Value of standard personality assessments in informing clinical decision - making in a medium secure unit.
BACKGROUND
Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.


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


METHODS
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.
Duggan
Conor
C
Sction of Fornsic Mental Health, University of Nottingham, UK. conor.duggan@nottshc.nhs.uk
Mason
Lauren
L
Banerjee
Penny
P
Milton
John
J
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D010552:Personality Assessment / Q000592:standards*; D010554:Personality Disorders / Q000175:diagnosis* / Q000628:therapy; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000523:psychology*; D012307:Risk Factors; D016896:Treatment Outcome; D016312:Treatment Refusal