Patients' characteristics, outcome and cost-benefit of hospital-based treatment for patients with personality disorder: a comparison of three different programmes.

In this study we aimed (a) to ascertain whether a relationship exists between different treatment programmes and settings for personality disorder and patient characteristics; (b) to give an indication of treatment effects in three personality disordered populations admitted to different treatment contexts; and (c) to compare costs in relation to outcomes. We collected and compared three samples from one in-patient site (Cassel in England) and two day hospitals (Halliwick in England and Ulleval in Norway) on a number of demographic, diagnostic and other key clinical variables. Outcome in the areas of symptom severity (Symptom Checklist-90-R) and social adaptation (Social Adjustment Scale) was evaluated by comparing admission with discharge scores. Treatment costs for each sample were also estimated and compared. Significant differences were found on most baseline variables across the three sites. In general with regard to severity of psychopathology, the Halliwick sample was the most disturbed, Ulleval the least, with Cassel somewhat in between. No significant differences in improvement were found among the three sites, but treatment costs were considerably higher at Cassel than in the two day centres. The differences found in the three samples bear no clear relationship to context of treatment. These results suggest that referral of personality disorder for in-patient or day hospital treatment is less influenced by severity of problem than had previously been supposed and may depend more on availability of treatment facility.