Assessing response to treatment

The treatability in general terms of antisocial personality disorder has not been demonstrated. (96) But even if it had, there are major problems in applying treatment to offender patients and particularly in secure settings. Measuring change in personality-disordered patients while they are detained in secure settings, and making decisions about discharge based on such change, is highly problematic. (9 98> Of the 400 personality-disordered offenders detained in secure hospitals, 50 per cent have been there for longer than !0 years.(99) Secure settings protect patients from those risk factors known to be associated with further offending, for example dysfunctional relationships, substance misuse, and opportunities to exploit others and be exploited, all of which are likely to be encountered in the community.

Follow-up studies show that personality-disordered patients discharged from secure hospitals reoffend at twice the rate of those with mental illness. (10°,101) Personality disorder in mental health law

Confusion arises when a term (e.g. psychopathic disorder) has both a clinical and legal meaning. In England and Wales the term that appears in the Mental Health Act 1983 has a legal definition and refers to a disorder that results in abnormal aggression or serious irresponsibility. The legal reification of psychopathic disorder in England dates from the 1950s, when it replaced earlier legal categories such as the 'moral imbecile' and the 'moral defective'. It would be wrong to assume that the disorder defined in law 50 years ago is the equivalent of any particular category of psychiatric disorder in current use.

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