Evaluation of the UK dangerous and severe personality disorder (DSPD) program

Background

The UK government has established four new specialist secure units to pilot a dedicated service aimed to reduce the risk to the public of those deemed to have DSPD [1]. This study aims to describe the characteristics of the patients/prisoners admitted to these pilot sites, their pathway through the treatment program and to evaluate the treatment received.

Methods

A Delphi process has been used to agree descriptions of key aspects of the treatment program, and data collected on patient characteristics. The primary outcome is to measure change in patients/prisoners' risk, clinical, behavioral and social profiles, and test these for their association with treatment experiences and baseline predictors. In addition, specific measures of outcome – the Violence Risk Scale (VRS); measures of cognitive and emotional functioning; perceived coercion and measures of satisfaction will be used to evaluate the effectiveness of the programs. In depth interviews are also being developed to gain insights into the expectation and experience of those detained within these units.

Results

The Delphi process identified ten categories of treatments (as distinct form care) which were seen as being central to the aims of one or more sites. These will be presented together with a description of the pilot sites and the development of the evaluation, together with the strengths and weaknesses of the methods used.

Conclusion

Dangerous and severe personality disorder is a controversial working definition for a small group of people posing a significant risk of very serious harm to others. Treatment programs are at an early stage of development [2] and robust evaluation of the structures and processes involved as well as the outcome needs to be a fundamental part of this process.