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This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality disorder. It raises the question: is personality disorder related to dangerousness, and (if so) what mediates the relationship? It then reviews recent findings suggesting that patients deemed to be dangerous and severely personality disordered are characterised by a combination of antisocial and borderline traits, and as such are a source of distress both to themselves and to others. It remains for future research to determine how this particular constellation of personality disorders is functionally linked to dangerousness, and whether the link is mediated by neuropsychological impairment resulting from early‐onset alcohol abuse, as recently proposed by Howard (2006). It is recommended that the current criteria for ‘dangerous and severe personality disorder’ be dispensed with.

This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disordered (DSPD) NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 DSPD admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. There is a high risk of violent/sexual recidivism as measured by the Static‐99, Violence Risk Scale, and the Historical, Clinical and Risk Management Scale.

Interest in people who are ‘dangerous by way of severe personality disorder’ (DSPD) has grown enormously over the last six years, following growing concern in government about the lack of services for this challenging group. This has led to the development of an innovative programme and the piloting of new treatments. The DSPD Programme results from a partnership between the Home Office's National Offender Management Service and the Department of Health, and aims to pilot a range of approaches involving both prison and health service provision. Associated with this pilot is a research and development programme that will provide valuable findings on whether or not treatment can affect risks for individuals who have hitherto been considered difficult or impossible to treat.

This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.

This article explores the development of an offender personality disorder strategy for the Department of Health (DH) and National Offender Management Service (NOMS). The strategy has two strands: offenders who present a high risk of serious harm to others, and workforce development. This article primarily considers the first of these. The strategy builds upon the learning so far from the Dangerous and Severe Personality Disorder (DSPD) programme and democratic therapeutic communities in prisons. This indicates the need for NOMS and the NHS to take joint responsibility for the assessment, treatment and management of this population and to deliver services, where appropriate, through joint operations. A greater focus is required on the early identification of personality disordered offenders who present a high risk of serious harm to others, leading to an active pathway of intervention predominately based in the criminal justice system (CJS).

The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway.

A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted.

Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness.

The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway.

While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation.

There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.

The Primrose Project has been developed, as part of the Dangerous People with Severe Personality Disorder (DSPD) programme in England and Wales, to specifically address the complex needs of women prisoners who pose a significant danger to the public. It has been recognised that the needs of these women prisoners may differ from those of men in the DSPD programme. The Primrose project therefore aims to deliver more effective prison‐based healthcare interventions to these dangerous women prisoners to reduce risk to self and others. The Primrose Project expects to initially support up to 12 women prisoners in HMP Low Newton, Durham. These women prisoners will be placed with other ‘non‐DSPD’ women prisoners in the prison and will receive a variety of therapeutic interventions. Overall, the Primrose Project aims to develop into a comprehensive assessment, treatment and management facility and the proposed evaluation aims to facilitate this development. The evaluation will look at the project as a whole, identifying strengths and limitations to overall improve the service for these women prisoners, who have not previously been provided for. The research is based on a list of comprehensive questions, which form the basis of evaluation of the existing four male DSPD sites in England and Wales, which will prove useful when comparisons are later made with the Primrose Project.

The three aims of the study reported were to investigate the functions of self‐harm in a population of patients detained in the Peaks Unit at Rampton hospital, to investigate the context and nature of this behaviour and to examine how staff respond to incidents of self‐harm. The findings indicate that there may be some functions of self‐harm specific to this population in addition to those found in other settings, namely expression of aggression and revenge. The context and nature of incidents were similar to those found in other secure settings. A range of staff responses were observed, and indicated high demand on staff time and resources. Limitations of the methods are discussed, with proposals for future research.

The PCL‐R has been heralded as the ‘unparalleled’ (Salekin et al, 1996) risk assessment tool for assessing risk of violent and non‐violent recidivism. In the UK, the PCL‐R looks likely to become an industry standard assessment in psychological evaluation of individuals thought to have a dangerous and severe personality disorder. However, current knowledge about the PCL‐R is unsatisfactory, and a number of issues need to be addressed before clinicians can be confident in the use of this measure. This paper highlights these issues from the perspective of the practising clinician. Questions are raised about the theoretical, methodological and treatment implications of the use of the PCL‐R. Future research needs are established in this context of caution over the use of the measure in routine clinical and academic assessment.