MEDICAL EVIDENCE
48. The Committee has been greatly assisted by witnesses
who have explained the difference between severe personality disorder
and mental illness, the variety of personality disorders and the
difficulties in predicting whether someone will be dangerous.
The phrase used in the consultation paper, "dangerous severe
personality disorder", is not a recognised medical term or
diagnosis. There are two international definitions of anti-social
or psychopathic personality disorder which are relevant and we
understand that it is only people who fall within these definitions
who are also liable to be judged dangerous. While the phrase "dangerous
severe personality disorder" is a convenient phrase for policy
development, there appears to be no good reason for it to be adopted
in either medical parlance or legislative drafting.
49. A greater difficulty arises in assessing whether
someone is so dangerous that he or she ought to be detained. The
evidence we have received from a wide variety of witnesses all
points in the same direction:
· "Current assessment tools
for severe personality disorder produce valid and reliable diagnoses
in around 70% of cases"[42]
· There remains much controversy
and equivocation concerning the diagnosis and prognosis of personality
disorders and risk assessment remains an inexact science, previous
violence alone being the best predictor of future violence"[43]
· "Risk assessment is far too
inaccurate at present to use as a basis for long-term decisions
regarding care and detention"[44]
· "Hard empirical data on the
performance of professional risk assessors does not inspire confidence
"[45]
· "confidential inquiry [into
suicide and homicide] which deals with risk assessment [showed
that] at the last contact in those homicides none of the people
was estimated to be of high risk and 94 per cent of them were
estimated to be of low risk or no risk and 6 per cent of moderate
risk".[46]
50. Mind illustrated the difficulties in assessing
risk thus: on the basis of 2,000 dangerous severe personality
disordered individuals of whom 400 (20%) will go on to commit
further serious crime, an assessment method with an accuracy of
the order of 90% to 95% will successfully identify 360, miss
40 and incorrectly predict 100 non-violent individuals.[47]
51. On the other hand the Government's proposals envisage
far more sophisticated procedures for the future assessment of
dangerous people with severe personality disorder. Some 70 experts
from across the health and criminal justice systems are engaged
in a project run jointly by the Home Office and Department of
Health aimed at devising a comprehensive battery of assessment
tests to be applied at all stages. The Home Office says "There
is every reason to believe that the processes will be at least
as good as those which operate at the moment and much reason for
optimism that they will be better".[48]
52. We welcome the commitment of the Home Office and
the Department of Health to developing more effective methods
of assessing risk, but we note the view of an academic and forensic
psychiatrist that these proposals:
"put the law before the science,
in the sense that the law to detain people is going to be put
in place before there is development of further science that is
the justification for deprivation of civil liberties".[49]
53. Real concern would arise if the law were to race
ahead of the science and it is imperative that this does not occur.
However, our judgment—having visited the Netherlands clinics
in Utrecht—is that there is already a sufficiently robust
scientific foundation for action, albeit that the United Kingdom
has hitherto lagged behind. The Government's commitment, described
in paragraph 51 above, will help this country catch up with the
best practice abroad, and then— hopefully—forge ahead.
42 Appendix
11, para 6 (National Association for the Care and Resettlement
of Offenders). Back
43 Appendix
12 (Dr Ruth Cooklin). Back
44 Appendix
5, para A5 (National Schizophrenia Fellowship). Back
45 Appendix
4, para 17. Back
46 Q78
(Mind). Back
47 Appendix
4, para 19. Back
48 Appendix
1, para 23. Back
49 Q194
(Dr Eastman). Back
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