Dangerous offenders scheme to be axed?

It was the killing in 1996 of Dr Lin Russell and her six-year-old daughter Megan by a known psychopath called Michael Stone which gave the impetus for what one psychiatrist has described as one of the most significant single initiatives ever developed in British forensic psychiatry.

Before the murders, Stone had been recognised as having a personality disorder. But under the law at the time he could not be detained because that disorder was viewed as untreatable.

So in 1999 the government decided to shake up the world of forensic psychiatry. It launched a radical and hugely controversial pilot scheme in England, at great cost. Four new units were set up: two at Broadmoor and Rampton high security hospitals, two at Whitemoor and Frankland prisons.

They were called the dangerous and severe personality disorder – or DSPD units.

The aim was to treat violent and sexual offenders whom most psychiatrists considered untreatable. There are currently 300 offenders in England’s DSPD units.

Cognitive behavioural principles

Professor Tony Maden, the lead clinician of the unit at Broadmoor, told Channel 4 News: “Generally it’s psychological treatment – cognitive behavioural treatments.

“So the principles are the same as those that are used in cognitive behavioural treatment of depression or something like that.

“So it’s psychological treatment along cognitive behavioural lines, and with sex offenders we also use anti-libidinal medication.”

Otherwise known as chemical castration.

A political invention?

The whole programme has proved controversial because many forensic psychiatrists argue that the term “dangerous and severe personality disorder” had no medical basis – that it is, in essence, a political invention.

The DSPD programme has been up and running for a decade now. It is estimated that £200m has been spent on this controversial programme.

Channel 4 News has been shown a DSPD research paper due to be published soon which has led its lead author, a former government adviser, to conclude that this whole programme has been largely ineffective and should now be abandoned.

And that is an option which we now understand is being considered by the Ministry of Justice.

Scarce evidence of ‘worthwhile outcomes’

In an article, as yet unpublished and currently under review for the journal Medicine, Science and The Law, Professor Peter Tyrer and his co-authors praise the DSPD programme for improving wider personality disorder services in England.

But they question whether it has had any effect on violent offenders. The article states: “The collective conclusion of all the trials and treatments for this condition is that only some forms of cognitive behaviour therapy show any promise…”

And it continues: “There was never any doubt that the DSPD programme would require a substantial commitment of government funds. The question for economics is whether this substantial funding was worthwhile in terms of improvements in outcomes. To date, there is scarce evidence that it is.”

Professor Tyrer told Channel 4 News: “One could say it (the DSPC programme) had worked, but it’s a very expensive way of providing public protection.

“I don’t think giving no treatment to this group of people is appropriate. But certainly, the amount of energy and effort that has gone into providing treatment for this group seems to have been largely ineffective.”

Recently the DSPD unit at Broadmoor has attracted much press coverage, as Channel 4 News revealed last July staff had been reprimanded there for forgetting to lock up patients.

In December a nurse on the unit was charged with having sex with one of the patients.

And in 2008 a newspaper secretly recorded one recently released patient, a convicted rapist, claiming that he was still a threat to women in his area. He would later be recalled to the DSPD unit.

‘The wrong approach’ to personality disorder

Tony Maden believes firmly that the programme has worked for some patients, but even he concedes it is time for high-security hospitals to reevaluate their DSPD programmes.

“The only way that somebody with personality disorder is going to make progress is through their own efforts,” he said.

“They can be helped by professionals, but nobody else can do it for them in terms of arriving at that understanding of their own responsibility for what’s happened.

“And the hospital ethos tends to be a bit counter-productive there, really. You know, as doctors and nurses we tend to want to look after people and make them better – to take responsibility away from them. And that’s the wrong approach to personality disorder.”

Channel 4 News understands that the heads of England’s four high-security DSPD units were told last Monday at the Ministry of Justice that the scheme, as currently structured, may be abandoned.

A government spokesman today described that meeting as a workshop to consider options on the way forward.

A full evaluation of the programme, she said, was underway and due to report later this year.