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Aims and methods: To show that long-term psychoanalytic psychotherapy can offset costs of psychiatric care when offered to a patient affected by borderline personality disorder with a severe presentation and co-morbid psychopathologies. Costs of mental health services were calculated for a nine-year period. Cost offset was calculated comparing the five years preceding therapy with the four years during and post-therapy. Results: In this case study the provision of long-term psychoanalytic psychotherapy has consistently and progressively reduced use of mental health services and related costs during the intervention and post-intervention period. Significant reduction in use of services and savings of approximately £5000 were obtained for the post-intervention year. Limitations: The research findings are limited by the lack of control conditions over confounding factors. Besides, cost-effectiveness could not be established. Clinical implications: Long-term psychoanalytic psychotherapy is rarely available in the modern National Health Service (NHS) and is unlikely to be offered to patients with severe character pathology. Although specialist tertiary services have been created to cater for this group, patients who cannot engage with these services risk not to be adequately treated. This case study suggests that long-term psychoanalytic psychotherapy could be used as a viable and cost-saving alternative for some of these patients.