Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-17T22:00:56.989Z Has data issue: false hasContentIssue false

Home-based versus hospital-based care for serious mental illness

Controlled cost-effectiveness study over four years

Published online by Cambridge University Press:  03 January 2018

Martin R. J. Knapp*
Affiliation:
Institute of Psychiatry, and London School of Economics
Isaac M. Marks
Affiliation:
Institute of Psychiatry and Bethlem – Maudsley Hospital
Jane Wolstenholme
Affiliation:
University of Nottingham
Jennifer K. Beecham
Affiliation:
Institute of Psychiatry
Jack Astin
Affiliation:
Institute of Psychiatry
Bernard Audini
Affiliation:
Royal College of Psychiatrists
Joseph Connolly
Affiliation:
Formerly Bethlem – Maudsley Hospital
Vik Watts
Affiliation:
Enfield Community Care Trust
*
Professor Martin Knapp, Centre for the Economics of Mental Health, Institute of Psychiatry, 7 Windsor Walk, Denmark Hill, London SE5 8BB, UK

Abstract

Background

The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.

Method

A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).

Results

The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.

Conclusions

The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.

Type
Papers
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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

Atkinon, 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.Google Scholar
Audlni, B. Marks, I. M. Lawrence, R. E. et al (1994) Home-based versus out-patient/in-patient care for people with serious mental illness. British Journal of Psychiatry, 165, 204210.Google Scholar
Beecham, J. K. (1995) Collecting and estimating costs. In The Economic Evaluation of Mental Health Care (ed. M. R. J. Knapp), pp. 6182, Aldershot: Arena.Google Scholar
Beecham, J. K. & Knapp, M. R. J. (1992) Costing psychiatric options. In Measuring Mental Health Needs (eds G. Thornicroft, C. Brewin & J. Wing), pp. 170190, Oxford: Oxford University Press.Google Scholar
Bond, G. R. McGrew, J. H. & Fekete, D. M. (1995) Assertive outreach for frequent users of psychiatric hospital; a meta-analysis. Journal of Mental Health Administration, 22, 416.Google Scholar
Burns, B. J. & Santos, A. B. (1995) Assertive community treatment: an update of randomized trials. Psychiatric Services, 46, 669675.Google Scholar
Connolly, J. Marks, I. M. Lawrence, R. et al (1996) Observations from community care for serious mental illness during a controlled trial. Psychiatric Bulletin, 20, 37.Google Scholar
Deci, A. Santos, A. B. Hiott, W. et al (1995) Dissemination of assertive community treatment programs. Psychiatric Services, 46, 676678.Google Scholar
Dixon, L. B. Krauss, N. Kernan, E. et al (1995) Modifying the PACT model to service homeless persons with severe mental illness. Psychiatric Services, 46, 684688.Google Scholar
Drake, R. E. & Burns, B. J. (1995) Spectral section on assertive community treatment: an introduction. Psychiatric Services, 46, 667668.Google Scholar
Drummond, M. F. O'Brien, B. Stoddart, G. L. et al (1997) Methods for the Economic Evaluation of Health Care Programmes. 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.CrossRefGoogle Scholar
Gray, A. M. Marshall, M. Lockwood, A. et al (1997) Problems in conducting economic evaluations alongside clinical trials: lessons from a study of case management for people with mental disorders. British Journal of Psychiatry, 179, 4752.Google Scholar
Houit, J. Reynolds, I. Charbonneau-Powis, M. et al (1983) Psychiatric hospital versus community treatment: a randomized trial. Australian and New Zealand Journal of Psychiatry, 17, 160167.Google Scholar
Kavanagh, S. & Stewart, A. (1995) Economic evaluations of mental health care: modes and method. In The Economic Evaluation of Mental Health Care (ed. M. R. J. Knapp), pp. 2760. Aldershot: Arena.Google Scholar
Knapp, M. R. J. (ed.) (1995a) The Economic Evaluation of Mental Health Care. Aldershot: Arena.Google Scholar
Knapp, M. R. J. (ed.) (1995b) Letter. British Journal of Psychiatry, 166, 120121.Google Scholar
Knapp, M. R. J. (ed.) (1995c) Community mental health services: towards an understanding of cost-effectiveness. In Collaborative Community Mental Health Care (eds F. Creed & P. Tyrer), pp. 111145. Sevenoaks: Edward Arnold.Google Scholar
Knapp, M. R. J. (ed.), Beecham, J. Koutiogeorgeopoulou, V. et al (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 195203.Google Scholar
Larsen, D. H. Atkinson, 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 cienten, Utrecht: Netherlands Centrum Geestelijke Volksgezondheid.Google Scholar
Lukoff, D. Libarman, R. P. & Neuchterlein, K. H. (1986) Symptom monitoring in the rehabilitation of schizophrenic patients. Schizophrenia Bulletin, 12, 578602.Google Scholar
McCrone, P. & Thornicroft, G. (1997) Reading about health economics. British Journal of Psychiatry, 171, 191193.Google Scholar
Marks, I. M. (1995) Synopsis of the Daily Living Programme for the seriously mentally ill: a controlled comparison of home and hospital based care. In Community Psychiatry in Action: Analysis and Prospects (eds F. Creed & P. Tyrer). pp. 2944. Sevenoaks: Edward Arnold.Google Scholar
Marks, I. M. Connolly, J. Muijen, M. et al (1994) Home-based versus in-/out-patient care for serious mental illness: a controlled study. British Journal of Psychiatry, 157, 661670.Google Scholar
Mechanic, D. (1996) Emerging issues in international mental health services research. Psychiatric Services, 47, 371375.Google Scholar
Netten, A. (1993) Costing informal care. In Costing Community Care: Theory and Practice (eds A. Netten & J. Beecham), pp. 4357. 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
Scott, J. E. & Dixon, L. B. (1996) Assertive community treatment and case management of schizophrenia. Schizophrenia Bulletin, 21, 657668.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
Teague, G. B. Drake, R. E. & Ackerson, T. H. (1995) Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services, 46, 689695.Google Scholar
Test, M. A. Knoedler, W. H. Allness, D. J. et al (1991) Long-term community care through an assertive continuous treatment team. Advances in Neuropsychiatry, 1, 239246.Google Scholar
Weistman, 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.Google Scholar
Wing, J. K. Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego System. Cambridge: Cambridge University Press.Google Scholar
Wolff, N. Helminiak, T. W. & Diamond, R. J. (1995) Estimated societal costs of assertive community mental health care. Psychiatric Services, 46, 898906.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.