This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality…
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…
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.
GGzE, a mental health care organisation in the south Netherlands, implemented treatment for patients with severe personality disorders and substance use: clinical case…
GGzE, a mental health care organisation in the south Netherlands, implemented treatment for patients with severe personality disorders and substance use: clinical case management (CCM). CCM is a special healthcare facility for patients whose needs do not match other existing treatment designs. These patients are characterised by unproductive or disturbed relationships and multiple crises that deregulate clinical practice and impede recovery. In the CCM team, patients are treated with the theoretical concepts of relationship management, interpersonal reconstructive therapy, Livesley's stage‐wise treatment and integrated dual disorder treatment (IDDT). These theoretical models and methods used within CCM have been described extensively, though there has been no clinical study about its effect within GGzE so far. Professionals working within the CCM team report that behaviour such as acting out is reduced after about one year of treatment, with less interventions from other caretakers or police involvement. To substantiate these claims, a single group pre‐test and posttest was conducted to find out whether these patients really experience changes in physical and psychological problems, as well as changes in their personality disorder.The sample consists of patients who started treatment between 2004 and 2009 (pre measurement T=0), (n = 21). At T=0, patients completed the Symptom Checklist (SCL‐90) and Personality Characteristics Questionnaire (Vragenlijst Kenmerken Persoonlijkheid, VKP). The outcomes are compared with the results of the same questionnaires that were completed by patients in 2010 (post measurement T=1). The outcomes of the SCL‐90 show significant changes for fear, depression, hostility, distrust and interpersonal sensitivity, as well as the total score of psychoneurosis. The VKP shows significant changes for general personality disorder, schizoid personality disorder and borderline personality disorder. More research is needed to find stronger evidence of treatment effects of CCM, using a bigger sample, a control group and more outcome measurements that also include the drug use of patients.
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…
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…
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…
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).
Some problems involved in the one‐to‐one management of offenders and offender‐patients demonstrating severe personality disorder (psychopathic disorder) are reviewed against a background of current public and central government concerns.
The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R…
The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) associated with treatment discontinuation in a sample of adult male prisoners.
Data from 92 male offenders in a high secure prison personality disorder treatment unit was analysed. PCL-R and personality disorder diagnoses were predicted as being related to increased treatment dropout.
Having a diagnosis of narcissistic personality disorder was related to treatment dropout, but PCL-R total scores were not. There was a trend for a diagnosis of antisocial personality disorder being associated with remaining in treatment.
The current study highlights that narcissistic personality disorder can be associated with treatment dropout, warranting further exploration as to why this is the case.
Managing responsivity issues for those presenting with a personality disorder diagnosis could be effective in maximising treatment engagement from this specific offender group.
Although treatment dropout has been explored previously, this is the first study to explore treatment dropout at a specialised unit designed specifically to provide treatment for this client group.
The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability…
The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.
The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.
The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.
Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.
There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.