Abstract
Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year post-treatment via a prospective survey of the patients, their original referrer and their general practitioner. The average annual cost of psychiatric and prison services (calculated from extra-contractual referrals (ECR) tariffs and Home Office data) was £13 966 pre-treatment compared to £1306 post-treatment, representing a cost-offset of £12 658 per patient per year. The average cost of the specialist admission was £25 641. Thus the cost to the Nation for treating these personality disordered patients in a tertiary treatment resource would be recouped within two years and represent a saving thereafter.
Highlights
Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year posttreatment via a prospective survey of the patients, their original referrer and their general practitioner
Patients suffering with personality disorder place a high demand on health, as well as social a'snudckecdrimIinn'alinjuastirceea,ctivseervaicneds uwnhpircohductetinvde towabye (Perry et al, 1987)
In an earlier study (Menzies et oÃ-1, 993) we showed that a single cohort of 29 personality disordered patients admitted to Henderson Hospital service used a total of £423 115 worth of psychiatric and prison services in the one year prior to their admission
Summary
Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year posttreatment via a prospective survey of the patients, their original referrer and their general practitioner. Many have long histories of repeated contacts with psychia tric, social, forensic, penal and probation services which, because they represent incomplete or inadequate treatments, do not confer lasting benefit; many patients with personality disorders learn new aberrant coping strategies in such settings, including inappropriate depen dence on professional carers Their antisocial and destructive behaviour often leads them to be seen as less deserving of health care service provision. Refusing to fund treatment for such patients is a false economy, even if viewed solely in financial terms, since spontan eous remission of severe personality disorders is uncommon and untreated a patient will continue to remain a burden to professionals In spite of this some purchasing Health Authorities, in apparent ignorance of the existing high costs of treating this group of patients, do not believe that additional financial outlay (in the form of expert, tertiary level, In-patient resources) is costbeneficial. We have had the opportunity to follow that same cohort of patients for one year following their discharge from treatment and have been able to calculate the actual service costs
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