The cost consequences of changing the hospital–community balance: the mental health residential care study

Knapp, Martín; Chisholm, Daniel; Astin, Jack; Lelliott, Paul; Audini, Bernard

doi:10.1017/s0033291796004667

Cited by 65 publications

(51 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The main proposal is the strengthening of the community psychiatric service system, particularly through the commitment of adequate financial and human resources. Corroborative research evidence has shown that community care has a better outcome for patient recovery 6 , and is also more cost effective 14 , given the existence of support structures. It also has the potential for promoting human rights of users in a manner not possible within institutional care.…”

Section: Discussionmentioning

confidence: 99%

“…This is in spite of research evidence that suggests that in the medium and long term, the community psychiatric system is more cost effective than institutionalisation in the psychiatric hospitals. 14 There are examples of initiatives with varying degrees of success in LAMICs, where attempts were made to decentralise psychiatric hospitals. Brazil had an effective shift from the psychiatric institutionalisation to the community service system as a result of operational edicts enacted by the Ministry of Health.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Akpalu¹,

Lund²,

Doku³

et al. 2010

Afr. J. Psych

View full text Add to dashboard Cite

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals, researchers, policy makers, politicians, users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0, using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155%. Most respondents were of the view that the state psychiatric hospitals were very congested, substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services, using psychiatric hospitals only as referral facilities, relapse prevention programmes, strengthening psychosocial services, adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Akpalu¹,

Lund²,

Doku³

et al. 2010

Afr. J. Psych

View full text Add to dashboard Cite

show abstract

“…96,99,109,110 The remainder included studies of the potential to locate renal dialysis services in three alternative hospital settings 111 and divert acute psychiatric inpatients to supported hostels. 112 Furthermore, although most studies focused only on downward shifts from supposedly more costly, institutional settings to cheaper, community provision, 91,97,98 a handful considered moves in both directions. 71,113,114 …”

Section: Included/excluded Literaturementioning

confidence: 99%

“…92,95,112,122,123 A further fifth incorporated some of these elements. 71,91,110 The remainder considered only public expenditure which, depending on their foci, covered the costs incurred by health and/or social services.…”

Section: Approaches To Profiling Servicesmentioning

confidence: 99%

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk THE BALANCE OF CARE APPROACH TO HEALTH AND SOCIAL CARE PLANNING Tramarin et al (1997) 97 Tucker et al (2005,2008) 117,118 Wanless et al (2006) 10 Wager (1972) 91 Challis et al (2000) 145 /Challis and Hughes (2002) 104 Kavanagh et al (1993,1995) 122,123 Mooney (1977,1978) 71 86 Opit (1977) 92 Plank (1977) 99 Knapp et al (1997) 112 Avon County Council (1980) 110 Wright et al (1981) 102 Whitfield and Symonds (1976) 109 Williams et al 98 Clarkson et al 96 Bebbington et al (1990) 103 Challis and Shepherd (1983) 106 O'Shea and Corcoran (1989,1990) 113,114 O'Shea and Costello (1991) 95 Audit Inspectorate (1983) 94 Canvin et al (1978) 119 / Boldy et al (1981/ Boldy et al ( , 1982 120,121 Klemperer and McClenahan (1981) 105 [two studies]…”

mentioning

confidence: 99%

See 1 more Smart Citation

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

View full text Add to dashboard Cite

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Cost and Cost-effectiveness of Hospital vs Residential Crisis Care for Patients Who Have Serious Mental Illness

Fenton¹,

Hoch²,

Herrell³

et al. 2002

Arch Gen Psychiatry

View full text Add to dashboard Cite

show abstract

The cost consequences of changing the hospital–community balance: the mental health residential care study

Cited by 65 publications

References 10 publications

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Cost and Cost-effectiveness of Hospital vs Residential Crisis Care for Patients Who Have Serious Mental Illness

Contact Info

Product

Resources

About