Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-28T08:14:03.941Z Has data issue: false hasContentIssue false

Service use and Costs of Home-Based Versus Hospital-Based Care for People with Serious Mental Illness

Published online by Cambridge University Press:  02 January 2018

M. Knapp*
Affiliation:
Personal Social Services Research Unit, University of Kent at Canterbury, and Centre for the Economics of Mental Health, Institute of Psychiatry, London
J. Beecham
Affiliation:
Personal Social Services Research Unit, University of Kent at Canterbury, and Centre for the Economics of Mental Health, Institute of Psychiatry, London
V. Koutsogeorgopoulou
Affiliation:
Personal Social Services Research Unit, University of Kent
A. Hallam
Affiliation:
Personal Social Services Research Unit, University of Kent
A. Fenyo
Affiliation:
Personal Social Services Research Unit, University of Kent
I. M. Marks
Affiliation:
Institute of Psychiatry, London
J. Connolly
Affiliation:
Maudsley Hospital, London
B. Audini
Affiliation:
Research Unit, Royal College of Psychiatrists, London
M. Muijen
Affiliation:
Sainsbury Centre for Mental Health, Borough High Street, London
*
Professor M. Knapp, Personal Social Services Research Unit, Cornwallis Building, The University, Canterbury, Kent CT2 7NF

Abstract

Background.

The Daily Living Programme (DLP) offered problem-oriented, home-based care for people aged 17–64 with severe mental illness facing emergency admission to the Bethlem–Maudsley Hospital. The multidisciplinary DLP team acted as direct provider and link with other services. Each patient had a key worker. Cost-effectiveness was assessed.

Method.

The comprehensive costs of DLP and standard in-patient care were compared within a randomised controlled trial. Cost measures ranged over all service inputs and living expenses. The costs of informal care and lost employment were also considered. Assessments of service use, costs and outcomes were conducted at referral, 4, 11 and 20 months.

Results.

The DLP was significantly less costly than standard treatment in both short and medium term (P = 0.000). Cost savings accrued almost exclusively to the NHS, with no other agency's costs being higher.

Conclusions.

Coupled with mildly encouraging outcome results over the 20 month period, the DLP was clearly cost-effective in this medium term.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1994 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Attkison, C. C. & Zwick, R. (1985) The Client Satisfaction Questionnaire: psychometric properties and correlation with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5, 233237.CrossRefGoogle Scholar
Beecham, J. & Knapp, M. R. J. (1992) Costing psychiatric options. In Measuring Mental Health Needs (eds Thornicroft, G., Brewin, C. & Wing, J.). Oxford: Oxford University Press.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766771.Google Scholar
Hoult, J., Reynolds, I., Charbonneau-Powis, M., et al (1983) Psychiatric hospital versus community treatment: a randomised trial. Australia and New Zealand Journal of Psychiatry, 17, 160167.Google Scholar
Knapp, M. R. J., (ed.) (1994a) The Economic Evaluation of Mental Health Services. Aldershot: Ashgate.Google Scholar
Knapp, M. R. J., (ed.) (1994b) Community mental health services: towards an understanding of cost-effectiveness. In Evaluation of Community Psychiatric Services (eds Creed, F. & Tyrer, P.). Cambridge: Cambridge University Press.Google Scholar
Knapp, M. R. J. & Beecham, J. (1990) Costing mental health service. Psychological Medicine, 20, 893908.CrossRefGoogle Scholar
Knapp, M. R. J., Beecham, J., Hallam, A., et al (1993) The costs of community care for former long-stay psychiatric hospital residents. Health and Social Care in the Community, 1, 193201.CrossRefGoogle Scholar
Knapp, M. R. J., Cambridge, P., Thomason, C., et al (1992) Care in the Community: Challenge and Demonstration. Aldershot: Ashgate.Google Scholar
Larsen, D. H., Attkison, C. C., Hargreaves, W. A., et al (1979) Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning, 2, 197207.Google Scholar
Lemmens, F. & Donker, M. (1990) Kwaliteitsbeoordeling door clienten. Utrecht: Nederlands Centrum Geestelijke Volksgezondheid.Google Scholar
Lukoff, D., Liberman, R. P. & Neuchterlein, K. H. (1986) Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578602.Google Scholar
McGuire, A., Henderson, J. & Mooney, G. (1988) The Economics of Health Care. London: Routledge & Kegan Paul.Google Scholar
Marks, I. M. (1994) Synopsis of the Daily Living Programme (DLP) for the seriously mentally ill: a controlled comparison of home- v. hospital-based care. In Evaluation of Community Psychiatric Services (eds Creed, F. & Tyrer, P.). Cambridge: Cambridge University Press (in press).Google Scholar
Muijen, M., Marks, I. M., Connolly, J., et al (1992a) The Daily Living Programme: preliminary comparison of community v. hospital-based treatment for the seriously mentally ill facing emergency admission. British Journal of Psychiatry, 160, 379384.Google Scholar
Muijen, M., Marks, I. M., Connolly, J., et al (1992b) Home-based care vs standard hospital-based care for the severely mentally ill: short-term outcome. British Medical Journal, 304, 749754.CrossRefGoogle Scholar
Netten, A. (1993) Costing informal care. In Costing Community Care: Theory and Practice (eds Netten, A. & Beecham, J). Aldershot: Ashgate.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family of psychiatric patients. British Journal of Psychiatry, 12, 651658.Google Scholar
Stein, L. I. & Test, M. (1980) Alternative to mental hospital treatment: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392397.CrossRefGoogle ScholarPubMed
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative to mental hospital treatment: economic benefit-cost analysis. Archives of General Psychiatry, 37, 400405.Google Scholar
Weissman, M. M., Paykel, E. S., Siegel, R., et al (1971) The social role performance of depressed women: comparisons with a normal group. American Journal of Orthopsychiatry, 41, 390405.CrossRefGoogle ScholarPubMed
Weissman, M. M., Klerman, G. L., Paykel, E. S., et al (1974) Treatment effects on the social adjustment of depressed patients. Archives of General Psychiatry, 30, 771778.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.