Making an impact: Have we got it right yet?

This concluding chapter adopts a formulation-based approach to reflect on the tough question of whether the Offender Personality Disorder (OPD) pathway has achieved a real impact in terms of the national strategy’s high-level outcomes. First, the explicit and implicit premises of the former Dangerous and Severe Personality Disorder (DSPD) developments are considered, contrasting them with those underpinning the OPD pathway strategy. It is suggested that while DSPD was predicated on an illness model, the OPD strategy more accurately reflects a public health model, with the associated benefits and disadvantages. Second, the evidence for impact to date is summarized. Third, the high-level strategy outcomes are reworked in line with our theoretical model to achieve a more coherent articulation of the hypothesized mechanism of change within the pathway.