News

UK proposes new approach to personality disorders

Clare Dyer, legal correspondent , BMJ

Proposals for new powers to lock up dangerous people with severe personality disorders who have committed no offence were outlined by the British government this week.

Ministers are considering two options in England and Wales: strengthening current powers to detain people who pose a risk in either prison or hospital, or creating a new specialist service to house those with severe antisocial personality disorders. Although those who commit serious crimes can be detained under the current law, civil detention or "sectioning" under the Mental Health Act is allowed only for the treatment of mental illness. Psychiatrists consider that most people with severe personality disorders are not treatable.

Government ministers estimated that the gap in the legislation currently leaves 300 to 600 untreatable dangerous adults with severe personality disorders in the community. The first option, suggested in a consultation paper produced jointly by the Department of Health and the Home Office, would include widening the use of discretionary life sentences for those convicted of a criminal offence and abolishing the "treatability" requirement for civil proceedings. There would also be new powers to supervise people with psychopathic disorders released from hospital and recall them to detention.

The second option would involve creating a new indeterminate order usable in civil or criminal proceedings for people judged to be a danger, and creating new institutions to house them. Those subject to the new order would have their detention regularly reviewed and it would be subject to appeal, but they would be detained until they were considered not to present a serious risk. After release they would be subject to recall for assessment. The home secretary, Jack Straw, said: "There is a very small group of very dangerous people who currently fall outside both the law and mental health provisions. We need to change this wholly unacceptable position and move beyond the rather artificial criterion of `treatability' in determining who should be detained."

Nigel Eastman, a forensic psychiatrist and chairman of the Royal College of Psychiatrists' law committee, said that it was surprising that the government had produced the proposals now when the first draft of a review of the mental health law by a panel headed by Professor Ginevra Richardson had recommended that the treatability test should be strengthened rather than abolished.

Managing Dangerous People with Severe Personality Disorder: Proposals for Policy Development is available from the Department of Health, PO Box 777, London SE1 6XH or on the websites of the Department of Health (www.doh.gov.uk) and the Home Office (www.homeoffice.gov.uk).