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

1994 ◽  
Vol 165 (2) ◽  
pp. 195-203 ◽  
Author(s):  
M. Knapp ◽  
J. Beecham ◽  
V. Koutsogeorgopoulou ◽  
A. Hallam ◽  
A. Fenyo ◽  
...  
Keyword(s):  
Mental Illness ◽  
Service Use ◽  
Controlled Trial ◽  
Cost Savings ◽  
Emergency Admission ◽  
Cost Effective ◽  
Medium Term ◽  
Home Based ◽  
Randomised Controlled ◽  
Home Based Care

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.

Home-Based Care and Standard Hospital Care for Patients with Severe Mental Illness: A Randomised Controlled Trial

1993 ◽  
Vol 162 (2) ◽  
pp. 239-243 ◽  
Author(s):  
C. J. Simpson ◽  
C. P. Seager ◽  
J. A. Robertson
Keyword(s):  
Mental Illness ◽  
Randomised Controlled Trial ◽  
Home Care ◽  
Daily Living ◽  
Hospital Care ◽  
Controlled Trial ◽  
Home Based ◽  
Randomised Controlled ◽  
Home Based Care ◽  
Hospital Group

ObjectiveTo compare the efficacy of home based care with standard hospital care in treating serious mental illness.DesignRandomised controlled trial.SettingSouth Southwark, London.Patients189 patients aged 18–64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated.Main outcome measuresUse of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff.ResultsHome care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non–significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme.ConclusionsHome based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.

Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness

1994 ◽  
Vol 165 (2) ◽  
pp. 204-210 ◽  
Author(s):  
B. Audini ◽  
I. M. Marks ◽  
R. E. Lawrence ◽  
J. Connolly ◽  
V. Watts
Keyword(s):  
Phase I ◽  
Patient Care ◽  
Phase Ii ◽  
Emergency Admission ◽  
Care Quality ◽  
Patient Admissions ◽  
Seriously Mentally Ill ◽  
Home Based ◽  
Randomised Controlled ◽  
Home Based Care

Background.The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.Method.Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.Results.The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.Conclusions.The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.

Home-Based Versus Hospital-Based Care for People with Serious Mental Illness

1994 ◽  
Vol 165 (2) ◽  
pp. 179-194 ◽  
Author(s):  
I. M. Marks ◽  
J. Connolly ◽  
M. Muijen ◽  
B. Audini ◽  
G. McNamee ◽  
...  
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Social Adjustment ◽  
Daily Living ◽  
Emergency Admission ◽  
Controlled Study ◽  
Patient Admissions ◽  
Home Based ◽  
Home Based Care

Background.A controlled study tested whether the superior outcome of community care for serious mental illness (SMI) in Madison and in Sydney would also be found in inner London.Method.Patients from an inner London catchment area who faced emergency admission for SMI (many were violent or suicidal) were randomised to 20 months or more of either home-based care (Daily Living Programme, DLP; n = 92), or standard in-patient and later out-patient care (controls, n = 97). Most DLP patients had brief in-patient stays at some time. Measures included number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.Results.Outcome was superior with home-based care. Until month 20, DLP care improved symptoms and social adjustment slightly more, and enhanced patients' and relatives' satisfaction. From 3 to 18 months DLP care greatly reduced the number of in-patient bed days as long as the DLP team was responsible for any in-patient phase its patients had. Cost was less. DLP care did not reduce the number of admissions, nor of deaths from self-harm (3 DLP, 2 control). One DLP patient killed a child. Even at 20 months many DLP and control patients still had severe symptoms, poor social adjustment, no job, and need for assertive follow-up and heavy staff input. (Beyond 20 months most gains were lost apart from satisfaction.)Conclusions.It is unclear how much the gain until 20 months from home-based care was due to its site of care, its being problem-centred, its teaching of daily living skills, its assertive follow-up, the home care team's keeping responsibility for any in-patient phase, its coordination of total care (case management), or to other care components. Home-based care is hard to organise and vulnerable to many factors, and needs careful training and clinical audit if gains are to be sustained.

Economic evaluation of a crisis resolution service: A randomised controlled trial

2009 ◽  
Vol 18 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Paul McCrone ◽  
Sonia Johnson ◽  
Fiona Nolan ◽  
Stephen Pilling ◽  
Andrew Sandor ◽  
...  
Keyword(s):  
Mental Health ◽  
Service Use ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cost Effective ◽  
Primary Outcome Measure ◽  
Crisis Resolution ◽  
Randomised Controlled ◽  
The Impact

SummaryAims – The use of specialised services to avoid admission to hospital for people experiencing mental health crises is seen as an integral part of psychiatric services in some countries. The aim of this paper is to assess the impact on costs and costeffectiveness of a crisis resolution team (CRT). Methods – Patients who were experiencing mental health crises sufficient for admission to be considered were randomised to either care provided by a CRT or standard services. The primary outcome measure was inpatient days over a six-month follow-up period. Service use was measured, costs calculated and cost-effectiveness assessed. Results – Patients receiving care from the CRT had non-inpatient costs £768 higher than patients receiving standard care (90% CI, £153 to £1375). With the inclusion of inpatient costs the costs for the CRT group were £2438 lower for the CRT group (90% CI, £937 to £3922). If one less day spent as an inpatient was valued at £100, there would be a 99.5% likelihood of the CRT being costeffective. Conclusion – This CRT was shown to be cost-effective for modest values placed on reductions in inpatient stays.

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

1998 ◽  
Vol 172 (6) ◽  
pp. 506-512 ◽  
Author(s):  
Martin R. J. Knapp ◽  
Isaac M. Marks ◽  
Jane Wolstenholme ◽  
Jennifer K. Beecham ◽  
Jack Astin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Standard Care ◽  
Cost Effective ◽  
Controlled Study ◽  
Sample Attrition ◽  
Home Based ◽  
The Difference ◽  
Randomised Controlled ◽  
The Cost ◽  
Home Based Care

BackgroundThe 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.MethodA 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).ResultsThe 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.ConclusionsThe 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.

Filmed v. live social contact interventions to reduce stigma: randomised controlled trial

2012 ◽  
Vol 201 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Sarah Clement ◽  
Adrienne van Nieuwenhuizen ◽  
Aliya Kassam ◽  
Clare Flach ◽  
Anisha Lazarus ◽  
...  
Keyword(s):  
Mental Illness ◽  
Controlled Trial ◽  
Student Nurses ◽  
Social Contact ◽  
Cost Effective ◽  
Emotional Reactions ◽  
Mental Health Stigma ◽  
Informal Carers ◽  
Randomised Controlled ◽  
Intended Learning Outcomes

BackgroundDirect social contact interventions are known to reduce mental health stigma. Filmed social contact may be equally effective and have practical and cost advantages.AimsTo compare the effectiveness of a DVD, a live intervention and a lecture control, in reducing stigma, testing the hypotheses that: (a) DVD and live interventions will be equally effective; and (b) the interventions with social contact (DVD/live) will be more effective than the lecture. Cost-effectiveness, process and acceptability are also assessed.MethodStudent nurses were randomised to: (a) watch a DVD of service users/informal carers talking about their experiences, (b) watch a similar live presentation, or (c) attend a lecture. Primary outcomes were changes in attitudes (using the Mental Illness: Clinicians Attitudes Scale, MICA), emotional reactions (using the Emotional Reactions to Mental Illness Scale, ERMIS), intended proximity (using the Reported and Intended Behaviour Scale, RIBS), and knowledge (using the Social Contact Intended Learning Outcomes, SCILO), immediately after the intervention and at 4-month follow-up.ResultsFor the 216 participants, there were no differences between the DVD and live groups on MICA, ERMIS or RIBS scores. The DVD group had higher SCILO (knowledge) scores. The combined social contact group (DVD/live) had better MICA and RIBS scores than the lecture group, the latter difference maintained at 4 months. The DVD was the most cost-effective of the interventions, and the live session the most popular.ConclusionsOur hypotheses were confirmed. This study supports the wider use of filmed social contact interventions to reduce stigma about mental illness.

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