De-constructing risk, therapeutic needs and the dangerous personality disordered subject
| DOI | 10.1177/1462474518811074 |
| Author | Ailbhe O’Loughlin |
| Published date | 01 December 2019 |
| Date | 01 December 2019 |
| Subject Matter | Articles |
Article
De-constructing risk,
therapeutic needs
and the dangerous
personality
disordered subject
Ailbhe O’Loughlin
University of York, UK
Abstract
The focus of this article is on the Dangerous and Severe Personality Disorder
Programme and its successor, the Offender Personality Disorder Pathway: two initia-
tives in England and Wales with the aim of protecting the public from dangerous
offenders through a combination of preventive detention and therapeutic intervention
in prisons and psychiatric hospitals. In this article, I first explore how the dangerous yet
potentially redeemable dangerous and severe personality disordered subject was
constructed by policymakers before turning to examine how the risks this group
posed were translated into therapeutic needs under the Dangerous and Severe
Personality Disorder Programme. In so doing, I contend that prisoners’ mental
health needs are not only targeted for humane reasons but also as a means of facilitating
the cost-effective management of difficult and disruptive individuals. Furthermore,
meeting these needs can serve as an intermediate step towards drawing difficult prison-
ers into mainstream offending behaviour programmes explicitly targeting criminogenic
risk factors. Ultimately, I conclude that, given that meeting prisoners’ mental health
needs is contingent on the compatibility of therapeutic regimes with the priorities of
the prison, treatment programmes will ultimately yield to the overriding concerns of
security and control in the event of conflict.
Keywords
dangerousness, mental health, personality disorder, prison, rehabilitation, risk, welfare
Corresponding author:
Ailbhe O’Loughlin, York Law School, University of York, Freboys Lane, York YO10 5GD, UK.
Email: ailbhe.oloughlin@york.ac.uk
Punishment & Society
2019, Vol. 21(5) 616–638
!The Author(s) 2018
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DOI: 10.1177/1462474518811074
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Introduction
The last two decades have seen increased recourse to measures to incapacitate
serious sexual or violent offenders who are perceived to be ‘dangerous’. Coercive
methods such as lengthy prison sentences and civil commitment in mental health
institutions can be seen not only in the UK but also in Germany, the Netherlands,
the US and Australia (Ashworth and Zedner, 2014; Malsch and Duker, 2016).
Reflecting on such trends, some have argued that penal systems have become
increasingly concerned with the identification and ‘elimination’ (Rutherford,
1997) of dangerous ‘monsters’ (Simon, 1998) or criminal ‘others’ who threaten
an innocent public (Garland, 2001). Conversely, a seemingly more progressive
development is the revival of interest in rehabilitation and efforts to reintegrate
even the most serious offenders into society. The therapeutic optimism of the ‘what
works’ movement in offender rehabilitation (Cullen and Gendreau, 2001) has even
begun to turn the tide of a long-held pessimism towards the treatability of
psychopathy or antisocial personality disorders (Pickersgill, 2012).
Despite their diverging ideological connotations, David Garland (2001) argues
that contemporary strategies of incapacitation and rehabilitation are unified by a
fundamental preoccupation with protecting potential victims from harm. Thus, by
contrast to the penal-welfarism of the mid-20th century, in ‘late-modern’ times,
rehabilitative programmes are increasingly presented as being ‘for the benefit of
future victims rather than for the benefit of the offender’ (Garland, 2001: 176). For
Gwen Robinson (2008: 432), this ‘disjunction of rehabilitation from welfarism’ is
reflected in the distinction between ‘criminogenic’ and ‘non-criminogenic’ treat-
ment needs in the dominant risk-need-responsivity model of offender rehabilita-
tion (Bonta and Andrews, 2007). In a similar vein, Kelly Hannah-Moffat (2005:
39) argues that in ‘risk/need’ programmes, individuals’ subjective treatment needs
that are not linked to a risk of recidivism are ‘considered a low priority in terms of
intervention, except for “humane” consideration’. Consequently, in a context of
limited resources, services that are ‘not readily amenable to evaluation or for which
improvements may take a considerable length of time, like those that target [...]
psychiatric symptoms, are devalued and cut’ while services that have been proven
to reduce recidivism are prioritised (Maurutto and Hannah-Moffat, 2006: 450).
The focus of this article is on a development in England and Wales that, at first
glance, seems not to fit neatly with such accounts of contemporary policy and
practice. Proposals put forward by the British government in 1999 to preventively
detain a small group of individuals described as ‘Dangerous and Severely
Personality Disordered’ (DSPD) to protect the public received considerable atten-
tion from criminologists, who characterised the development as an exclusionary
risk management strategy aimed at neutralising a group of pathological ‘monsters’
(Rutherford, 2006; Seddon, 2007, 2008). Less attention has, however, been paid to
the therapeutic ambitions of an initiative that used the language of health and
wellbeing alongside narratives of risk and dangerousness (Home Office and
Department of Health, 1999). These ambitions were to become more significant
O’Loughlin 617
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