A Randomized Controlled Trial Of Community-Oriented and Hospital-Oriented Care for Discharged Psychiatric Patients: Influence of Personality Disorder on Police Contacts

Abstract

An important forensic psychiatric measure, contacts with police, was compared in a randomized, controlled trial of 155 patients with severe mental illness with a previous admission within the past two years. The patients, who also had their personality status addressed formally before randomization, were allocated to community multidisciplinary teams or to hospital-based care programs after discharge from in-patient care and were followed up for one year. A total of 138 patients (89%) had at least one post-baseline assessment and of these patients, 16 (12%) had at least one police contact in the year of the study, most of which were emergency assessments. The data showed significantly greater numbers of police contacts in patients with increasing severity of personality disturbance. Patients with such disturbance were six times more likely to have police contacts than those with no personality disorder. There were significantly more contacts in patients with borderline and antisocial (dissocial) personality disorder allocated to community-oriented care compared with hospital-oriented care. These findings have important implications for risk assessment in severe mental illness.

Personality disorder and outcome in schizophrenia: A negative systematic review

“…Some other studies (e.g. Dean et al, 2006;Dolan & Davies, 2006;Gandhi et al, 2001) are also in keeping with this conclusion. It may also be relevant that most assessments for personality disorder, particularly in the United States, depend on cooperative and insightful patients, and in schizophrenia this degree of cooperation and awareness is missing.…”

Program Planning and Staff Competencies for Forensic Assertive Community Treatment: ACT-Eligible Versus FACT-Eligible Consumers

“…FACT consumers were more likely to be diagnosed with antisocial personality disorders and this is particularly important for FACT teams to know in light of evidence that schizophrenia and antisocial personality disorder combine to create a number of challenges, such as increased homelessness, greater psychosis, higher rates of police contact and persistent criminality, increased violent and suicidal behaviors, and increased substance abuse (Gandhi, Tyrer, Evans, McGee, Lamont, & Harrison-Read, 2001; Hodgins & Cote, 1993; Moran, Walsh, Tyrer, Burns, Creed, & Fahy, 2003a; Moran, Walsh, Tyrer, Burns, Creed, & Fahy, 2003b; Moran &…”

Services for personality disorder: organisation for inclusion

“…It has also been reported that people with personality disorders managed under an assertive community approach are more likely to show antisocial behaviour than are those managed under a more hospital-oriented policy (Gandhi et al, 2001). People with personality disorders have fewer attachment and support figures in the community than do others (Tyrer et al, 1994), and few community teams can provide the level of support and treatment needed when function begins to disintegrate.…”