Rep36 Understanding Personality Disorder

part of a wider strategy for combating drug
misuse within the prison service.
3.3.2 Evidence for effectiveness
Some of the recent evaluations of accredited
interventions in forensic settings are summarised
in this section. Evaluations in the UK are ongoing
and for some programmes results will not be
available for a number of years. For example, the
probation service currently has a suite of 15
accredited programmes, most of which have only
recently been implemented on a large scale. 
3.3.2a Sex Offender Treatment Programmes
An evaluation of the prison-based SOTP was
recently published (Friendship 
et al
., 2003). The
results showed that, with the exception of high-
risk offenders, those who participated on the
programme had lower reconviction rates for
sexual and violent re-offending within two years
of release. A recent review examining the
effectiveness of psychological treatment of sex
offenders (Hanson 
et al
., 2002) reported that
current treatments were effective in reducing
recidivism. There was some evidence that insight
oriented therapies increased recidivism rates.
Evaluations of community-based sex offender
programmes run by the probation service have
also shown evidence of effectiveness in reducing
re-offending (Beech 
et al
., 2001). There is a
general consensus that cognitive-behavioural
treatment can be effective in reducing recidivism,
at least for some types of sex offenders, although
some researchers (Rice & Harris, 2003) have
dissented from this view. It is generally agreed
that better quality research is needed.
Dangerous and Severe Personality Disorder (DSPD)
In its plans to reform the Mental Health Act in 2000, the Government proposed to introduce a
new category of ‘dangerous as a result of severe personality disorder’ (DSPD). This provoked
widespread concern among mental health professionals, service users, lawyers, and others
concerned with civil liberties because of the implications for the extension of state coercion, and
the possibility that people with no history of offending could be arrested and detained indefinitely.
Such a category also lacked any scientific basis. Not only is risk assessment a developing art, little is
known about the relationship of risk to personality disorder other than psychopathy as assessed by
the PCL-R. Also, using the term ‘severe’ to indicate risk rather than clinical severity causes confusion.
The Government responded positively to these criticisms. DSPD will no longer appear as a
formal category in the reformed Mental Health Act, and DSPD is now specified to be a description
of ‘a programme’ rather than a legal or clinical category. The aim of this programme is not only
to provide public protection but also to deliver high quality services to offenders with serious
mental health problems, and it is now thought improbable that people without a history of violent
or sexual offending could be admitted to the programme. The programme is viewed as a pilot
project, subject to change in the light of research findings on its utility. 
Four units within high security prisons or special hospitals are currently being developed to
provide services for 300 male offenders, all units being led by psychologists or psychiatrists. A
comparable service for women is under review. The development of such units also implies a need
for treatment facilities at lower levels of security to which offenders who have shown sufficient
progress can be moved. Some regional secure services are involved in planning services for this
group as well as becoming more responsive to the needs of personality disordered patients
generally. The Government has acknowledged the urgent need for research into the effectiveness
of risk assessment methods and the development of effective psychological treatments for
personality disorder. To this end, the DSPD programme is commissioning a number of relevant
research projects by leading behavioural scientists. The programme now involves considerable
investment in meeting the clinical needs of a hitherto poorly serviced group, and has the potential
to benefit both the public and offenders themselves. 

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