Editor—In his editorial Szmukler expressed concerns about government plans to introduce legislation that would enable the preventative detention of people classified as having a dangerous severe personality disorder.1 We believe that most psychiatrists in Britain share these concerns.
This view is supported by the results of a survey that we conducted last year, which entailed sending a brief questionnaire to every consultant psychiatrist in England and Wales. The questionnaire provided background information on what at that point was known about the proposals.2
We mailed the questionnaire to 2655 consultant psychiatrists and received 1171 (44%) replies. Overall, 735 (62%) responded that they were against the plans, 230 (20%) supported them, and 214 (18%) said that they were unsure about them. In addition to this, a substantial minority (363 (31%)) said that they would be prepared to refuse to implement this legislation, and 625 (53%) wrote additional comments in a space provided on the form. The most frequent comment was that more information was needed before a clear view about the proposals could be reached. Many expressed concerns about the reliability and validity of this diagnosis. Others felt the proposals were oppressive and antitherapeutic and would result in psychiatrists becoming increasingly involved in the process of social control. Few comments in favour of reviewable detention were made.
At a time when psychiatrists and other healthcare professionals are rightly being encouraged to practice evidence based medicine, evidence concerning the management of people who are diagnosed as having personality disorders remains largely absent. What we do know is that discrete personality disorders do not exist and that levels of agreement between clinicians about who should be classified in this way are often no better than chance.3,4 Antisocial personality traits tend to persist, and no interventions have been shown to change their course.5 Although society has a right to be protected from those who commit violent offences, the moral basis for allowing the detention of those who have not been convicted of a crime is as questionable as the evidence to suggest that the medical profession can be involved in their “treatment.”
References
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