Why are programmes for offenders with personality disorder not informed by the relevant scientific findings?

Abstract

This paper examines the evidence to justify intervening in those with personality disorder, specifically antisocial personality disorder (ASPD) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association 1994). The evidence from randomized controlled trials in the mental health literature is reviewed and found to be deficient with only five trials satisfying Cochrane criteria, all of which had a reduction in substance misuse as their primary outcome, rather than a change in the personality disorder per se . Next, I consider the contribution of Thomas Kuhn to explain why it is difficult to develop a scientific basis in forensic mental health. I argue that, because forensic mental health is inclusive in its purpose (interacting with the law, social services and the penal system, all of which have different rules and agendas), it is difficult to develop a consensus on fundamentals, this consensus being a hallmark of a science. Finally, I argue that despite the absence of evidence from mental health, providers for ASPD are in a fortunate position in being able to draw upon the correctional literature. This is relevant, provided that we agree that a reduction in offending is the primary outcome. While mental health can learn much from correctional practice, it can also enhance the efficacy of the latter by, for instance, drawing attention to the specific vulnerabilities of the personality structure that might impede programme delivery in correctional settings. Means of achieving a conjunction of mental health and correctional practice are urgently required as this would be beneficial to both.

Cool and Hot Executive Function Impairments in Violent Offenders with Antisocial Personality Disorder with and without Psychopathy

“…While cognitive-behavioural programs have been shown to reduce criminal recidivism [61], [62], offenders with ASPD+P fail to benefit [12], [13]. Further, such knowledge will contribute to unravelling the etiology of persistent violent behaviour that is a prerequisite for preventing it.…”

The Inpatient Treatment of Personality‐disordered Offenders: Multidisciplinary Successes and Tensions

“…Duggan () points out that high quality research evidence on treatments for severe personality disorder is sparse. However, the chosen treatment model for the medium secure pilot DSPD service – that of a modified TC – has seen some success in improving outcomes (Taylor, ; Warren et al ., ).…”

“…An environment built upon commitment and consideration is precisely what these individuals have been deprived of during so much of their lives (Zanarini & Frankenburg, 1997). Duggan (2008) points out that high quality research evidence on treatments for severe personality disorder is sparse. However, the chosen treatment model for the medium secure pilot DSPD servicethat of a modified TChas seen some success in improving outcomes (Taylor, 2000;Warren et al, 2001).…”

Domains of Need in a High Secure Hospital Setting: A Model for Streamlining Care and Reducing Length of Stay

“…Whilst this is not the focus of this paper, it is worth noting that one indicator of successful high secure service provision is transfer to conditions of lesser security. Whilst this might be as objective an indicator as the frequently used outcome measure of recidivism, both measures will be affected by difficulties relating to poor continuity of care and communication across services (Duggan, 2008) and, consequently, longitudinal evaluation of outcomes of service provision (and therefore generation of evidence-based practice) is hindered. Furthermore, international differences in contexts of secure care, treatment philosophies and legal systems often renders outcomes evaluation unique to specific services rather than applicable to all (Lindqvist, Taylor, Dunn, Ogloff, Skipworth, Kramp, Kaliski, Yoshikawa, Gagné and Thomson, 2009).…”