A cost and economic evaluation of the Leeds personality disorder managed clinical network—A service and commissioning development initiative

Kane, Eddie; Reeder, Neil; Keane, Kimberley; Prince, Sharon

doi:10.1002/pmh.1329

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…With respect to specialist community 'personality disorder' services, numerous evaluations [47][48][49][50][51][52][53] have highlighted the benefit that these services provide through delivery of holistic support (i.e. psychological, social, occupational interventions) [48,52,54,55], which can improve clinical outcomes and service satisfaction among service users [47,[49][50][51], and reduce further health service use costs [56]. It is important to note, however, that the uptake of specialist community 'personality disorder' services remains limited and highly varied.…”

Section: Holistic Approachesmentioning

confidence: 99%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

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Background There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs. Methods A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data. Results Participants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs. Conclusions Relational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them.

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Section: Holistic Approachesmentioning

confidence: 99%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

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“… 6 Several studies estimated that the cost on mental disorder problem in London was estimated at £ 252 million in 2009, and the mean total mental health service costs per patient per year reached £6823 between 2007 and 2012. 7 8 …”

Section: Introductionmentioning

confidence: 99%

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study

Chen

Wang

et al. 2017

BMJ Open

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ObjectivesTo provide cost burden estimates and long-term trend forecast of mental disorders that need hospitalisations in Shanghai, China.DesignDaily hospital admissions and medical expenditures for mental disorder hospitalisations between 1 January 2011 and 31 December 2015 were used for analysis. Yearly total health expenditures and expenditures per hospital admission for different populations, as well as per-admission-per-year medical costs of each service for mental disorder hospitalisations, were estimated through data from 2015. We also established time series analyses to determine the long-time trend of total direct medical expenditures for mental disorders and forecasted expenditures until 31 December 2030.SettingShanghai, China.ParticipantsDaily hospital admissions for mental disorders of registered residents living in all 16 districts of Shanghai, who participated in workers’ basic medical insurance or the urban residents’ basic medical insurance (n=60 306).ResultsFrom 2011 to 2015, there were increased yearly trends for both hospitalisations (from 10 919 to 14 054) and total costs (from US$23.56 to 42.13 million per year in 2015 currency) in Shanghai. Cost per mental disorder hospitalisation in 2015 averaged US$2998.01. Most direct medical costs were spent on medical supplies. By the end of 2030, the average cost per admission per month for mental disorders was estimated to be US$7394.17 (95% CI US$6782.24 to 8006.10) for mental disorders, and the total health expenditure for mental disorders would reach over US$100.52 million (95% CI US$92.20 to 108.83 million) without additional government interventions.ConclusionsThese findings suggest total health expenditures for mental disorders in Shanghai will be higher in the future. Effective measures should be taken to reduce the rapid growth of the economic burden of mental disorders.

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“…Additionally, we have not analysed any hidden costs, such as the impact of any increased social care spending with these service users now living in community residential settings. Kane et al 31 undertook an economic analysis of the healthrelated costs for the Leeds PD Network, finding that in the short/medium term, the service resulted in significant reductions in health usage (saving £4 740 per year per service user). However, even in this case, he had to input data for the control group based on the results of other previous studies.…”

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confidence: 99%

A preliminary service evaluation of a personality disorder case management service

Graham

Sullivan

Briggs

et al. 2019

Personality & Mental Health

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Aims The aim of this study is to assess the impact of establishing a specialized community personality disorder team on out of area placements, local hospital admissions and out of hours crisis contacts for service users with borderline personality disorder. Method This is a before–after interim evaluation of a new service. We tested, through a paired t‐test, whether the intervention generated statistically significant differences over a range of measures of service usage, including out of area placements, local hospital admissions and out of hours crisis contacts. Data from 12 months after the intervention started were compared with the previous 12 months of routine care, to determine the effect on crisis contacts, days in hospital and those returning from/or sent out of area for care. Finally, we have assessed the likelihood to generate cost savings. Results All service users in out of area placements were repatriated to live in the community locally (100%), and there was a statistically significant decrease in inpatient admissions (80%). This was counterbalanced by a smaller but statistically significant increase in out of hours community crisis contacts (30%), although these reduced over time. Conclusion Reorganizing local care pathways can lead to less out of area placements and less hospital admissions. © 2019 John Wiley & Sons, Ltd.

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A cost and economic evaluation of the Leeds personality disorder managed clinical network—A service and commissioning development initiative

Cited by 5 publications

References 14 publications

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study

A preliminary service evaluation of a personality disorder case management service

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