The lessons and legacy of the programme for dangerous and severe personality disorders.

Abstract

The State Hospital, Carstairs, ScotlandIntroductionIn 1999, the UK government introduced theconcept of dangerous and severe personalitydisorder (DSPD) and established four pilot DSPDservices in high security prisons (Frankland andWhitemoor) and hospitals (Broadmoor andRampton) to develop a process to assess and treatmen meeting certain criteria for dangerousness,personality disorder and risk. The aims of thesehigh security DSPD services were (1) to improvepublic protection; (2) to provide new treatmentservices that improve mental health outcomesand reduce risk and (c) to better understand whatworks in the treatment and management of thosewho meet the DSPD criteria (Department ofHealth, 2005).The DSPD programme was highly controver-sial at inception. It was set up in the immediate af-termath of a horrific murder of a mother and herchild walking home from school. The perpetratorwas an individual identified with antisocial per-sonality disorder who was not properly engagedin any form of treatment programme because hewas regarded as too difficult to help. Although thiswas the immediate precipitant to the introductionof the DSPD programme, it also chimed morebroadly with the Government dissatisfaction withpsychiatry’s failure to provide interventions forthose with personality disorder (believing themto be untreatable) together with a need to protectthe public (Rutherford, 2010). Pressure then grewup to remove what was commonly called the‘treatability clause’ from the Mental Health Act.This clause allowed dangerous people with signifi-cant personality disorder to be spared from com-pulsory admission on the grounds that noeffective treatment was available, and so the newlegislation changed this. As a consequence, dan-gerous people with personality disorder could bedetained in hospital for treatment. This had thedual purpose of providing for a group hitherto de-nied treatment together with protecting thepublicfrom those with this mental disorder.There was also a political motive. Tony Blair,the Prime Minister, had repeatedly said in opposi-tion that any new Labour government would be‘tough on crime, and tough on the causes ofcrime’, and the envisaged programme was an ex-cellent way of demonstrating this. In its 2001Manifesto, the Labour Party declared that it wouldprotect citizens from ‘…the most dangerous of-fenders of all…i.e. those with severe personalitydisorder.’ It was not a policy envisaged by the