Manchester University NHS Foundation Trust, Manchester, UK.
East London NHS Foundation Trust, London, UK.
BMC Psychiatry. 2019 Sep 10;19(1):280. doi: 10.1186/s12888-019-2268-3.
Personality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD.
A modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning.
Fifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual's presenting need, the overall clinical picture and formulation in their free text responses.
Professionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.
人格障碍（PD）是一种持久的、多方面的精神障碍，与不良健康后果、人际关系困难有关，在某些情况下对他人的风险增加。只有少数专门的法医精神卫生服务可用于严重犯罪且患有严重人格障碍的罪犯。最近的罪犯人格障碍（OPD）战略旨在确保大多数此类罪犯在监狱中接受治疗，而不是在安全的精神病服务中接受治疗，除非在极其复杂的情况下无法做到这一点。虽然该战略规定了与这方面相关的非常广泛的标准，但需要更明确的标准来支持关于适当转移的决策，从而增强公众保护。本研究探讨了专业专家与具有 PD 的高风险罪犯从监狱转移到法医精神卫生服务相关的哪些特征。
通过在线调查系统进行了两轮修改后的 Delphi 调查，调查对象是从法医精神保健、刑事司法和专门委托中招募的专业专家。
共有 51 名（56%）受访者完成了 Delphi 调查的第一阶段，其中 34 名（61%）完成了第二阶段。共有 22 项指标达成了共识，这些指标表明存在复杂性，包括共病性精神疾病、高风险水平、监狱内缺乏进展和对治疗的高度积极性。为此类因素制定了初步清单。小组成员在其自由文本回复中始终强调个人表现出的需求、整体临床情况和构想的重要性。
在决定是否适合将患有 PD 的高风险男性罪犯入院时，专业人员面临着一幅复杂的画面，专业专家对于干预的优先事项存在不同意见，并且侧重于通过构想来满足个人需求。然而，仍有可能将这些观点浓缩为一组一致的变量，用于突出需要转移到基于医院的治疗服务。
