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The clinical and risk characteristics of patients admitted to a secure hospital-based Dangerous and Severe Personality unit
- Authors:
- SHELDON Kerry, KRISHNAN Gopi
- Journal article citation:
- British Journal of Forensic Practice, 11(3), September 2009, pp.19-27.
- Publisher:
- Emerald
Four high secure units at HMP Whitemoor, HMP Frankland, Broadmoor Hospital and Rampton Hospital were set up in order to deal with patients with severe personality disorder who pose a risk to the public. This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disorder NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. The patients also exhibited a high risk of violent and sexual recidivism. The authors conclude that it is too soon to come to a view about the effectiveness of the treatment offered, although a primary aim of the Dangerous and Severe Personality Disorder service will be to establish the impact of treatment on the risk posed by the patients.
Considerations for working with personality-disordered patients
- Authors:
- SHELDON Kerry, TENNANT Allison
- Journal article citation:
- British Journal of Forensic Practice, 13(1), February 2011, pp.44-53.
- Publisher:
- Emerald
This paper discusses the challenges that can arise when working with dangerous and severe personality-disordered patients in a high secure hospital. It is based on observations made from clinical experience of working at the Peaks Unit, a health-based inpatient facility, with patients with a history of violence and often sexual offending. Considerations for working with personality-disordered patients include poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles. The paper discusses the impact of these features, and suggests how clinicians can overcome them to engage effectively with individuals who have personality disorders. It concludes that assessing individuals for their readiness to engage and change is a necessary part of any treatment strategy. Early assessment of disclosure styles, and developing an empathic response to the participant’s perception of risks related to self-disclosure, are also important. Strategies to deal with dominant behaviour in group work are also discussed.
Assessing the functions of self-harm behaviours for dangerous and severely personality disordered males in a high secure hospital
- Authors:
- GALLAGHER Jen, SHELDON Kerry
- Journal article citation:
- British Journal of Forensic Practice, 12(1), February 2010, pp.22-32.
- Publisher:
- Emerald
Self-harm, defined as any intentional act that might cause physical harm to an individual, is expensive, requiring hospitalisation, health care and increased observation for inpatients. The three aims of this study were: to investigate the functions of self-harm behaviour for a population of male patients deemed dangerous with severe personality disorders; investigate the context and nature of the self-harm incidents; and investigate staff responses to these incidents. Fifty three patients in the Peaks Unit at Rampton high security hospital where included in the study. The results show that there may be some functions of self-harm specific to this population in addition to those found in other settings, namely expression of aggression and revenge. The context and nature of incidents were similar to those found in other secure settings. A range of staff responses were observed, and indicated high demand on staff time and resources. Limitations of the methods are discussed, with proposals for future research.