Intended for healthcare professionals


Who should take responsibility for antisocial personality disorder?

BMJ 1999; 318 doi: (Published 23 January 1999) Cite this as: BMJ 1999;318:206

Fallon suggests emphasising custody, but psychiatrists' future role remains unclear

  1. Nigel Eastman, Senior lecturer in forensic psychiatry.
  1. St George's Hospital Medical School, London SW17 0RE

    News p 211 and Personal viewp 271

    The diagnostic boundaries and treatability of personality disorders have always been medically controversial. Whether offenders with antisocial1 or dissocial2 personality disorder—“a most elusive category [with] wavering confines”3—should be treated in hospital or punished in prison is profoundly controversial. Now, because of highly publicised cases of paedophilic violent offenders released from prison and the case of Michael Stone, a convicted psychopathic murderer, the medical response to personality disorder has become a subject of national political debate. The dispute between the home secretary4 and the president of the Royal College of Psychiatrists5 about whether psychiatrists should be preventively detaining untreatable psychopaths under the Mental Health Act illustrates well the field of political conflict.

    Into this debate comes the Fallon inquiry into the personality disorder unit at Ashworth high security hospital.6 This will soon be followed by the announcement of government policy on future services and legal provisions for personality disordered offenders, arising out of a Home Office-Department of Health working party that has been running in parallel with the inquiry. Fallon investigated and largely confirmed complaints of patients trading in …

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