The treatability of psychopathic disorder: how clinicians decide

A clinician must establish that treatment will alleviate or prevent deterio ration in a patient with psychopathic disorder to satisfy the legal conditi ons in the 1983 Mental Health Act. A researcher prospectively studied a con secutive series of psychopathically disordered patients referred to a Speci al Hospital over 1 calendar year (i.e. from February 1994 to January 1995) to determine how this test of treatability was applied. Of the 48 cases stu died, 21 (44%) were deemed untreatable. The following factors were associat ed with untreatability: a referral from prison (rather than hospital); prev ious poor compliance with and response to treatment; an offence in which th e victim was unknown to the patient; and low levels of motivation for treat ment. Demographic, criminological and diagnostic factors showed no signific ant association with apparent treatability. This study suggests that clinic ians are using a pragmatic approach to the treatability test relatively uni nfluenced by demographic, criminological and diagnostic data. Despite motiv ation appearing to be important in the assessment of treatability, this was not often used explicitly by clinicians when assessing treatability.