The assessment of dangerous and severe personality disorder: service use, cost, and consequences

Abstract

The dangerous severe personality disorder (DSPD) programme in England provides high security services for offenders with a personality disorder who have a high risk of re-offending. The cost and economic value of the programme is unknown. The aims of this study were to examine patterns in the service use of prisoners in assessment, to evaluate the cost and outcomes of prisoners in DSPD assessment compared to controls, and to identify the clinical and personal characteristics of prisoners with high costs. Individual-level service use data were collected from prisoner files and individual total costs estimated. Prisoners in DSPD assessment had contact with a variety of professionals and group activities. The DSPD group cost £3,500 more on average than those in the control prisons over six months (£25,150 vs. £21,963; p = .094). There were no significant differences in outcome, although there was a consistent trend for the DSPD assessment group to have worse outcomes than controls. In a cost-function analysis, social functioning had a positive impact on cost and psychopathy had a negative impact on cost. Given the substantially higher costs and observed deterioration in outcome among those in assessment compared to those who remain in a high security prison, the additional benefit of assessment is unclear and needs further exploration.

Keywords:

• dangerous severe personality disorder
• costs
• service use

Acknowledgements

This study was supported by a grant from the Home Office and Department of Health, but was carried out independently and does not represent the views of either of these bodies. We thank the staff of the pilot sites for their cooperation, the DSPD Programme of the Home Office for facilitating this study, and Sandra O'Sullivan for acting as study coordinator. We are also grateful to the very useful comments of two anonymous reviewers.