The mental health residential care study: Predicting costs from resident characteristics

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

doi:10.1192/bjp.170.1.37

Cited by 39 publications

(31 citation statements)

References 14 publications

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“…As noted earlier, it is important to compare like with like; if the costs cover a similar scope, are the patient groups similar? Thus, to address Question B, a series of multiple regression analyses were estimated (Chisholm et al. 1997b).…”

Section: Resultsmentioning

confidence: 99%

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience

Knapp¹,

Beecham²,

McDaid³

et al. 2010

Health &Amp; Social Care in the Community

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What is known about this topic Understanding the economic consequences of deinstitutionalisation is fundamentally important. What this paper adds dThe evidence base on the economics of deinstitutionalisation is modest and uneven across countries. There are strong economic arguments for closing psychiatric hospitals in favour of community-based arrangements, but rebalancing care will not generate great savings. There are also many challenges. Decision-makers should plan a dynamic community-based system to match the needs of people moving from institutions, and must take the long view. AbstractMany European mental health systems are undergoing change as community-centred care replaces large-scale institutions. We review empirical evidence from three countries (UK, Germany, Italy) that have made good progress with this rebalancing of care. We focus particularly on the economic consequences of deinstitutionalisation. A systematic literature review was conducted using a broad search strategy in accordance with established guidelines. We searched the International Bibliography of the Social Sciences, Health Management Information Consortium, British Nursing Index and PUBMED ⁄ Medline to 2008. The on-line search was supplemented by advice and assistance from contacts with government departments, European Commission, professional networks and known local experts. Community-based models of care are not inherently more costly than institutions, once account is taken of individuals' needs and the quality of care. New community-based care arrangements could be more expensive than long-stay hospital care but may still be seen as more cost-effective because, when properly set up and managed, they deliver better outcomes. Understanding the economic consequences of deinstitutionalisation is fundamental to success. Local stakeholders and budget controllers need to be aware of the underlying policy and operational plan. Joint planning and commissioning or devolving certain powers and responsibilities to care managers may aid development of effective and cost-effective care. People's needs, preferences and circumstances vary, and so their service requirements and support costs also vary, opening up the possibility for purposive targeting of services on needs to improve the ability of a care system to improve well-being from constrained resources. As the institutional ⁄ community balance shifts, strategic planning should also ensure that the new care arrangements address the specific contexts of different patient groups. Decision-makers have to plan a dynamic communitybased system to match the needs of people moving from institutions, and must take the long view.

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Section: Resultsmentioning

confidence: 99%

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience

Knapp¹,

Beecham²,

McDaid³

et al. 2010

Health &Amp; Social Care in the Community

View full text Add to dashboard Cite

show abstract

“…A cost function analysis explored the impact of baseline factors on cost (Knapp, 1998). A limited set of baseline factors (referring agency, age, gender, ethnic group, living situation, comorbidity at entry, HoNOSCA score at entry, level of need at entry, sexualised behaviours at entry, difficult family relationships at entry) were pre‐selected from previous evidence (Byford et al., 2001; Byford, Barber, & Harrington, 2002; Chisholm et al., 1997; McCrone et al., 1998) and clinical experience. Univariate and multiple regression explored associations between the pre‐specified baseline variables and total cost using the same methodology as outlined above for outcomes.…”

Section: Methodsmentioning

confidence: 99%

Children with Complex Mental Health Problems: Needs, Costs and Predictors over One Year

Clark¹,

O’Malley²,

Woodham³

et al. 2005

Child Adoles Ment Health

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Background: Little is known regarding children of greatest concern with complex mental health problems. Method: A one‐year prospective study of psychiatric diagnosis, psychosocial functioning, need status and service receipt in 60 children identified as most concerning. Results: Thirty‐two (53%) had two or more disorders. The mean number of needs per child was five. One year later mean needs were unchanged but with considerable individual variation. Mean weekly costs were £1017 (€1627) (SD = £957 (€1531)). Higher costs related to social factors rather than diagnosis or need. Conclusions: The mean annual cost of services to children with complex mental health problems is ten times that in other studies of children with mental health problems.

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“…Other variables reflecting, for example, socioeconomic background or support from family and friends may help explain more of this variation. However, a low R 2 with patient level cost data is not unusual in similar populations 14,15 and does not invalidate the results. The fact that the model passed the RESET test means that the inference of a trend towards reduced costs was correct and that the model used was appropriate.…”

Section: Total Costmentioning

confidence: 93%

Economic impact of a specialist outreach team in residential and nursing home settings

Richardson

Davies

South

et al. 2000

J Ment Health Policy Econ

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Background: The results of a randomized controlled trial have indicated that a training and educational programme for staff in nursing or residential homes may result in reductions in levels of depression and levels of cognitive impairment for residents presenting with an active management problem. The training and educational intervention consisted of members of a hospital outreach team who presented a series of 1 hour seminars on topics which staff had indicated would improve their knowledge and skills. Aims of the study: The aim of this study was to present an exploratory analysis of the impact on costs associated with providing an old age psychiatry outreach team giving training and education for staff in nursing and residential homes. Method: For the economic study, a societal perspective was employed. Measures of resource use and costs to the health service, social and community services and the nursing and residential homes were analysed for 120 residents from 12 nursing or residential homes, as part of a randomized controlled trial to assess a training package provided in residential and nursing homes. Cost estimates were based on estimates from generalized estimated equations. To allow for clustering effects within homes, the unit of randomization was the home as opposed to the individual. To ensure models were correctly specified, several tests including the Ramsey RESET test were employed. Results: There were no significant differences in the total cost per person in the homes that received the intervention and the control homes. This study has shown that the additional cost of providing the specialist outreach team was likely to be covered by reductions in the use of other resources such as GP visits to nursing and residential homes. Therefore, though the study had limitations, it appeared that improved care could be provided at little or no extra cost. Implications for Health Care Provision and Use: The evidence presented suggests that the specialist outreach team was unlikely to add to the total cost of caring for residents in nursing and residential homes. This finding combined with the benefits in terms of lower levels of depression and cognitive impairment suggested that the intervention was good value for money. The intervention should be considered for use in other nursing and residential homes.

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The mental health residential care study: Predicting costs from resident characteristics

Abstract: The associations uncovered by these analyses can inform commissioners' planning and purchasing activities, at both the macro and micro levels, by revealing those resident needs and circumstances that are associated with higher costs.

Cited by 39 publications

References 14 publications

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience

Children with Complex Mental Health Problems: Needs, Costs and Predictors over One Year

Economic impact of a specialist outreach team in residential and nursing home settings

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