Barbara Barrett1, Sarah Byford. 1. Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK. barbara.m.barrett@kcl.ac.uk
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.
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.
Authors: Paul G Ramchandani; Christine O'Farrelly; Daphne Babalis; Marian J Bakermans-Kranenburg; Sarah Byford; Ellen S R Grimas; Jane E Iles; Marinus H van IJzendoorn; Julia McGinley; Charlotte M Phillips; Alan Stein; Jane Warwick; Hillary C Watt; Stephen Scott Journal: Trials Date: 2017-11-15 Impact factor: 2.279