Skip to main content
×
×
Home

Value of standard personality assessments in informing clinical decision-making in a medium secure unit

  • Conor Duggan (a1), Lauren Mason (a2), Penny Banerjee (a2) and John Milton (a3)
Abstract
Background

Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.

Aim

To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study.

Method

A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments.

Results

Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist–Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished ‘completers' from ‘non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%).

Conclusions

Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Value of standard personality assessments in informing clinical decision-making in a medium secure unit
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Value of standard personality assessments in informing clinical decision-making in a medium secure unit
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Value of standard personality assessments in informing clinical decision-making in a medium secure unit
      Available formats
      ×
Copyright
Corresponding author
Professor Conor Duggan, Arnold Lodge RSU, Cordelia Close, Leicester LE5 0LE, UK. Email: conor.duggan@nottshc.nhs.uk
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA.
Berrigan, L. P. & Garfield, S. L. (1981) Relationship between missed psychotherapy appointments to premature termination and social class. British Journal of Clinical Psychology. 39, 239242.
Berry, A., Duggan, C. & Larkin, E. (1999) The treatability of psychopathic disorder: how clinicians decide. Journal of Forensic Psychiatry, 10, 710719.
Collins, P. (1991) The treatability of psychopaths. Journal of Forensic Psychiatry, 2, 103110.
D'Zurilla, T. N. & Nezu, A. (1990) Development and preliminary evaluation of the Social Problem Solving Inventory. Psychological Assessment, 2, 156163.
Endicott, J. & Spitzer, R. L. (1979) Use of Research Daignostic Criteria and the ‘Schedule of Affective Disorders and Schizophrenia’ to study affective disorders. American Journal of Psychiatry. 136, 5256.
Fallon, P., Bluglass, R., Edwards, B., et al (1999) Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital. TSO (The Stationery Office).
First, M. B., Spitzer, R. L., Williams, J. B. W., et al (1997) Structured Clinical Interview for DSM–IV Disorders (SCID). American Psychiatric Association.
Garfield, S. L. (1986) Research on client variables in psychotherapy. In Handbook of Psychotherapy and Behavior Change (3rd edn), (eds Garfield, S. L. & Bergin, A. E.), pp. 213256. Wiley.
Hare, R. D. (1991) Manual for the Revised Psychopathy Checklist. Multi-Health Systems.
Hollin, C. R. (1995) The meaning and implication of ‘Treatment Integrity’. In What Works: in Reducing Re-Offending? Guidelines from Research and Practice. (ed. McGuire, J.), pp. 195208, Wiley.
Home Office (2002) Criminal Statistics, England and Wales 2001 (Cm 5696). TSO (The Stationery Office).
Home Office & Department of Health (2001) DSPD Programme: Dangerous People with Severe Personality Disorder Initiative: Progress Report. Home Office.
Loranger, A., Sartorious, N., Andreoli, A., et al (1994) The International Personality Disorder Examination: the WHO/ADAMHA international pilot study of personality disorders. Archives of General Psychiatry, 51, 215224.
Maden, A., Willaims, J., Wong, C. P., et al (2004) Treating dangerous and severe personality disorder in high security: lessons from the Regional Centre, Saskatoon, Canada. Journal of Forensic Psychiatry and Psychology, 15, 375390.
Malik, M. L. & Beutler, L. E. (2002) The emergence of dissatisfaction with the DSM. In Rethinking DSM: A Psychological Perspective (eds Beulter, L. E. & Malik, M. L.), pp. 316. American Psychological Association.
McMurran, M. & Theodosi, E. (2007) Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime and Law, in press.
Milton, J. (2000) A postal survey of the assessment procedure for personality disorder in forensic settings. Psychiatric Bulletin, 24, 254257.
Milton, J., Duggan, C., McCarthy, L., et al (2007) Characteristics of offenders referred to a medium secure NHS service: the first five years. Criminal Behaviour and Mental Health, 17, 5767.
Reed, J. (1994) Report of the Department of Heath and Home Office working group on Psychopathic Disorder. Department of Health & Home Office.
Robins, E. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry, 126, 983987.
Smith, T. E., Koenigsberg, H. W., Yeomans, F. E., et al (1995) Predictors of dropout in psychodynamic psychotherapy of borderline personality disorder. Journal of Psychotherapy Practice and Research, 4, 205213.
Tyrer, P. & Johnson, T. (1996) Establishing the severity of personality disorder. American Journal of Psychiatry, 153, 15931597.
Tyrer, P., Mitchard, S., Methuen, C., et al (2003) Treatment-rejecting and treatment-seeking personality disorders: Type R and Type S. Journal of Personality Disorders, 17, 265270.
Webster, C. D., Douglas, K. S., Eaves, D., et al (1997) HCR–20: Assessing Risk for Violence (version 2). Mental Health Law and Policy Institute, Simon Fraser University.
Wechsler, D., Wyncherley, R. J., Benjamin, L., et al (1998) Wechsler Adult Intelligence Scale (3rd edn). The Psychological Corporation.
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Value of standard personality assessments in informing clinical decision-making in a medium secure unit

  • Conor Duggan (a1), Lauren Mason (a2), Penny Banerjee (a2) and John Milton (a3)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *