ABSTRACT
DSPD constitutes a fascinating area for mental health and crime. In many respects it represents the opposite end of the spectrum of disorder and offending with which we have been dealing, and yet it poses dilemmas of similar diffi culty. Here is a category (if it is a category) of offenders for whom offending presents as the most troubling and marked aspect of their behaviour; their disorder, if it indeed exists as an identifi able entity, is one of personality rather than some disruption or disturbance in cognitive or functional processes. So, whilst the offending may be readily apparent, the underlying disorder is contentious. Without an agreed diagnosis, treatment of the disorder becomes highly problematic. Indeed, what is it that one is trying to treat, above and beyond the offending behaviour? Or is one trying to manage the behaviour? If many, if not most, of these patients retain capacity, and the treatment being offered is largely one that entails their willing and enthusiastic participation (hence, motivating offenders to participate becomes critical) why is compulsion necessary? Indeed, wouldn’t the need for compulsion be the one factor most likely to predict an unsuccessful outcome? But if this is the case why have such efforts and fi nancial resources gone into developing treatment programmes under compulsion for these offender-patients? A brief and all too crude diversion into history is necessary at this point. The early chapters of this book have established, if anything, that the relationship between offending and mental disorder is at its strongest when the categories of relevant mental disorder focus on either various forms of personality disorder or on offences involving drug and alcohol abuse. Much of the strength of these associations comes from defi nitional overlap between what constitutes a mental disorder and what constitutes a crime. Hence, the legal defi nition of psychopathic disorder under the MHA 1983 (unamended) was ‘a persistent disorder or disability of mind (whether or not including signifi cant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’ (s 1(2)). It was a manifest tautology. Few patients were sectioned as suffering from psychopathic disorder even where they had offended, and almost none under the civil sections of the MHA 1983.
