Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders

Abstract

Personality-disordered offenders are difficult individuals to manage, and knowledge about effective treatment is sparse. In the UK, novel forensic psychiatric services were recently established for the treatment of offenders with personality disorder. In this paper we report the clinical and economic findings from a 2-year follow-up of a cohort of service users recruited from these services. Baseline information on developmental, clinical and offending histories was obtained from case records. Case records were checked at 6 and 24 months for new episodes of self-harm, violence, alcohol and substance use, and offending behaviour. Ratings of social functioning and therapeutic alliance were obtained from service users at baseline, 6 and 24 months. Fifty-six percent of service users were still engaged with the services at 24-month follow-up. Service users involved in the greatest number of behavioural incidents had greater impairment in baseline social functioning and lower IQ scores. There was no significant change in either therapeutic alliance or social functioning at 6 or 24 months. The economic analysis showed that although the services were predominantly run by the Health Service, there were considerable economic burdens shared by other service providers. Treatment costs at six-month follow-up were also significantly higher. Implications are discussed.

Community DSPD pilot services in South London: Rates of reconviction and impact of supported housing on reducing recidivism

“…Many characteristics of our sample were similar to those in DSPD cohort studies (Burns et al, ; Fortune et al, ; Freestone et al, ; Kirkpatrick et al, ; Sheldon and Krishnan, ), suggesting that our findings may have wide applicability for such men. In these other samples, the mean age was 36 years, somewhat younger than in our sample (40 years), and we had a slightly lower proportion of white British participants (64.5%) than in two DSPD studies (90%, Burns et al, ; 80%, Fortune et al, ), although similar to that of another (63%, Freestone et al, ) in which participants had also been drawn from an inner city London borough. The level of personality disturbance in our series was very similar to that described elsewhere, for example in rates of multiple personality disorder diagnoses within any cluster (our finding: 55%; McCarthy et al, : 58%).…”

“…There were similarities too in reported history of drug problems (79%) and alcohol problems in (73%) (Burns et al, ); over 70% of our men also had misused substances. Finally, in our sample prior conviction rates had been slightly lower (average nine previous conviction occasions) than in other studies (Burns et al, , median = 12 and Fortune et al , mean = 14), although this may be accounted for by the fact that only a subset of the men referred to our DSPD community pilots had progressed from high security services.…”

“…No study has yet, however, shown that accommodation support has a similar benefit specifically for high risk offenders with personality disorder. Publications from the secure DSPD pilots have so far been descriptive, only reporting the characteristics of those using the services (Burns et al, ; Fortune et al, ; Freestone et al, ).…”

How effective are interventions to improve social outcomes among offenders with personality disorder: a systematic review

“…Fortune et al [ 35 ] conducted a two-year prospective study of a cohort of 54 male service users from three forensic personality disorder services, 24 of whom were stated to be in the community. They collected baseline data in 2005-06 and followed up in 2007-08.…”

Do “complex needs” need “complex needs services”? – part one

“…So, for example, we find CN is the term most adopted whenever service users are asked to help find the name for their service in the pilot projects for innovative responses to PD, inspired and developed under the NIMHE programme (Fortune et al, 2011;Haigh, 2012).…”