Predictors of progression from high to medium secure services for personality-disordered patients

Abstract

A significant number of inpatients in English high secure hospitals are detained under the Mental Health Act of 2007 with a diagnosis of personality disorder. The main route of discharge for these patients is via medium-security units. This study sought to determine if male personality-disordered patients' ability to progress from high to medium secure services is associated with a level of violent risk (Historical, Clinical, Risk Management 20), clinical psychopathy (Psychopathy Checklist-Revised (PCL-R)) and evidence of specific personality disorder diagnoses (assessed using the Personality Diagnostic Questionnaire-4th edition plus (PDQ-4+) and Personality Assessment Inventory (PAI)). Sixty-five male inpatients within an English high secure personality disorder service who had been assessed using the relevant instruments in 2001 were followed up six years post-assessment to determine if they had progressed to a medium secure service. The results revealed that the antisocial scales of the PAI and PDQ-4+, the PCL-R (particularly factor 1) and the PAI-Paranoid scale were reliable inverse predictors of institutional progression. The findings from this study suggested that the needs of more severely antisocial and psychopathic, individuals might require greater consideration within forensic psychiatric services. Copyright (C) 2009 John Wiley & Sons, Ltd.