The assessment of dangerous and severe personality disorder: Service use, cost, and consequences
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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 pound 3,500 more on average than those in the control prisons over six months ( pound 25,150 vs. pound 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.