Key priorities for implementation

Developing an optimistic and trusting relationship

  • Staff working with people with antisocial personality disorder should recognise that a positive and rewarding approach is more likely to be successful than a punitive approach in engaging and retaining people in treatment. Staff should:

    • explore treatment options in an atmosphere of hope and optimism, explaining that recovery is possible and attainable

    • build a trusting relationship, work in an open, engaging and non-judgemental manner, and be consistent and reliable.

Assessment in forensic/specialist personality disorder services

  • Healthcare professionals in forensic or specialist personality disorder services should consider, as part of a structured clinical assessment, routinely using:

    • a standardised measure of the severity of antisocial personality disorder such as Psychopathy Checklist–Revised (PCL-R) or Psychopathy Checklist–Screening Version (PCL-SV)

    • a formal assessment tool such as Historical, Clinical, Risk Management-20 (HCR-20) to develop a risk management strategy.

Treatment of comorbid disorders

  • People with antisocial personality disorder should be offered treatment for any comorbid disorders in line with recommendations in the relevant NICE clinical guideline, where available. This should happen regardless of whether the person is receiving treatment for antisocial personality disorder.

The role of psychological interventions

  • For people with antisocial personality disorder with a history of offending behaviour who are in community and institutional care, consider offering group-based cognitive and behavioural interventions (for example, programmes such as 'reasoning and rehabilitation') focused on reducing offending and other antisocial behaviour.

Multi-agency care

  • Provision of services for people with antisocial personality disorder often involves significant inter-agency working. Therefore, services should ensure that there are clear pathways for people with antisocial personality disorder so that the most effective multi-agency care is provided. These pathways should:

    • specify the various interventions that are available at each point

    • enable effective communication among clinicians and organisations at all points and provide the means to resolve differences and disagreements.

      Clearly agreed local criteria should also be established to facilitate the transfer of people with antisocial personality disorder between services. As far as is possible, shared objective criteria should be developed relating to comprehensive assessment of need and risk.

  • Services should consider establishing antisocial personality disorder networks, where possible linked to other personality disorder networks. (They may be organised at the level of primary care trusts, local authorities, strategic health authorities or government offices.) These networks should be multi-agency, should actively involve people with antisocial personality disorder and should:

    • take a significant role in training staff, including those in primary care, general, secondary and forensic mental health services, and in the criminal justice system

    • have resources to provide specialist support and supervision for staff

    • take a central role in the development of standards for and the coordination of clinical pathways

    • monitor the effective operation of clinical pathways.