A descriptive evaluation of patients and prisoners assessed for dangerous and severe personality disorder

Abstract

The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted.

Keywords:

• personality disorder
• psychopathy
• risk assessments
• prison
• high-security hospital

Acknowledgements

This study was supported by a grant from the Ministry of Justice but the work was carried out independently and the views expressed in this paper do not necessarily represent the views of the Ministry of Justice.

Notes

1. This paper does not include all individuals referred to the DSPD service between May 2000 and August 2007. Rather, it only includes those individuals referred to the DSPD service who were admitted to one of the DSPD units for assessment. Each site undertakes various degrees of pre-screening so that only those patients who are likely to meet the criteria for DSPD are actually transferred to a unit and administered the full battery of assessments. Also, the term ‘patients’ will be used to refer to both patients and prisoners throughout this paper.

2. There were a small number of patients who had been convicted of non-sexual offences, where the clinical team considered there to have been a sexual motivation, such that the offence would not have occurred had it not been for this sexual motivation. For example, kidnapping a child with the intention of sexually abusing the child but being disturbed before actually abusing the child would fall into this category.

3. These patients had committed a range of offences, including kidnap, false imprisonment, possession of fire arms, breach of sex offender orders and robbery (which was not categorised as a violent offence in the current study). Typically, while the index offences of these patients may have been less serious in nature to that of other patients, they had extensive histories of violent and/or sexual offending.

4. One of the DSPD units differed from the other three units in the way it used collateral information when administering the IPDE. This resulted in the IPDE results indicating fewer PD diagnoses at that site compared to the other three sites. Therefore, for consistency purposes, IPDE data are not included from that DSPD unit in this paper. However, it is acknowledged that there is a lack of guidance on the use of collateral information when administering the IPDE, both in terms of what information should constitute collateral information and the weight such information should be given. The DSPD units are planning to undertake research into this area.

5. VRS data were only available for 143 patients as one of the units had only recently started using the assessment, and the data were not yet available for many patients from that unit.