OBJECTIVES

: Prison and forensic health has lagged behind the National Health Service both in terms of investment, innovation and in application of economic evaluation methodologies. Over the last 20 years significant investment has been made by the Ministry of Justice to manage and treat offenders with personality disorders, the latest of which is the Offender Personality Disorder (OPD) pathway. This pathway provides enhanced monitoring of offenders who are either diagnosed as having personality disorders (PD) or show traits of PD, tailoring their supervision to these traits to provide a more nuanced level of supervision. In addition, the pathway contains high intensity residential treatment programmes in prisons around the country, that offenders can be streamed into for treatments lasting up to 5 years.

This study aimed to use state-of-the-art-health economic techniques to evaluate whether the OPD pathway was cost-effective.

METHODS

: This model was built using offender level datasets provided by Her Majesty’s Prison and Probation Service (HMPPS) in tandem with discrete event simulation modelling methods to estimate the projected short-, medium- and long-term costs and outcomes of behaviour change programmes at both a service and societal level.

RESULTS

: The model simulates 20,000 offenders over 20 years. The model shows costs and areas of potential cost savings from implementing an enhanced supervision pathway for offenders with PD traits. However, due to data problems, these results are not complete and significant outcomes are missing from the analysis. Therefore, scenario and break-even analyses were done to gives estimates of the required level of improvement in behaviour dimensions.

CONCLUSIONS

: Health economic concepts, discrete event simulation and use of large datasets have a lot to offer the prison and probation service to support decision making. Before this can be fully implemented, data quality and completeness of data needs to be addressed.