Cost implications of treatment non‐completion in a forensic personality disorder service

Abstract

BackgroundA high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive treatment at all.AimsIn this study, we sought to determine the economic consequences of non-completion of treatment, using case study data from a secure hospital sample. Both health and criminal justice service perspectives were taken into account.MethodsData were collected from a medium secure hospital personality disorder unit. A probabilistic decision-analytic model was constructed, using a Markov cohort simulation with 10,000 iterations. The expected cost differential between those who do and those who do not complete treatment was estimated, as was the probability of a cost differential over a 10-year post-admission time horizon.ResultsOn average, in the first 10 years following admission, those who do not complete treatment go on to incur £52,000 more in costs to the National Health Service and criminal justice system than those who complete treatment. The model estimates that the probability that non-completers incur greater costs than completers is 78%.ConclusionIt is possible that an improvement in treatment completion rates in secure hospital personality disorder units would lead to some cost savings. This might be achievable through better selection into treatment or improved strategies for engagement and retention. Our study highlights a financial cost to society of individuals discharged from secure hospital care when incompletely treated. We suggest that it could, therefore, be useful for secure hospitals to introduce routine monitoring of treatment completion. © 2013 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons, Ltd.

Mental health services costs within the Alberta criminal justice system

“…The length of sentences does not leave sufficient time for psychiatric treatment within the criminal justice system. This is a consideration that has been raised in other jurisdictions (Sampson, James, Huband, Geelan, & McMurran, 2013).…”

Readiness Enhancement Management Strategies (REMS): a proof of concept and evaluation feasibility study of staff training to improve service engagement by people with personality difficulties

“…, Webb & McMurran ) and increased service costs (Sampson et al . ). This information was the catalyst for developing this training programme to improve engagement and prevent non‐completion.…”

“…A recent study calculated that offenders admitted to a medium secure hospital who did not complete treatment incurred greater costs in the 10 years after discharge than those who completed treatment, a cost accounted for by greater use of expensive inpatient services and less successful community reintegration (Sampson et al . ).…”

Support for the predictive validity of the multifactor offender readiness model (MORM): forensic patients' readiness and engagement with therapeutic groups

“…Readiness may be defined as the presence or absence of various responsivity factors in the person and/or the therapeutic contexts that promote therapeutic engagement (Ward et al, ). Its accurate assessment would have the added advantage of reducing costs associated with treatment non‐engagement (Langevin, ; McMurran and Theodosi, ; Sampson et al, ).…”