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Costs and outcomes of an intervention programme for offenders with personality disorders

  • Barbara Barrett (a1) and Sarah Byford (a1)

Abstract

Background

The dangerous severe personality disorder programme was developed in high secure prisons and hospitals at great expense to identify and treat the most dangerous offenders with personality disorders.

Aims

To evaluate whether the long-term costs of the programme are greater or less than the long-term outcomes.

Method

We used a Markov decision model with a cost-effectiveness analysis to determine the incremental cost of the programme per serious offence prevented and a cost-offset analysis to consider whether monetary benefits were greater than costs.

Results

Costs were consistently higher for the intervention programme and the cost per serious offence prevented was over £2 million, although there was some evidence that adjustments to the programme could lead to similar interventions becoming cost-effective.

Conclusions

Little evidence was found to support the cost-effectiveness of the intervention programme for offenders with personality disorders, although delivery of the programme in a lower-cost prison would probably yield greater benefits than costs. There are frequent calls for mentally disordered offenders to be detained in secure hospitals rather than prisons; however, if reoffending remains the outcome of interest for policy makers, it is likely that the costs of detention in hospital will remain greater than the benefits for dangerous offenders with a personality disorder.

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Copyright

Corresponding author

Barbara Barrett, Centre for the Economics of Mental and Physical Health, Box P024, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email: barbara.m.barrett@kcl.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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3 Home Office, Department of Health. Managing Dangerous People with Severe Personality Disorder: Proposals for Policy Development. Department of Health, 1999.
4 DSPD Programme. Dangerous and Severe Personality Disorder (DSPD) High Secure Services for Men: Planning and Delivery Guide. DSPD Programme, 2005.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Costs and outcomes of an intervention programme for offenders with personality disorders

  • Barbara Barrett (a1) and Sarah Byford (a1)
Submit a response

eLetters

The effectiveness in cost effectiveness is important

Ahmed S Huda, Consultant
04 April 2012

The authors in their economic modelling postulates that the intervention group will have a reoffending rate of 3% vs 5% in the non intervention group but give no evidence of this being the correct figure or even the justification for this being a reasonable estimate. It is possible that the authors are assuming that the protective effects of being in detention receiving treatment as part of the DSPD programme reduces the risk to the public more than being at freedom in the community. However this protective effect may just be down to being detained whether receiving treatment or not.In any case for cost effectiveness there has to be a justification for theeffectiveness figures used and none were presented in the paper.It is clear that in the modelling that the best option is being detained in a low cost prison and the authors should have modelled the possibility of the therapeutic part of the DSPD programme having limited effect over detention i.e. that it is the preventative detention effect that is important not the therapeutic part. Despite these caveats the authors provide further evidence that the best management of violent offenders is for the criminal justice system to manage risk by protecting the public by keeping dangerous offenders in prison for long periods. There does not seem to be economic reasons to divert these patients into mental health treatment programs of so far unknown efficacy but high costs. The health pound would better be spent inevidence based treatment programs for mental illness instead.

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Conflict of interest: None declared

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