Mental health care costs: paucity of measurement

  • P. McCrone
  • S. Weich
Original Paper

Abstract

For an evaluation of a mental health care programme to be comprehensive, it should include an economic component. However, very few cost instruments appear to exist, and only one has been fully described in the literature. This paper seeks to review the studies where costs have been calculated. For this exercise to be facilitated the different elements which make up overall cost are described. A number of areas have experienced economic evaluations, and the more important studies are described. The paper concludes that all too often evaluations either fail to measure costs or do so in an incomplete and inappropriate way.

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References

  1. Allen C, Beecham J (1993) Costing services: ideals and reality. In: Netten A, Beecham J (eds) Costing community care: theory and practice. Ashgate, Aldershot, pp 25–42Google Scholar
  2. Bedell J, Ward J (1989) An intensive community-based treatment alternative to state hospitalization. Hosp Community Psychiatry 40: 533–535Google Scholar
  3. Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing J (eds) Measuring mental health needs. Gaskell, London, pp 163–183Google Scholar
  4. Beecham J, Knapp M, Fenyo A (1991) Costs, needs, and outcomes. Schizophr Bull 17: 427–439Google Scholar
  5. Beecham J, Cambridge P, Hallam A, Knapp M (1993) The costs of domus care. Int J Geriatr Psychiatry 8: 827–831Google Scholar
  6. Bond GR, Miller LD, Krumwied RD, Ward RS (1988) Assertive case management in three CMHCs: a controlled study. Hosp Community Psychiatry 39: 411–418Google Scholar
  7. Bound GR, Witheridge TF, Wasmer D, Dincin J, McRae SA, Mayes J, Ward RS (1989) A comparison of two crisis housing alternatives to psychiatric hospitalization. Hosp Community Psychiatry 40: 177–183Google Scholar
  8. Burns T, Raferty J (1991) Cost of schizophrenia in a randomized trial of home-based treatment. Schizophr Bull 17: 407–410Google Scholar
  9. Burns T, Raftery J, Beadsmoore A, Mcguigan S, Dickson M (1993) A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs. Br J Psychiatry 163: 55–61Google Scholar
  10. Cardin V, McGill C, Falloon I (1985) An economic analysis: costs, benefits, and effectiveness. In: Falloon I (ed) Family management of schizophrenia: a study of clinical, social, family, and economic benefits. John Hopkins, Baltimore, pp 115–123Google Scholar
  11. Cassell WA, Smith CM, Grunberg F, Boan JA, Thomas RF (1972) Comparing costs of hospital and community care. Hosp Community Psychiatry 23: 17–20Google Scholar
  12. Challis D, Chesterman J, Traske K (1993) Case management: costing the experiments. In: Netten A, Beecham J (eds) Costing community care: theory and practice. Ashgate, Aldershot, pp 143–162Google Scholar
  13. Clark RE, Drake RE, Teague GB (1993) The costs and benefits of case management. In: Harris M, Bergman HC (eds) Case management for mentally ill patients. Harwood, Langorne, pp 217–235Google Scholar
  14. Dick P, Cameron L, Cohen D, Barlo M, Ince A (1985) Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 147: 246–250Google Scholar
  15. Dickey B, Cannon NL, McGuire TG, Gudeman JE (1986) The Quarterway House: a two-year cost study of an experimental residential program. Hosp Community Psychiatry 37: 1136–1143Google Scholar
  16. Doubilet P, Weinstein MC, McNeil BJ (1986) Use and misuse of the term “cost effective” in medicine. N Engl J Med 314: 253–256Google Scholar
  17. Drummond M (1980) Principles of economic appraisal in health care. Oxford University Press, OxfordGoogle Scholar
  18. Drummond M, Stoddart G, Torrance G (1987) Methods for the economic evaluation of health care programmes. Oxford University Press, OxfordGoogle Scholar
  19. Endicott J, Herz MI, Gibbon M (1978) Brief verses standard hospitalization: the differential costs. Am J Psychiatry 135: 707–712Google Scholar
  20. Fenton FR, Tessier L, Struening EL, Smith FA, Benoit C, Contandriopoulos A-P, Nguyen H (1984) A two-year follow-up of a comparative trial of the cost-effectiveness of home and hospital psychiatric treatment. Can J Psychiatry 29: 205–211Google Scholar
  21. Franklin JL, Solovitz B, Mason M, Clemons JR, Miller GE (1987) An evaluation of case management. Am J Public Health 77: 674–678Google Scholar
  22. Ginsberg G, Marks I, Waters H (1984) Cost-benefit analysis of a controlled trial of nurse therapy for neuroses in primary care. Psychol Med 14: 683–690Google Scholar
  23. Glass NJ, Goldberg D (1977) Cost-benefit analysis and the evaluation of psychiatric services. Psychol Med 7: 701–707Google Scholar
  24. Glick ID, Hargreaves WA, Goldfield MD (1974) Short vs long hospitalization. Arch Gen Psychiatry 30: 363–369Google Scholar
  25. Goldberg D, Jones R (1980) The costs and benefits of psychiatric care. In: Robins L, Clayton P, Wing J (eds) The social consequences of psychiatric illness. Brunner/Mazel, New York, pp 55–70Google Scholar
  26. Grizenko N, Papineau D (1992), A comparison of the cost-effectiveness of day treatment and residential treatment for children with severe behaviour problems. Can J Psychiatry 37: 393–400Google Scholar
  27. Gudeman JE, Shore MF, Dickey B (1983) Day hospitalization and an inn instead of inpatient care for psychiatric patients. N Engl J Med 308: 749–753Google Scholar
  28. Haefner H, Heiden Wan der, (1989) Effectiveness and cost of community care for schizophrenic patients. Hosp Community Psychiatry 40: 59–63Google Scholar
  29. Hoult J, Reynolds I, Charbonneau-Powis M, Weekes P, Briggs J (1983) Psychiatric hospital verses community treatment: the results of a randomised trial. Aust N Z J Psychiatry 17: 160–167Google Scholar
  30. Hu T-W, Jerrall J (1991) Cost-effectiveness of alternative approaches in treating severely mentally ill in California. Schizophr Bull 17: 461–468Google Scholar
  31. Hyde C, Bridges K, Goldberg D, Lowson K, Sterling C, Faragher B (1987) The evaluation of a hostel ward: a controlled study using modified cost-benefit analysis. Br J Psychiatry 151: 805–812Google Scholar
  32. Jones R, Goldberg D, Hughes B (1980) A comparison of two different services treating schizophrenia: a cost-benefit approach. Psychol Med 10: 493–505Google Scholar
  33. Kivlahan DR, Heiman JR, Wright RC, Mundt JW, Shupe JA (1991) Treatment cost and rehospitalization rate in schizophrenic outpatients with a history of substance abuse. Hosp Community Psychiatry 42: 609–614Google Scholar
  34. Knapp M (1991) The direct costs of the community care of chronically mentally ill people. In: Freeman H, Henderson J (eds) Evaluation of comprehensive care of the mentally ill. Gaskell, LondonGoogle Scholar
  35. Knapp M, Beecham J (1990) Costing mental health services. Psychol Med 20: 893–908Google Scholar
  36. Knapp M, Beecham J, Anderson J, Dayson D, Leff J, Margolius O, O'Driscoll C, Wills W (1990) The TAPS project. 3. Predicting the community costs of closing psychiatric hospitals. Br J Psychiatry 157: 661–670Google Scholar
  37. Knapp M, Beecham J, Gordon K (1992) Predicting the community cost of closing psychiatric hospitals: national extrapolations. J Ment Health 1: 315–325Google Scholar
  38. Levenson AJ, Lord CJ, Sermas CE, Thornby JI, Sullender W, Comstock BS (1977) Acute schizophrenia: an efficacious outpatient treatment approach as an alternative to full-time hospitalization. Dis Nerv Syst 38: 242–245Google Scholar
  39. Linn MW, Caffey EM, Klett CJ, Hogarty GE, Lamb R (1979) Day treatment and psychotropic drugs in the aftercare of schizophrenic patients. Arch Gen Psychiatry 36: 1055–1066Google Scholar
  40. Linn MW, Gurel L, Williford WO, Overall J, Gurland B, Laughlin P Barchiesi A (1985) Nursing home care as an alternative to psychiatric hospitalization. Arch Gen Psychiatry 42: 544–551Google Scholar
  41. Mangen SP, Paykel ES, Griffith JH, Burchell A, Mancini P (1983) Cost-effectiveness of community psychiatric nurse or out-patient psychiatric care of neurotic patients. Psychol Med 13: 407–416Google Scholar
  42. Marinoni A, Grassi M, Ebbli D, Brenna A, Silva S, Torer E (1988) Cost-effectiveness of managing chronic psychotic patients: Italian experience under the new psychiatric law. In: Schwefel D, Zöllner H, Potthoff P (eds) Costs and effects of managing chronic psychotic patients. Springer, Berlin Heidelberg New YorkGoogle Scholar
  43. May PRA (1971) Cost efficiency to treatments for the schizophrenic patient. Am J Psychiatry 127: 118–121Google Scholar
  44. McCrone P, Beecham J, Knapp M (1994) Community psychiatric nurses in an intensive community support team: cost-effectiveness comparisons with generic CPN care. Br J Psychiatry 165: 218–221Google Scholar
  45. Moscarelli M, Capri S, Neri L (1991) Cost evaluation of chronic schizophrenic patients during the first 3 years after the first contact. Schizophr Bull 17: 421–426Google Scholar
  46. Mosher LR, Menn A, Matthews SM (1975) Soteria: evaluation of a home-based treatment for schizophrenia. Am J Orthopsychiatry 45: 455–467Google Scholar
  47. Mueller J, Hopp M (1983) A demonstration of the cost benefits of case management services for discharged mental patients. Psychiatr Q 55: 17–24Google Scholar
  48. Muijen M, Marks IM, Connolly J, Audini B, McNamee G (1992) The Daily Living Programme: preliminary comparison of community verses hospital-based treatment for the seriously mentally Ill facing emergency admission. Br J Psychiatry 160: 379–384Google Scholar
  49. Muller CFR, Caton CLM (1983) Economic costs of schizophrenia: a postdischarge study. Med Care 21: 92–104Google Scholar
  50. Murphy JG, Datel WE (1976) A cost-benefit analysis of community verses institutional living. Hosp Community Psychiatry 27: 165–170Google Scholar
  51. Rappaport M, Goldman H, Thornton P, Stegner B, Moltzen S, Hall K, Gurevitz H, Attkisson C (1987) A method for comparing two systems of acute 24-hour psychiatric care. Hosp Community Psychiatry 38: 1091–1095Google Scholar
  52. Rubin J (1982) Cost measurement and cost cata in mental health settings. Hosp Community Psychiatry 33: 750–754Google Scholar
  53. Schulz RI, Greenley JR, Peterson RW (1983) Management, cost, and quality of acute inpatient psychiatric services. Med Care 21: 911–928Google Scholar
  54. Scott AIF, Freeman CPL (1992) Edinburgh primary care depression study: a treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ 304: 883–887Google Scholar
  55. Sheehan D, Atkinson J (1974) Comparative costs of state hospital and community-based inpatient care in Texas: who benefits most? Hosp Community Psychiatry 25: 242–244Google Scholar
  56. Thornicroft G, Bebbington P (1989) Deinstitutionalisation-from hospital closure to service development. Br J Psychiatry 155: 739–753Google Scholar
  57. Washburn S, Vannicelli M, Longabaugh R, Scheff B-J (1976) A controlled comparison of psychiatric day treatment and inpatient hospitalization. J Consult Clin Psychol 44: 665–675Google Scholar
  58. Weisbrod BA (1981) A guide to benefit-cost analysis, as seen through a controlled experiment in treating the mentally ill. J Health Polit Policy Law 808–845Google Scholar
  59. Weisbrod BA, Test MA, Stein LI (1980) Alternative to mental hospital treatment: II. economic benefit-cost analysis. Arch Gen Psychiatry 37: 400–405Google Scholar
  60. Weisman G (1985) Crisis-orientated residential treatment as an alternative to hospitalization. Hosp Community Psychiatry 36: 1302–1305Google Scholar
  61. Wherley M, Bisgaard S (1987) Beyond model programs: evaluation of a countywide system of residential treatment program. Hosp Community Psychiatry 38: 852–857Google Scholar
  62. Wiersma D, Kluiter H, Nienhuis FJ, Ruphan M, Giel, R (1991) Costs and benefits of day treatment with community care for schizophrenic patients. Schizophr Bull 17: 411–419Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • P. McCrone
    • 1
  • S. Weich
    • 2
  1. 1.PRiSM (Psychiatric Research in Service Measurement)Institute of PsychiatryLondonUK
  2. 2.Section of Epidemiology and General PracticeInstitute of PsychiatryLondonUK

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