Patients with personality disorder admitted to secure forensic psychiatry services

Background Treatment of patients with personality disorder remains controversial and severe mental illness is prioritised in secure forensic psychiatry services. Aims To compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity. Method A record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales. Results Personality disorder admissions declined over time; more were female,White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline. paranoid and dependent personality disorder were most prevalent. Conclusions Patients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.