Shine A Light

Stuck in “Dangerous and Severe Personality Disorder” limbo

'David' suffered child abuse, and developed a disorder that led him to kill a man who for him symbolised his abusers. He was labelled DSPD and must prove he is a 'reduced risk' before his release. But how can he, when DSPD is not a medical diagnosis, but a political construct?

Lydia Smith
4 October 2011

Note: “Lydia Smith” and “David” are pseudonyms.

DSPD stands for Dangerous and Severe Personality Disorder, a term which, according to the Department of Forensic Psychiatry at Kings College, London, is not a medical diagnosis at all but a political construct — and one which has potential to be used for social control. The Labour government proposed the grave step of preventative detention for people labelled DSPD, regardless of whether they had committed a proportionate criminal offence. Mike Shooter of the Royal College of Psychiatrists contends that most people who are dangerous do not have a personality disorder and most people with personality disorders are not dangerous.

My partner David does have a personality disorder and in certain situations with certain types of people (primarily sex offenders) he has sometimes been dangerous. After being horrifically abused as a child he developed an undiagnosed personality disorder in his 20s which eventually led to him killing a man who symbolised for him those men who had abused him.
He has now served nearly 16 years of a life sentence that had a tariff of 13 years, but it was only after he attacked a sex offender in prison 3 years ago that it was finally decided to look seriously at the roots of his offending behaviour.  
A DSPD unit — treating men with severe personality disorder — was suggested. According to a leaflet from HMP Whitemoor Fens Unit, these units work therapeutically “on the developmental experiences that generated these areas of dysfunction and so addresses maladaptive coping strategies themselves”. David's hopes were raised that this might be a route to mental wellness and eventual freedom.

This treatment is available only in a couple of specialised hospitals and prison units. After one brief, hurried meeting with Broadmoor Hospital staff David was rejected — they said he lacked sufficient motivation. Then, he was accepted onto Whitemoor's Fens Unit DSPD, but the very next week they withdrew the offer saying he was "too high risk", even though they had all his details from the beginning and “high risk” is exactly what DSPD units are for.

All therapy in these units includes group therapy and all group therapy would include sex offenders — this is part of the programme. But before being accepted onto a unit where he would have to sit amicably in group therapy with sex offenders David is told he must first "reduce his risk" to them. He is striving hard to do this in one-to-one psychotherapy at his prison's Close Supervision Centre, but he won't ever be considered a sufficiently reduced risk until he has been tested in group therapy with sex offenders — and he won't be tested until he is considered a reduced risk.

Many psychiatrists have noted how impossible it is accurately to predict risk and how, because of high profile failures, psychiatrists tend to overpredict as a safeguard. (Such opinions, and the comments noted at the beginning of this piece are gathered in Max Rutherford’s report ‘Blurring the Boundaries: The convergence of mental health and criminal justice policy, legislation, systems and practice,’ Sainsbury Centre for Mental Health 2010). 

Risk assessment for sex offenders does not and cannot test them in situations where they will be dangerous (they are frequently freed to offend again). David won't be freed because his admittance to group therapy and progression will be blocked by the sex offenders who are allowed to progress to group therapy. So, as well as wrecking his childhood, they are wrecking his adulthood too.

Even after David completes years of successful one-to-one psychotherapy, if nobody will take responsibility for testing him, how will he ever prove he is a reduced risk and move towards release? He has already had nearly 16 years on the prison shelf and the DSPD programme itself, at the end of its 10 year pilot, has cost half a billion pounds and still has no concrete evidence of success.

David's predicament is not unique. The prison population has a high percentage of inmates with serious mental problems who are not getting the help they need and deserve. Prison cannot do the work of specialised hospitals so, on the whole, these people are simply contained; their problems are never addressed and generally worsen over time putting themselves and others at risk.

An offender’s past surely needs to be taken into account and addressed so that vulnerable people don't unnecessarily lose years of their lives neglected in prison. At the trial stage — and certainly once someone is convicted — in-depth, intensive psychological profiling and evaluation needs to be carried out swiftly, followed by prompt referrals for the necessary treatment. The present system lets problems fester indefinitely, so that 20 years later someone may still be offending and still be punished for it.

Perhaps some inmates will prove to be untreatably dangerous and need to be kept locked up but many, like David, have difficulties that have a root cause and can be treated.
Ultimately his risk is limited, and time ticks on. Why can he not now attend treatment daily as an outpatient? A loving supportive home environment would help him progress far better than prison and at much less cost. A single year for David in the Close Supervision Centre costs taxpayers £300,000. He could be tagged, sign on daily at a police station, spend the whole day in a day centre or hospital, and keep taking the pills that are now proving to keep him stable.

Professor Peter Tyrer, of Imperial College, London led research into the DSPD programme and concluded last year: "It has been incredibly expensive. We cannot say it has made any difference to the public and it seems patients have not been helped." He said that prisoners in the scheme spent only 10% of their time doing anything resembling therapy.

Jill Peay, professor of law at the London School of Economics (cited by Rutherford) says DSPD “is not an evidence-based programme. How could it be? If there is no agreed definition, no clear diagnosis, no agreed treatment, no means of assessing when the predicted risk may have been reduced, and no obvious link between the alleged underlying condition and the behaviour, how could outcome measures be agreed and then evaluated?”

How many more years of David's life are going to be wasted in prison limbo before the Ministry of Justice starts properly to address these problems?

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