Lowering the Cost of Psychiatric Care

Abstract

This paper reports a four-year experience and includes follow-up data from the operation of a novel inpatient general hospital unit. The two main features of the unit are: a relatively brief duration of hospitalization; and the employment of nursing staff as therapists in exactly the way residents are usually used. The inpatient stay is considered to be a special opportunity for organizing important changes in the life styles and living arrangements of patients. It is also a time for making careful observations of behaviours and treatment trials. Daily interviews are conducted, including family members and other relevant persons. The nurse-therapists are trained to perform individual and family therapy as well as to organize all the social and environmental contacts. They conduct groups and behaviour therapies and are in charge of the planning for discharge. The patients here differ little from those in other general hospital units and the follow-up data show results to be at least as good as those reported anywhere else. The shortened hospital stay represents a considerable saving, and the use of the nurse-therapist has important implications for economies in the health care system. There are some problems with the role changes required to make this system work but it is felt that the benefits far outweigh the disadvantages.

Cost-effectiveness of community psychiatric nurse or out-patient psychiatrist care of neurotic patients

“…Climent and his colleagues (1978), in a small study of an emergency out-patient service in Colombia, discovered that auxiliary psychiatric nurses were clinically more effective and less expensive than psychiatrists. A limited analysis of the costs of psychiatric nurse therapists in Canada also indicated that the margin of advantage accrued to nursing (Smith, 1972). In Britain, Ginsberg & Marks (1977), in an uncontrolled study of nurse behaviour therapists, found that patients made fewer claims on health care resources and on the worktime of their relatives in the year after therapy than in the year before.…”