Managing Personality Disordered Offenders in the Community

A Psychological Approach

John Dowsett, Jackie Craissati

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000144390
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

Drawing on the latest evidence from the disparate worlds of mental health and criminal justice, Managing Personality Disordered Offenders in the Community provides a practical guide to the management and treatment of a group who comprise some of the most troubled offenders, who provoke the most anxiety in our society.

Illustrated throughout with relevant case examples, this book provides a detailed account of key issues in the assessment of both personality disorder and offending. Dowsett and Craissati explore the current state of knowledge regarding treatment approaches, before suggesting a framework for thinking about community management, legislation, and multi-agency practice. The book concludes with a discussion of community pilot projects currently taking place throughout England and Wales.

Managing Personality Disordered Offenders in the Community is an accessible and informative guide for trainees and practitioners working in the fields of mental health, social services, and the criminal justice system.

Chapter 1

Introduction

On ninth of July 1996 Lin Russell and her two daughters, Megan and Josie, aged six and nine respectively, were walking down a Kent country lane when they and their dog were viciously attacked. Lin and Megan died, Josie was severely injured and left for dead. The incident gave rise to instant and justifiable national horror.

Michael Stone is one of the group of patients who are among the most difficult and challenging for the health, social and probation services to deal with. He presented with a combination of problems, a severe antisocial personality disorder, multiple drug and alcohol abuse, and occasionally, psychotic symptoms consistent with the adverse effects of drug misuse and/or aspects of his personality disorder. This complex and shifting picture made consistent and accurate diagnosis difficult.

…

This is not a case of a man with a dangerous personality disorder being ignored by agencies with responsibilities for supervising and caring for him. He received a considerable degree of attention over the years in question. The challenge presented by cases such as Michael Stone’s is that his problems are not easily attributable to a single feature of his condition or to combinations of them. Further, he did not easily fall into the province of one agency or a combination of them. While at times there will be things that can be done for such a person to reduce any dangers he may pose to the public and to help him cope, at other times there will be little that can be offered by any of the services.

(Report of the Independent Inquiry into the Care and Treatment of Michael Stone (NHS South East Coast, 2006, pp. 4–8))

In December 2005 Damien Hanson and Elliot White were convicted of the murder of John Monckton and the attempted murder of his wife Homeyra Monckton on the 29th of November 2004, at the time when both men were under the supervision of London Probation Area. The dreadful circumstances of these crimes were widely reported and very understandably caused much public concern.

…

With Damien Hanson, a high Risk of Harm offender, there was an overall collective failure within London Probation Area, both to identify the nature of his risk to others and to keep that Risk of Harm to a minimum.

(An Independent Review of a Serious Further Offence Case: Damien Hanson and Elliot White (HM Inspectorate of Probation, 2006a, pp. 2, 4–7))

In October 2005 Anthony Rice was convicted of the murder of Naomi Bryant on the 17th of August 2005, at the time when he was being supervised on a life licence by Hampshire probation area. A number of other agencies had been working jointly with the probation service on this case through the Hampshire MAPPA (Multi-Agency Public Protection Arrangements).

…

Although managing offenders from start to end of a sentence is in many ways a science it is not an exact science…. Nevertheless we find evidence to conclude that on balance Anthony Rice should not have been released on Life Licence in the first place, and once he had been released he could and should have been better managed … a sequence of deficiencies in the form of mistakes, misjudgements and miscommunications at all three phases of the whole process of this case had a compounding effect so that they came to amount to what we call a cumulative failure.

…

They did not have full knowledge of his past offending behaviour…. They received cautiously encouraging but ultimately over-optimistic reports of Anthony Rice’s progress under treatment … their own earlier decision in 2001 to transfer him to open prison conditions in our view set in motion a momentum towards release … created in this case a set of expectations that release had now become a matter of ‘when’ not ‘if’…. People managing this case started to allow its public protection considerations to be undermined by its human rights considerations, as these required increasing attention from all involved, especially as the prisoner was legally represented.

(An Independent Review of a Serious Further Offence Case: Anthony Rice (HM Inspectorate of Probation, 2006b, pp. 4–8))

John Barrett was convicted of three serious assaults in January 2002. He committed the offences under the influence of abnormal mental processes. A restricted hospital order was imposed under the Mental

Health Act 1983 on the grounds that his detention was considered necessary for the protection of the public from serious harm.

…

In October 2003 John Barrett was conditionally discharged from detention under the Mental Health Act by a mental health review Tribunal. He was readmitted to hospital informally on two occasions in 2004. On the second of September 2004, the day after the second readmission, he was at large in Richmond Park where he stabbed to death a stranger, Denis Finnegan.

…

This report shows that many aspects of John Barrett’s management as a patient of forensic mental health services were not attended to with sufficient thoroughness. Too much confidence was placed in clinical judgments unsupported by evidence and rigorous analysis. Ways of working did not facilitate effective discussion and challenge of clinical views. There was a tendency to emphasize unduly the desirability of engaging John Barrett rather than intervening against his wishes to reduce risk.

…

We criticized the team for not fully implementing the care plans during this period when John Barrett was subject to conditional discharge.

…

We conclude that during the period he was a patient of forensic service deficiencies in systems, processes and governance arrangements put patients and the public at risk.

(Report of the Independent Inquiry into the Care and Treatment of John Barrett (NHS London, 2006, pp. 9–11))

These are four extracts from the Executive Summaries of four independent inquiry reports, all of which were published in 2006. Catastrophic violence, personality functioning, risk assessment, standards of management and the culpability of the agencies and/or professionals involved were all features of the inquiries.

Why personality disordered offenders?

Personality disordered offenders have become a more high profile group in the UK in the last ten years. There are several reasons for this but it is undoubtedly due to a number of cases which attracted strong media and public interest. Perhaps the most well known of these is that of Michael Stone, who was convicted of the murder of a mother and her daughter in a quiet village in Kent in 1998. The public was gripped by the horror of this story, including the survival of the mother’s other daughter who sustained life-threatening hammer injuries during the attack. The extra dimension that was highlighted (and inevitably simplified) by the media was that the perpetrator was assessed by the local forensic mental health clinicians and deemed untreatable. This in turn drew the media’s attention — at the time — to the potential resistance of the mental health services to engaging with this group (this was rather in contrast to the muted response to the Inquiry report (NHS South East Coast, 2006) which provided a more considered view).

The Stone case came on the back of an increasing public awareness of, and concerns about, paedophiles returning to the community, which itself culminated in a well publicised vigilante-style response in some communities in the UK. The paedophile cases raised the issue once again of indefinite detention of those members of society who have paid the price of their crimes in prison but are still considered to be highly dangerous.

DSPD proposals

Partly as a result of such high profile cases, the UK government set out their proposals for the management of the risks posed by so-called dangerous severe personality disordered (DSPD) individuals, in a joint Home Office and Department of Health paper (Dept. of Health and Home Office, 1999), which was circulated for consultation. The working definition for DSPD was designed to cover those individuals:

• Who show significant disorder of personality

• Who present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover (e.g. homicide, rape)

• In whom the risk presented appears to be functionally linked to the personality disorder

The proposals contained a variety of options, including amendments to existing criminal justice legislation to allow for greater use of discretionary life sentences, and amendments to the Mental Health Act to remove the ‘treatability criterion’ for civil detainees. Suggestions were made to develop new powers in civil and criminal proceedings for the indeterminate detention of DSPD individuals in a new service separately managed from mainstream prison and health services. It should be noted that the UK is not the first western country to go down this route, and there are important forerunners in the Dangerous Offender statutes in the United States (see American Psychiatric Association, 1999) and the TBS system in the Netherlands.

As well as being triggered by a series of high profile cases, these proposals recognised a number of issues and obstacles in this field:

• Gaps in service provision specifically targeted at this group

• The possibility that more appropriate and effective legislation was necessary

• The lack of a robust research base for effective treatment in this area

• The lack of relevant training of mental health and criminal justice professionals

• Problems in the wider field of risk assessment

• Negative attitudes towards working with this client group

There is no doubt that the proposals for detention (as well as better treatment resources) for personality disordered offenders were a further response to the concern about dangerous individuals in general.

Why is it important to identify personality disorder in the management of offenders?

It is quite possible to classify offenders without reference to the diagnosis of personality disorder, and indeed the criminal justice system has largely adopted the need to focus upon offence-specific or criminogenic needs in its approach to offenders, rather than the more ephemeral idea of personality disorder. The question therefore arises as to what is gained by focusing on the individual’s personality, disordered or not. We would argue that an understanding of personality deviation or disorder does add considerable incremental knowledge about a number of key issues in relation to offenders. These include issues about the motivation to offend, risk assessment (Webster et al., 1997), predictions about course or prognosis for the individual (Black, 1999), and finally the likely impact and success of any multi-agency risk management strategy (Craissati, 2003). In relation to this last issue, we will argue that a failure to understand an individual’s personality may run the risk of certain interventions being at best redundant and ineffective and at worst destabilising and actually liable to increase the risk.

Aims of the book

The aim of this book is to be a practical guide to the management and treatment of personality disordered offenders in the community. There are several authoritative volumes on the general field of personality disorder (Livesley, 2001, 2003), and we do not seek to emulate the range of expertise they include. The reader is referred to these in several places for more in-depth analysis. These do not, however, focus on offending and therefore may not be entirely applicable in addressing the practical issues of dealing with this client group in the community. The aim of our book is to be more pragmatic — it is aimed at clinicians/probation officers — rather than focusing on theoretical issues and controversies.

We do recognise the important role that medical treatments such as medication have to play in the client group, but will not discuss this in great detail as it is outside our professional training and field of practice.

There are several other comorbidities which can complicate the already difficult mix of personality disorder and offending. These include the presence of learning disability, substance misuse and mental illness. Female and adolescent offenders also raise particular issues in terms of epidemiology and service provision. While we have acknowledged some of these issues in places and included them in some of the case examples, we feel these represent specialisms within this field which would take us away from our core themes.

We will also focus on violent and sexual offending. This is because much public concern centres on these crimes, and the relational or interpersonal dimension involved may be closely related to the perpetrator’s personality.

Finally we should note that we have aimed to include relevant case examples to illustrate certain points. Though based on real cases, we have ensured that they are sufficiently disguised to protect patient confidentiality.

Although we wanted to give a basic theoretical and empirical background to the subject, we also wanted to focus the reader on thinking about intervention both within and outside the boundaries of what is understood as treatment. The untreatable individuals also need to be assessed and managed. Related to this, we wanted to include the role of other agencies in the multi-agency framework that many of these clients find themselves in. It is vital that both mental health and criminal justice agencies have a clear understanding of the ethos and limitations of each other’s role. It is hoped that the book will therefore have something to say to the police or probation officer dealing with these clients from their own perspective.

The rest of this chapter will present an overview of the chapters that follow, with particular reference to some of the social and political factors that may be relevant in this field.

Chapter 2 will focus on definitions and conceptual issues related to the question of personality disorder. While sociological models of offending have often held sway, the notion that many offenders have an underlying personality pathology or clinical condition has never been far away. Something about personality disordered offenders was known even in classica...

Table of contents

• Cover
• Fontmatter
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• 1 Introduction
• 2 Theory
• 3 Assessment
• 4 Treatment models
• 5 Management approaches
• 6 Personality traits and strategic approaches
• 7 Where are we now?
• References
• Index