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Value of standard personality assessments in informing clinical decision – making in a medium secure unit

Section of Forensic Mental Health, University of Nottingham

Lauren Mason, BSc

Arnold Lodge, Nottinghamshire Healthcare NHS Trust

Penny Banerjee, MRCPsych

Arnold Lodge, Nottinghamshire Healthcare NHS Trust

John Milton, MRCPsych

Rampton Hospital, Nottinghamshire Healthcare NHS Trust

Correspondence: Professor Conor Duggan, Arnold Lodge RSU, Cordelia Close, Leicester LE5 0LE, UK. Email: conor.duggan{at}nottshc.nhs.uk

Declaration of interest None.

Background Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.

Aim To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study.

Method A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments.

Results Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist-Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished `completers' from `non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%).

Conclusions Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.