Published: 12/12/2001, Volume II2, No. 5835 Page 9
Risk assessments of dangerous people with severe personality disorders will be deliberately weighted to ensure only those with convictions for violence will be sectioned under the draft Mental Health Bill, HSJ has learned.
There has been widespread anger from mental health campaigners and civil liberties groups that under the new bill, DSPD patients who have committed no crime could be subject to indefinite, preventive detention.
But a government source said: 'Patients will be assessed on risk before a decision is taken whether or not to detain them. But part of that assessment will be looking at previous behaviour, and without a history of violent offences you are simply not going to score enough points to qualify.'
The proposal appears to be an attempt to drive through the controversial legislation while appeasing some of the concerns from opponents of the draft bill.
The risk assessment of patients falling under the DSPD criteria will also be carried out by specialist staff working on the joint Department of Health and Home Office pilot programme developing diagnosis and treatment measures for DSPD - instead of 'ordinary' psychiatric consultants.
Claims that hundreds of people could be diagnosed with a form of DSPD, rounded up and removed from society when the bill became law were 'ridiculous', insisted the source.
'The numbers are going to be restricted by the available treatment, by available services. With each order [to detain a patient] there will be a care plan. If there is no care plan because of the lack of places, then we will not be able to detain them.'
One headache facing the DoH has been the response of psychiatrists to the proposals. According to the source, officials are seriously concerned and will be working to ease some of the fears expressed, particularly by the Royal College of Psychiatrists.
Despite its absence from the Queen's Speech last month, the government is to press ahead with the bill and put it before Parliament this spring.
Last month, Dr Fiona Spencer, head of the mental health unit at the Home Office, spoke at a London conference on working with dangerous offenders.
She said: 'DSPD is a working title for the problem. It is not a diagnosis. It has never been intended as a diagnosis and we will probably refine it over time.
And it is not the driving force behind the bill and it is not about locking up 'psychos' for life. It is about developing service so we can treat them more effectively.'
She stressed there was no proof the treatment being developed would work, but nor was there any proof that it would not.
The programme's aim was to concentrate on treating personality disorders rather than focusing on perceived levels of danger.
Assessment of DSPD would use the Hare psychopathy checklist and the DSM-IV diagnosis of personality disorder. The public safety risk would be worked out using 'actuarial risk tools' combined with structured clinical judgement - a process that would take around 16 weeks for each patient.
Gill Atrill, principal psychologist based in the prison service's offending behaviour programmes unit, spoke of the crucial importance of motivation in the successful treatments.
She said there were difficulties in engaging DSPD patients with treatment programmes, which were regarded by many as pointless and used only as a method through which to ensure early release.
'We understand very clearly that these people like the idea of winning, like the idea of status. One thing we could be doing is to stop talking up their dangerousness.'