Violent personality disordered offenders detained in secure care : a two part case study - I - revisiting the over-undercontrolled typology of violent offenders and II - examining risk assessment in practice

BACKGROUND: Violent personality disordered offenders detained in secure hospital care present 2 major challenges. The first is the provision of appropriate treatment, as the group is heterogeneous. Here, it has been suggested that a typology based on the degree of anger control may be useful. The second is the assessment of their risk to others. AIMS: 1) To revisit the over-undercontrolled typology by examining the evidence for distinguishing criminological and psychopathological features between violent personality disordered subjects whose index offence was their only violent offence (Single Violent offenders, SV) and those who had more than one conviction for violence (Repeat Violent Offenders, RV). 2) To explore the process of risk assessment in respect of these offenders. METHODS: 1) 51 violent personality disordered offenders detained in medium or high secure care, were divided into SV and RV groups and were compared on variables of interest. 2) The process of assessing their risk was examined using a questionnaire administered to members of the patients' multidisciplinary team. RESULTS: 1) In comparison to the RV group, the SV group were less likely to be convicted of non violent offences. They were less antisocial and psychopathic, and showed greater anger and behavioural control. 2) Although perceived agreement as to the risk of future violent behaviour of their patients was high, actual agreement within the MDT was low. Clinicians rated offence and treatment factors as more influential on their risk judgments than other historical and social factors, and structured risk assessment tools. CONCLUSIONS: There were some distinguishing features between the SV and RV groups but these appeared to be due to the undercontrolled nature of the RV group, rather than the overcontrolled nature of the SV group. Risk assessment, as recommended in the research literature was not being carried out in practice.