Treatments for dangerous severe personality disorder (DSPD)

Abstract

Four units established in England for individuals with dangerous severe personality disorder differ significantly in their treatment regimes. Their distribution and relationship to risk are unknown. In this study, a modified Delphi process identified the treatments and allocated them to 11 mutually exclusive categories. Attendance at treatments was obtained from records, and these were compared to annual assessments of risk. Of 150 proposed treatments, 50 were allocated to the 11 categories. Only two treatment categories were provided in all units. Specified psychological treatment programmes occupied an average of less than 2 h a week, and 10% of patients had no treatment in each year. Reduction in risk was significantly associated with total hours of treatment received. A rigorous rationalisation of the treatments is needed to permit a robust evaluation of their effectiveness. Further research is needed to determine whether reductions in risk reflect reoffending rates.

Keywords:

• personality disorder
• DSPD
• risk assessment
• treatments

Acknowledgements

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. 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 highly secure settings places significant burdens on all involved, and we were received with cooperation and generosity. The opinions expressed in this article are those of the authors and not necessarily those of the Ministry of Justice.