Medication records are less complete. Only since late 1992 has the pharmacy kept dispensing data on computer. The 1990/91 figure is therefore an extrapolation from the prescribing patterns as recorded in June 1991; the 1992/93 data is based on the first 6 months of 1993; 1994 is an extrapolation of drugs dispensed to the end of January 1995. The 12 month periods run from July 1st in each year.

RESULTS:
The numbers of inmates in the Special Unit throughout this period did not vary widely, usually in the range of 14 to 16, with a maximum of 18; a total of 54 men passing through in 9 years. Currently there are 15, all lifers except one serving 16 years, and all for murder or attempted murder, except one for firearms offences.

The inidence of actual physical assault on another person is shown on table 1. Graph 1 groups this data into two year bands. Attacks on property are omitted.

DISCUSSION: This data is interesting for two reasons in particular. Firstly though measurement of mental health is essentially subjective, happiness for instance being notirously difficult to define, weighing the drugs dispensed in this relatively closed Special Unit (only four newcomers per annum on average) xomes close to objectively measuring the subjective mental health of the inmates.

Secondly the conventional view that symptoms of violent disorders should be tackled by increasing medication has been stood on its head. Here a group of violent, unstable, ill-disciplined lifers have had their tranquillising medication consciously cut by 95%. This has not led to an increase in violence. A reduction of one assault per inmate per annum in 1986, to zero in 1994. should do more than encourage the team surrently working on the Unit. A reduction of around 5 thousand pounds in sedative drug costs annually for 15 patients would, if applied nationally , represent savings of several million pounds.

It is clear that the staff on the Special Unit are now adept defusing violent incidents and for the most part containing them within the Unit. They provide an indespensable supportive ethos which alone permits the weekly psychiatric therapy sessions to function. Sensitive areas simply could not even be discussed, let alone explored without it

Psychopaths are widely regarded as untreatable - and clearly they commonly are, when the treatment offered is either unfocussed psychodynamic counselling, or sedative medication. The fantasies, symbolisms and "free association" favoured by Freud have little relevance to the harsh realism of amximum security prisoners - indeed, on occasion they can be counter-productive.

What severe Personality Disorders require is a positive emotional involvement, together with a proactive approach in undoing the buried terror remaining form childhood trauma. This terror distorts thinking, and is therefore difficult to resolve unaided. It freezes the individual at the emotional age of five or thereabouts. By gently teasing out the implications, "value therapy" demonstrates that the original trauma is now over, and will not recur in adult life. Mature social strategies therefore become available, and violence is seen to be both socially maladaptive and emotionally immature. The target is to eliminate it altogether, an aim shared by all participating inmates, who now, for the most part co-operate with the Unit staff in reducing it.

Subjective clinical impressions are that most prisoners, once over their initial shock, warmly welcome the opportunity to disentangle their childhood traumas, in the safe, supportive atmosphere that this Special Unit currently provides. The results suggest the possibility of a method to reverse the rising tide of violence which besets society at large and prisons in particular.TOP