Barbara Barrett1, Peter Tyrer. 1. Institute of Psychiatry, King's College, De Crespigny Park, London, SE5 8AF, UK. barbara.m.barrett@kcl.ac.uk.
Abstract
BACKGROUND: Much resource (c £500M) has been spent in setting up the programme of treatment for those deemed to be suffering from dangerous and severe personality disorder (DSPD). It has now begun to contract, and it is an appropriate time to evaluate its cost-effectiveness. AIMS: The aim of the study was to review all published and known unpublished material, examining the cost, cost function and cost-effectiveness of the DSPD programme since its introduction in 1999. METHODS: Narrative review of studies was used. RESULTS: Four studies, one unpublished, were identified. The costs of treating people in the DSPD programme are considerably higher than those in other parts of the prison service. This could be justified if the gains justified this increased investment, but the evidence suggests that the outcomes in the short term are not good, and the monetary value of reductions in serious offences is very small compared with the extent of the higher costs incurred. There is a dearth of randomised trials that would allow an adequate assessment of cost-effectiveness. IMPLICATIONS FOR PRACTICE: Future plans for expansion or development of DSPD and similar services need to have cost-effectiveness of agreed outcomes assessed as a central element.
BACKGROUND: Much resource (c £500M) has been spent in setting up the programme of treatment for those deemed to be suffering from dangerous and severe personality disorder (DSPD). It has now begun to contract, and it is an appropriate time to evaluate its cost-effectiveness. AIMS: The aim of the study was to review all published and known unpublished material, examining the cost, cost function and cost-effectiveness of the DSPD programme since its introduction in 1999. METHODS: Narrative review of studies was used. RESULTS: Four studies, one unpublished, were identified. The costs of treating people in the DSPD programme are considerably higher than those in other parts of the prison service. This could be justified if the gains justified this increased investment, but the evidence suggests that the outcomes in the short term are not good, and the monetary value of reductions in serious offences is very small compared with the extent of the higher costs incurred. There is a dearth of randomised trials that would allow an adequate assessment of cost-effectiveness. IMPLICATIONS FOR PRACTICE: Future plans for expansion or development of DSPD and similar services need to have cost-effectiveness of agreed outcomes assessed as a central element.