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Utilisation and costs of community mental health services

PRiSM Psychosis Study 5

Published online by Cambridge University Press:  02 January 2018

Paul McCrone*
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Graham Thornicroft
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Michael Phelan
Affiliation:
Charing Cross Hospital, London
Frank Holloway
Affiliation:
Maudsley Hospital, London
Til Wykes
Affiliation:
Department of Psychology, Institute of Psychiatry, London
Sonia Johnson
Affiliation:
Department of Psychiatry and Behavioural Sciences, University College London Medical School, London
*
Paul McCrone, Section of Community Psychiatry (PRiSM), Institute of Psychiatry. De Crespigny Park, London SE5 8AF. Fax: 0171-277 1462; e-mail: spjupmc@iop.bpmf.ac.uk

Abstract

Background

The costs and the effectiveness of mental health services need to be evaluated if provision is to be efficient. Service use and costs are described for two geographical areas in south London.

Method

Service use was measured comprehensively for clients in both sectors for two six-month time periods using the Client Service Receipt Interview This information was combined with unit costs to calculate service costs. The ‘hidden’ costs of informal care and unsupported accommodation were also calculated.

Results

At baseline significantly more intensive sector clients had in-patient stays but by the follow-up this difference had disappeared. There was significantly more use of supported accommodation in the intensive sector during both time periods. Baseline and follow-up total service costs were significantly higher for the intensive sector. Costs were spread disproportionately and a small number of services accounted for a large proportion of cost.

Conclusions

While the cost at Time 2 was significantly greater in the intensive sector, this was largely due to the high use of supported accommodation. There was some convergence in cost between the sectors over time.

Type
PRiSM Psychosis Study
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Aitchison, K. J. & Kerwin, R. W. (1997) Cost-effectiveness of clozapine. A UK clinic-based study. British Journal of Psychiatry, 171, 125130.CrossRefGoogle ScholarPubMed
Becker, T., Holloway, F., McCrone, P., et al (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study 2. British Journal of Psychiatry, 173, 371375.CrossRefGoogle ScholarPubMed
Beecham, J. & Knapp, M. (1992) Costing psychiatric interventions. In Measuring Mental Health Needs (eds Thornicroft, G., Brewin, C. & Wing, J., pp. 163183. London: Gaskell.Google Scholar
Casper, E. S. & Pastva, G. (1990) Admission histories, patterns, and subgroups of the heavy users of a state psychiatric hospital. Psychiatric Quarterly, 61, 121134.CrossRefGoogle ScholarPubMed
Department of Health (1991) The Health of the Nation. London: HMSO.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, I. 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
Giel, R. & Ten Horn, G. H. M. M. (1982) Patterns of mental health care in a Dutch register area. Social Psychiatry, 17, 117123.CrossRefGoogle Scholar
Hadley, T. R., McGurrin, M. C., Pulice, R. T., et al (1990) Using fiscal data to identify heavy service users. Psychiatric Quarterly, 61, 4148.CrossRefGoogle ScholarPubMed
Hansson, L. & Sandlund, M. (1992) Utilization and patterns of care in comprehensive psychiatric care organisations. A review of studies and some methodological considerations. Acta Psychiatrica Scandinavica, 86, 255261.CrossRefGoogle ScholarPubMed
Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal, 286, 17051709.CrossRefGoogle ScholarPubMed
Jefferson, T., Mugford, M., Gray, A., et al (1996) An exercise on the feasibility of carrying out secondary economic analyses. Health Economics, 5, 155165.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Knapp, M. & Beecham, J. (1990) Costing mental health services. Psychological Medicine, 20, 893908.CrossRefGoogle ScholarPubMed
Knapp, M. & Beecham, J. Anderson, J., et al (1990) The TAPS Project. III: Predicting the community costs of closing psychiatric hospitals. British Journal of Psychiatry, 157, 661670.CrossRefGoogle Scholar
Knapp, M. & Beecham, J. (1993) Reduced list costings: examination of an informed short cut in mental health research. Health Economics, 2, 313322.CrossRefGoogle ScholarPubMed
Knapp, M. & Beecham, J. Koutsogeorgopoulou, 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.CrossRefGoogle ScholarPubMed
Lavik, N. J. (1983) Utilization of mental health services over a given period. Acta Psychiatrica Scandinavica, 67, 404413.CrossRefGoogle Scholar
Leese, M., Johnson, S., Slade, M., et al (1998) User perspective on needs and satisfaction with mental health services. PRiSM Psychosis Study 8. British Journal of Psychiatry, 173, 409415.CrossRefGoogle ScholarPubMed
McCrone, P., Beecham, J. & Knapp, M. (1994) Community psychiatric nurse teams: cost-effectiveness of intensive support versus generic care. British Journal of Psychiatry, 165, 218221.CrossRefGoogle ScholarPubMed
McGuffin, P., Farmer, A. & Harvey, I. (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry, 48, 764770.CrossRefGoogle ScholarPubMed
Netten, A. (1994) Unit Costs of Community Care. Canterbury: Personal Social Services Research Unit.Google Scholar
Office of Population Censuses and Surveys (1995) National Psychiatric Morbidity Survey. London: HMSO.Google Scholar
Saarento, O., Öiesvoid, T., Göstas, G., et al (1995) The Nordic comparative study on sectorized psychiatry. II. Resources of the psychiatric services and treated incidence. Acta Psychiatrica Scandinavica, 92, 202207.CrossRefGoogle ScholarPubMed
Saarento, O., Öiesvoid, T., Göstas, G., et al (1996a) The Nordic comparative study on sectorized psychiatry. III. Accessibility of psychiatric services, degree of urbanization and treated incidence. Social Psychiatry and Psychiatric Epidemiology, 31, 259265.CrossRefGoogle ScholarPubMed
Saarento, O., Hansson, L., Sandlund, M., et al (1996b) The Nordic comparative study on sectorized psychiatry. Utilisation of psychiatric hospital care related to amount and allocation of resources to psychiatric services. Sociol Psychiatry and Psychiatric Epidemiology, 31, 327335.CrossRefGoogle ScholarPubMed
Salize, H. J. & Rossler, W. (1996) The cost of comprehensive care of people with schizophrenia living in the community: A cost evaluation from a German catchment area. British Journal of Psychiatry, 169, 4248.CrossRefGoogle ScholarPubMed
Simes, R. J. (1986) An improved Bonferroni procedure for multiple tests of significance. Biometrika, 73, 751754.CrossRefGoogle Scholar
Sytema, S., Balestrieri, M., Giel, R., et al (1989) Use of mental health services in south Verona and Groningen. Acta Psychiatrica Scandinavica, 79, 153162.CrossRefGoogle ScholarPubMed
Tansella, M., Micciolo, R., Balestrieri, M., et al (1986) High and long-term users of mental health services. Social Psychiatry, 21, 96103.CrossRefGoogle ScholarPubMed
Ten Horn, G. H. M. M., Moschel, G., Giel, R., et al (1988) Patterns of mental health care in two European areas: Mannheim, Federal Republic of Germany; and Groningen, The Netherlands. Acta Psychiatrica Scandinavica, 77, 271279.CrossRefGoogle ScholarPubMed
Thornicroft, G., Strathdee, G. & Johnson, S. (1995) The case for catchment areas for mental health services. Psychiatric Bulletin, 19, 343345.CrossRefGoogle Scholar
Thornicroft, G., Strathdee, G., Phelan, M., et al (1998) Rationale and design. PRiSM Psychosis Study I. British Journal of Psychiatry, 173, 363370.CrossRefGoogle ScholarPubMed
Wing, J. (1989) Health Service Planning and Research. Contributions from Psychiatric Case Registers. London: Gaskell.Google Scholar
World Health Organization (1992) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Geneva: WHO, Division of Mental Health.Google Scholar
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