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Unformatted text preview: The medico-legal background Personality disorders represent a medico-legal problem that refuses to go away, despite continuing attempts to debunk them as mythological (Mullen, 2007). In the 1970s and early 1980s psychiatrists became increasingly reluctant to use the psychopathic disorder label to section people under the 1959 Mental Health Act (MHA), with the consequence that personality-disordered offenders were increasingly more likely to serve prison sentences than be detained in special (high security) hospitals. In the 1983 revision of the MHA, a treatability requirement was inserted such that, to be detained in a special hospital, an individual must be deemed to be treatable. Since there was, at that time, very little by way of effective treatment intervention for personality-disordered offenders, this further restricted the flow of such individuals into the special hospital system. In the 1990s, two infamous cases in which personality-disordered individuals committed horrendous crimes on their release from prison forced the Government to re-think mental health legislation, culminating in a Bill, currently before Parliament, proposing revision of the 1983 mental health legislation. This revision changes the existing legislation in at least three important respects. First, it proposes to replace the 1983 Acts treatability requirement by an appropriate treatment test, according to which medical treatment appropriate to the patients mental disorder is available. There is no longer a requirement that the treatment is likely to alleviate or prevent a deterioration of the patients condition. Second, it essentially omits What is the link between personality disorder and dangerousness? A critique of dangerous and severe personality disorder ABSTRACT This paper reviews the medico- legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality disorder. It raises the question: is personality disorder related to dangerousness, and (if so) what mediates the relationship? It then reviews recent findings suggesting that patients deemed to be dangerous and severely personality disordered are characterised by a combination of antisocial and borderline traits, and as such are a source of distress both to themselves and to others. It remains for future research to determine how this particular constellation of personality disorders is functionally linked to dangerousness, and whether the link is mediated by neuropsychological impairment resulting from early-onset alcohol abuse, as recently proposed by Howard (2006). It is recommended that the current criteria for dangerous and severe personality disorder be dispensed with....
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