Twelve years on: Service use and costs for people with mental health problems who left psychiatric hospital

Abstract

Background: Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. Aims: To assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and people's characteristics, needs and outcomes. Method: Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative. For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Results: Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (£555 per week) are lower than long-stay hospital residence or community costs 1 year later. Conclusions: High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents' increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs. Declaration of interest: The Department of Health funded the research.

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

“…2004). Twelve years after people left hospital, 128 of the original study group of 130 were traced and interviewed: 39% were living in residential or nursing homes, 17% in less intensively staffed group homes or small hostels, 34% in settings with minimum formal support, and the remaining 9% were permanently resident in psychiatric wards (Beecham et al. 2004).…”

Health economic evaluation of community-based psychiatric interventions

“…Eine weitere, ebenfalls in England durchgeführte Enthospitalisierungsstudie zeigte für 128 Patienten im Langzeitverlauf von 12 Jahren im Vergleich zur stationären Unterbringung signifikant niedrigere Kosten einer gemeindepsychiatrischen Versorgung [2,18]. Die Autoren weisen allerdings darauf hin, dass es sich bei der untersuchten Patientengruppe um die eher weniger beeinträchtigte erste Entlasskohorte stationärer Langzeitpatienten ("early movers") handelte und dass die für diese Gruppe ermittelten Kosten deshalb die tatsächlichen Kosten für eine gemeindepsychiatrische Versorgung aller stationären Langzeitpatienten unterschätzen [2].…”

“…Die Autoren weisen allerdings darauf hin, dass es sich bei der untersuchten Patientengruppe um die eher weniger beeinträchtigte erste Entlasskohorte stationärer Langzeitpatienten ("early movers") handelte und dass die für diese Gruppe ermittelten Kosten deshalb die tatsächlichen Kosten für eine gemeindepsychiatrische Versorgung aller stationären Langzeitpatienten unterschätzen [2].…”

Política de Saúde Mental no Brasil: evolução do gasto federal entre 2001 e 2009

“…In the mental health fi eld, when effectiveness is mentioned, it means, generally speaking, and despite some inconsistencies, a specifi c measure of wellbeing related to mental health. Longitudinal studies in Europe 2,6 with people that left psychiatric hospitals and were included in community-based services agree that community-based care has a better cost-effectiveness relation than hospital care for the majority of people, in spite of the fact that the absolute cost of hospital care and of community care are similar. The evidences are strong, mainly in high income countries, but also in low and middle income ones, that a range of interventions in primary care performed in the community is effective both in maintaining people with mental disorders in the society and in social reinsertion.…”

“…European researchers 2,4,6,7 point to a better cost-effectiveness relationship of community-based care compared to hospital care.…”