Historically we have not known how to respond to offenders with personality disorder. In many respects all we have done is contain them, but this has failed to keep a hold of our anxieties. The Dangerous and Severe Personality Disorder (DSPD) Programme and four high security hospital and prison units for men have been developed in an attempt to reduce uncertainty and to help us 'know' more. Drawing from the case records of DSPD patients and prisoners and interviews with Parole Board (PB) and Mental Health Review Tribunal (MHRT) members this thesis explores how the journeys of patients and prisoners prior to and following DSPD admission are presented to the PB and MHRT, and how DSPD may impact on PB and MHRT decision-making. DSPD patients and prisoners share many similar characteristics, but following DSPD admission, some differences in their institutional responses can be identified. While the outcomes of PB and MHRT reviews with DSPD participants are different, the reviews serve many similar purposes. The uncertainty that surrounds DSPD disrupts PB and MHRT conceptions of what a normal journey through the criminal justice and/or mental health system looks like. We are not entirely certain who DSPD patients and prisoners have been, who they are, and who they may become. We do not know the extent to which DSPD treatment will reduce risk. Nor do we know how, or whether, DSPD patients and prisoners can progress to lower security facilities. Paradoxically, what we do know about DSPD, and the precautionary logic that structures DSPD, may serve to heighten our anxieties. It is this problematic terrain for decision-making, and journeys through managing the unknowable that this thesis explores.

In 1999, policymakers in England and Wales advanced controversial proposals for the preventive detention of a group they termed 'dangerous people with severe personality disorders'. Against a background of uncertain scientific knowledge, legal and policy actors have long faced challenges in reconciling the need to prevent crime with the need to respect the rights of the 'dangerous'. Ailbhe O'Loughlin's book, Law and Personality Disorder, situates contemporary debates about 'dangerous' offenders within this decades-old battle between the proponents of liberal legal principles and advocates of social defence. Law and Personality Disorder deconstructs competing images of offenders with personality disorders and the dilemmas they present, combining insights from criminology, psychiatry, psychology, and law. The book thus critically engages with an alluring narrative: the state has a duty to protect the public from 'dangerous' individuals, but it can also protect the human rights of the 'dangerous' by providing them with rehabilitation opportunities. While human rights law is often invoked as a means of curbing the excesses of preventive justice, O'Loughlin demonstrates that the case law of the European Court of Human Rights tends to legitimise coercive measures. Criminal law, furthermore, enables the punishment of offenders with mental disorders by resisting psychiatric evidence that they may not be fully responsible for their actions. Examining gaps in sentencing law, mental health law, and human rights law, this innovative book offers readers a comprehensive interpretation of the laws governing offenders with personality disorders and puts forward proposals for reform.

The UK Government's Offender Personality Disorder (OPD) Strategy is one of the most significant developments in mental health and criminal justice in recent years. The challenges presented by personality disorder offenders are not unique to the UK and this book also provides a useful overview of developments in the UK for those working with this population in countries where health service provision and legal frameworks pose different challenges. Managing Personality Disordered Offenders: A Pathways Approach describes how the OPD Strategy has been implemented by a consortium of mental health trusts in the UK, in collaboration with the National Probation Service and the Prison Service. This volume covers the broad range of key tasks in developing and delivering an OPD service. This includes reviewing the political and clinical context and how it aims to address some of the criticisms levelled at previous initiatives developed to meet the needs of this population. In each chapter, the authors review the existing literature and discuss the various options that were considered during the development of each of the services. Through this lens, the reader gains a better understanding of the direction taken, followed by a detailed, practical "how to do it" guide.

This thesis examines the assessment and treatment of violence in personality disordered offenders, with the view of identifying pertinent issues to be considered when appraising risk within clinical practice. Chapter 1 reviews the relevant literature and outlines the remaining thesis. A systematic review evaluating Dialectical Behaviour Therapy (DBT) with borderline personality disordered (BPD) inpatients can be found in Chapter 2. Despite highlighting a number of methodological limitations, the review indicates DBT as having positive therapeutic effects within secure settings. Chapter 3 examines the predictive validity of the Historical/Clinical/Risk Management- 20 (HCR-20; Webster, Douglas, Douglas Eaves & Hart, 1997) showing it to be a valid and reliable within forensic populations. However, the review indicates the need for additional research, making recommendations for such work. The empirical paper in Chapter 4 investigates the concept Dangerous and Severe Personality Disorder (DSPD). A DSPD sample is compared to a non DSPD personality disordered group from the same setting on a number of risk related variables. Analysis of hospital incident data and Historical Clinical Risk Management-20 (HCR-20) scores suggests DSPD patients are at a higher risk of imminent harm to themselves and others than the comparison group. These findings offer substantiation to the DSPD label and the accompanying therapeutic programme. An individualised approach to risk assessment and treatment of a Learning Disabled offender with Borderline Personality Disorder is presented in Chapter 5, serving to highlight the difficulties with management of personality disordered inpatients. Chapter 6 offers concluding comments, discussing further implications for clinical practice.

The economic impact of society's attempts to rehabilitate and contain psychopathically disordered individuals can be enormous. Understanding the nature of these disorders, developing accurate and valid assessment methods, and providing effective treatment and safe management cannot be underestimated. Including contributions from an international panel of experts from Europe, North America, and Asia, this two-volume set offers an in-depth, multidisciplinary look at key aspects of the development and etiology of psychopathic disorders; current methods of intervention, treatment, and management; and how these disorders impact decision-making in civil and criminal law. The most comprehensive major reference work available on psychopathy and the law, The Wiley International Handbook on Psychopathic Disorders and the Law, 2nd Edition: Covers the full history and conceptual development of psychopathic disorders Provides unique and enlightening perspectives on the subject from some of the world’s most well-renowned professionals in the field Looks at the etiology and pathogenesis of psychopathic disorders Examines current methods for the intervention, treatment, and management of ADHD, antisocial behavior, and impulsive aggression Provides in-depth discussions of civil and criminal law issues The Wiley International Handbook on Psychopathic Disorders and the Law, 2nd Edition is a must-have reference for practitioners and academics in clinical psychology, forensic psychology, psychiatry, probation, law, law enforcement, and social work.

HMP Grendon hosts the UK's only prison-based therapeutic community, inhabited by around 200 residents, almost all convicted of crimes against the person, and about half of whom have killed. This is an inside account of the work, and the theory behind the work, carried out at a prison which not only exemplifies the best in prison philosophy, but also a pioneering approach to the treatment of psychopaths. Previously the Director of Therapies at Grendon, Mark Morris provides a unique insight into the work of this experimental prison regime. He tracks its history from the 1950s, and describes how its approaches have evolved over the decades. He explores Grendon's status as a provider of a psychological therapy, and positions its treatment process as a therapeutic community, explaining why this approach is so appropriate and effective for helping prisoners with personality disorders, and how the prison environment can help in the rehabilitation of offenders.