Journeys through managing the unknowable: making decisions about dangerous patients and prisoners with severe personality disorder

Historically we have not known how to respond to offenders with personality disorder. In many respects all we have done is contain them, but this has failed to keep a hold of our anxieties. The Dangerous and Severe Personality Disorder (DSPD) Programme and four high security hospital and prison units for men have been developed in an attempt to reduce uncertainty and to help us 'know' more. Drawing from the case records of DSPD patients and prisoners and interviews with Parole Board (PB) and Mental Health Review Tribunal (MHRT) members this thesis explores how the journeys of patients and prisoners prior to and following DSPD admission are presented to the PB and MHRT, and how DSPD may impact on PB and MHRT decision-making. DSPD patients and prisoners share many similar characteristics, but following DSPD admission, some differences in their institutional responses can be identified. While the outcomes of PB and MHRT reviews with DSPD participants are different, the reviews serve many similar purposes. The uncertainty that surrounds DSPD disrupts PB and MHRT conceptions of what a normal journey through the criminal justice and/or mental health system looks like. We are not entirely certain who DSPD patients and prisoners have been, who they are, and who they may become. We do not know the extent to which DSPD treatment will reduce risk. Nor do we know how, or whether, DSPD patients and prisoners can progress to lower security facilities. Paradoxically, what we do know about DSPD, and the precautionary logic that structures DSPD, may serve to heighten our anxieties. It is this problematic terrain for decision-making, and journeys through managing the unknowable that this thesis explores.