Developing services for people with dangerous and severe personality disorders

Abstract

This paper describes the conflicting attitudes that exist within wider society and the people who deliver services for people with dangerous and severe personality disorder. The importance of recognizing the nature of these conflicting attitudes that are based on the desire for 'punishment', 'keeping society safe' and 'treatment and care' is discussed. Potential ways of resolving these conflicts at an organizational and practice level are explored. The resolution might involve replacing the notions and associated practices of 'punishment' and 'safety' with 'containment', and 'treatment and care' with psychosocial therapy and rehabilitation.

An exploratory study of the needs of staff who care for offenders with a diagnosis of personality disorder

“…Little has been published about the experiences of forensic mental health staff, although this area of work is regarded as particularly challenging because of a complex and demanding patient group and tensions in combining therapeutic and custodial responsibilities (Grubin & Duggan, 1998; Kurtz, 2005; Lavender, 2002). Government inquiries into malpractice at Broadmoor and Ashworth have highlighted systemic difficulties within these organizations, suggesting that mistakes can result from the general impact of work and work‐setting on groups of staff, rather than the failures of particular individuals (Blom‐Cooper, 1999; Fallon, Bluglass, Edwards, & Daniels, 1999).…”

“…Offenders with a diagnosis of personality disorder have often been the victims, as well as the perpetrators, of physical and sexual abuse (National Institute for Mental Health in England, 2003). The theoretical literature has described how work with such patients impacts on staff at both the level of the individual and the organization (Lavender, 2002; Menzies Lyth, 1960; Winnicott, 1949). However, there is a dearth of theory pertaining to the forensic mental health field, leading to curiosity in the authors about how the dual responsibilities of providing therapy to patients and ensuring public safety influence staff‐patient relationships and organizational processes.…”

“…The attitude of society to individuals with a diagnosis of personality disorder who are considered a risk to others has been characterized as ambivalent, alternating between a rehabilitative emphasis and the desire to punish or simply to lock away (Lavender, 2002). A previous theoretical paper by the first author proposed that society's anxiety about the risk presented by these patients results in unrealistic demands being placed on forensic services (Kurtz, 2002a).…”

Working with Psychopathic Offenders: Lessons from the Chromis Program

“…The importance of a coherent sense of purpose (Kurtz, 2002;Lavender, 2002), which is discussed with staff at all levels of the organization including external progression services, is important to ensure clarity regarding roles and priorities. Tumin (1996) emphasizes that an integrated view of the custodial and treatment needs of offenders is necessary to balance the requirement for security and containment with therapeutic risk taking.…”

Staff Needs When Working in Secure Forensic Child and Adolescent Mental Health

“…Control and structure within the unit was viewed in a positive light by staff; however, there is a risk that staff may develop a belief that a high degree of structure and control is the only alternative to chaos (Lavender, 2002). Inquiries into forensic services have highlighted lack of control by staff (Fallon, 1999).…”