A descriptive evaluation of patients and prisoners assessed for dangerous and severe personality disorder

The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted.