from severe personality disorder that caused them to be dangerous.  With  respect to personality disorder, most had elevated psychopathic traits and 40% met criteria for psychopathy on the Psychopathy Checklist-Revised (Hare, 2003). With respect to dangerousness, 25% of patients had a history of homicide; 28%, sexual offenses; and 41%, other violent offenses. Median time spent in prison was more than 12 years. According to standardized measures of violence risk, those admitted to DSPD units resembled other groups of high risk offenders described in the international literature. There were some significant differences between those admitted to prison- versus hospital-based units. The findings confirmed that DSPD units contain dangerous offenders with no evidence of preemptive incarceration.

Keywords:

• personality disorder
• violence
• risk assessment
• DSPD

Acknowledgments

The IDEA group comprises, in alphabetical order: Martin Clarke (Department of Psychiatry, University of Oxford), Wendy Dyer (Department of Psychiatry, University of Oxford), Zoe Elkington (Department of Psychiatry, University of Oxford), Alison Foster (Department of Psychiatry, University of Oxford), Lindsey Johnston (Department of Psychiatry, University of Oxford), Cara Jones (Department of Psychiatry, University of Oxford), Helen McKinnon (Department of Psychiatry, University of Oxford), Jacinta Prendergast (Department of Psychiatry, University of Oxford), and Lucy Willmott (Department of Psychiatry, University of Oxford).

This work was funded by the Ministry of Justice and Department of Health through the DSPD Programme. We thank the DSPD Expert Advisory Group for comments on the manuscript and Jay Singh for compiling international comparator data. We are also deeply indebted to the clinical staff, at each of the four sites, led by Professor Tony Maden, Julie Luther, Lawrence Jones, Dr. Gopi Krishnan, and Dr. Jacqui Saradjian. Conducting research in such high secure settings places significant burdens on all involved and we were received with cooperation and generosity. The opinions expressed in this paper are those of the authors and not necessarily those of the Ministry of Justice.