Intended for healthcare professionals


Dangerous people with severe personality disorder

BMJ 1999; 319 doi: (Published 30 October 1999) Cite this as: BMJ 1999;319:1146

British proposals for managing them are glaringly wrong—and unethical

  1. Paul E Mullen, professor of forensic psychiatry
  1. Monash University and Institute of Forensic Mental Health, Victoria, 3084 Australia

    This summer the British Department of Health and the Home Office jointly issued a paper on Managing Dangerous People with Severe Personality Disorder.1 The paper was apparently “based on the results of extensive informal discussions” and sets out the government's policy objectives in dealing with what the paper calls the “dangerous severely personality disordered.” The paper avoids descending into the apparently unending debate over what is, or is not, a personality disorder and to what extent personality disorders are treatable and attempts to cut through the gordian knot with what presumably are intended as straightforward and practical proposals for action. If only it were that simple.

    This government “framework for the future” proposes legal powers for detaining indefinitely people with dangerous severe personality disorder. Specialists, including psychiatrists, are to be employed both to better identify people with dangerous severe personality disorder and to develop “approaches to detention and management.” Finally a comprehensive programme of research is to be established to support development of policy and practice. The proposals make a point of insisting that “indeterminate detention will be authorised only on the basis of evidence from an intensive specialist assessment” …

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