Community supervision

Many people with personality disorder are reluctant to change and will only take part in a treatment programme under duress. This is a particular concern with personality disorders that lead to antisocial behaviour. Because of this there have been moves to introduce community supervision of those with antisocial personality disorder or judged to have a serious risk of reoffending. Although the procedure has not been evaluated formally, it has been suggested that people with these disorders who are discharged under some form of community supervision are less likely to reoffend than those who do not receive such supervision. (38) These results are difficult to interpret as the patients were not randomized to type of care.

There is also a dispute as to who should carry out community supervision and the form that it should take. Most studies have been carried out on patients who are subject to particular sections of mental health legislation(39) and therefore supervised by health workers. It has also been suggested that probation officers could carry out this role under the criminal justice rather than the mental health system. This type of intervention has a simple measure of outcome—reconviction—but this is not necessarily correlated with improvement in the personality disorder. Measures of behavioural change, improvement in relationships, or formal personality assessment should also be included. Currently there is much dispute as to whether some form of community supervision of severe personality disorder should be introduced by legislation, and it is regrettable that there is no hard evidence of efficacy on which to base action, although community supervision has face validity.

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