Payment by results in forensic mental health

Abstract

Forensic mental health services are low-volume, high-cost services. Payment by results (PbR) is the UK s latest attempt to improve efficiency and controls pending behaviours within the secure services. This article discusses the utility of the PbR mechanic in forensic mental health. It explores PbR implementation in non-forensic mental health settings, similar funding processes internationally, and early PbR implementation work in the UK's secure services. Finally, the article discusses the challenges faced when implementing PbR in forensic mental health services and puts forward possible next steps in determining the utility of PbR in forensic mental health.

Models of care in forensic psychiatry

“…Routine outcome measures can be considered under four headings: forensic recovery, symptomatic recovery, functional recovery and personal recovery (Kennedy 2019a) (Box 6 and supplementary Table 3). These are broadly comparable to clinician-reported outcome measures, patient-reported outcome measures and patient-reported experience measures (Gibbons 2015).…”

“…Routine (Gibbons 2015). Forensic recovery can be measured in milestones concerning increasing autonomy, independence and responsibility.…”

“…Lists of principles are seldom difficult to agree on, although the ordering and prioritising of principles can be very difficult. Good ideas are never good enough – evidence for effectiveness must be shown and weighed against unintended consequences (Duggan 2011; Gibbons 2015) or banishment pressure, the exclusion of difficult patients who do not fit a theory or model of care (Gunn 1977). Goals are therefore the most useful starting point for a model of care (Box 1).…”

“…It follows that when planning a model of care, the ability to admit numbers of this order is essential, it must be sustainable over time and should include surge capacity. Modelling future needs should take account of annual admission rates and case mix (need for therapeutic security) and likely length of stay in half-lives and the effects of alternatives such as community treatment orders (Davoren 2015a; Gibbons 2015).…”

Predicting discharge from long-term forensic treatment: patients characteristics, protective factors, needs and treatment-related factors study in the Czechia

“…There is evidence that an inadequate level of security is applied to a large proportion of patients in some service systems (Flynn, 2011;Hare Duke, 2018;Harty, 2004). Furthermore, long-term hospitalization raises resource issues (Gibbons, 2015), and a shortening is welcomed in every system as long as the danger to the public is sufficiently reduced (van Lier, 2018).…”