Mental health articles

OF mental health care and mentally ill

The case of ‘dangerous and severe personality disorder’

In recent years, the British State has exerted its right to impose an administrative concept of personality disorder in order to cut through or over-ride professional ambivalence. This has involved the construction of and use of a new category of ‘dangerous and severe personality disorder’ (DSPD) and new legislation has been devised to provide legal backing for the pre-emptive detention of people who have had this label applied to them.

The impasse over which sector (prison or health service) has responsibility for the management and containment of people with personality disorder has in part been resolved by this State intervention, which includes the development and funding of new services. The solution to the tensions posed by the precarious validity of personality disorder noted above would not have been resolved without the intervention of the State, which refused to rely upon ‘medical science’ alone. Manning (2002) has shown, through the use of actor network theory (Law 1992) and the analysis of policy networks, the mechanisms behind the effective intervention of the State in this arena. It managed to secure a practical policy outcome, despite the controversies surrounding the description and treatability of personality disorder rehearsed above.

The State funded and promoted professional networks and research designed to achieve the outcome it desired. It even named and promoted this sponsored network, as the ‘Virtual Institute of Severe Personality Disorder’ (VISPED). Key players within forensic psychiatry, and others in the academic medical and criminological centres of excellence, were recruited into the policy development. Money was made available to generate both research capability and capacity. Younger people were attracted into the field through PhD, postdoctoral and other research fellowships. ‘Pilot’ services were funded and evaluated. The characterization of the new service as a ‘pilot’, when it actually looked like the final version, acknowledged the difficulties of a thin evidence base.

At the same time, it warded off criticism from professionals and engaged them in a policy development, which could build upon what had been started by government initiative. The research capacity and activity has been put in place to furnish the technical capability of DSPD diagnosis, assessment and treatment, in the classic manner of the sociology of ‘translation’ whereby the network has enrolled, coopted and disarmed the key elements, technical and human, and stabilized the development and production of new knowledge. If the research falters in this quest, then the government may not be able to hold the network together against the sceptics, and the ‘translation’ may unravel.

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