Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 30, Issue 5, pp 206–212 | Cite as

Schizophrenia: Shifting the balance of care

  • S. Kavanagh
  • L. Opit
  • M. Knapp
  • J. Beecham
Original Paper
  • 79 Downloads

Abstract

Schizophrenia poses a major challenge to policy makers in health and social care in England. As deinstitutionalisation has progressed, public concern about people with the condition has increased owing to a small number of public incidents. This paper describes the overall balance of care or support for people with schizophrenia, particularly between different settings and the services received. Using these data we are able to provide a basic estimate of the current resource implications of schizophrenia care in England with respect to different public sector agencies, the voluntary sector and service users and their families. The targeting of public sector resources between different care settings is also considered. The discussion suggests that resources are still targeted at existing care facilities rather than on individuals, and examines the roles of individual care agencies and the relationships between them. Four broad resource guidelines are suggested that could improve the effective use of resources for schizophrenia care.

Keywords

Schizophrenia Policy Maker Public Sector Care Setting Care Facility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ritchie J, Dick D, Lingham R (1994) The report of the inquiry into the care and treatment of Christopher Clunis. HMSO, LondonGoogle Scholar
  2. 2.
    Goldacre M, Shiwach R, Yeates D (1994) Estimating incidence and prevalence of treated psychiatric disorders from routine statistics: the example of schizophrenia. J Epidemiol Community Health 318–322Google Scholar
  3. 3.
    Castle D, Wessely S, Der G, Murray RM (1991). The incidence of operationally defined schizophrenia in Camberwell, 1965–84. Br J Psychiatry 159: 790–794Google Scholar
  4. 4.
    Harrison G, Cooper JE, Gancarczyk R (1991) Changes in the administrative incidence of schizophrenia. Br J Psychiatry 159: 811–816Google Scholar
  5. 5.
    Shepherd M, Watt D, Falloon L, Smeeton N (1989) The natural history of schizophrenia: a five year follow up study of outcome and prediction in a representative sample of schizophrenics. Psychol Med [Monogr Suppl] 15Google Scholar
  6. 6.
    Scottish Schizophrenia Research Group (1992) The Scottish first episode schizophrenia study VIII. Five-year follow-up: clinical and psychosocial findings, Br J Psychiatry 161: 496–500Google Scholar
  7. 7.
    Prudo R, Blum HM (1987) Five-year outcome and prognosis in schizophrenia: a report from the London field research centre of the international pilot study of schizophrenia. Br J Psychiatry 150: 345–354Google Scholar
  8. 8.
    Leff J, Sartorius N, Jablensky AJ, Korten A, Ernberg G (1992) The international pilot study of schizophrenia: five year follow-up findings. Psychol Med 22: 131–145Google Scholar
  9. 9.
    Allebeck P (1989) Schizophrenia: a life-shortening disease. Schizophr Bull 15: 81–89Google Scholar
  10. 10.
    Baldwin JA (1979) Schizophrenia and physical disease, Psychol Med 9: 611–618Google Scholar
  11. 11.
    Mortensen PB, Juel K (1993) Mortality and causes of death in first admitted schizophrenic patients, Br J Psychiatry 163: 183–189Google Scholar
  12. 12.
    Roy A (1982 Suicide in chronic schizophrenia. Br J Psychiatry 141: 171–177Google Scholar
  13. 13.
    Brughal TS, Wing JK, Smith BL (1989) Physical health of the long-term mentally ill in the community: is there unmet need. Br J Psychiatry 155: 777–781Google Scholar
  14. 14.
    Department of Health (1993) The health of the nation, Key area handbook: mental illness. Department of Health, LondonGoogle Scholar
  15. 15.
    Kavanagh SM, Opit LJ (1995) Estimating the prevalence of schizophrenia: a model for service development and evaluation. Discussion Paper 953, PSSRU, University of Kent at Canterbury, CanterburyGoogle Scholar
  16. 16.
    Harrison G, Owens D, Holton A et al (1988) A prospective study of severe mental disorder in Afro-Caribbean patients, Psychol Med 18: 643–657Google Scholar
  17. 17.
    Lewis G, David A, Andreasson S, Allebeck P (1992) Schizophrenia and city life. Lancet 340: 137–140Google Scholar
  18. 18.
    Lister ES, Scott J (1988) Current comment. Health Trends, 20: 65–66Google Scholar
  19. 19.
    Kavanagh SM, Opit LJ (1995) The prevalence of schizophrenia amongst the homeless and prison populations. Discussion Paper, 866, PSSRU, University of Kent at Canterbury, CanterburyGoogle Scholar
  20. 20.
    House of Commons (1993) Development of services for people with learning disabilities (mental handicap) or mental illness in England, fifth report prepared pursuant to Section 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986. House of Commons paper 86, HMSO, LondonGoogle Scholar
  21. 21.
    Hallam A, Beecham JK, Knapp MRJ, Fenyo AJ (1994) The costs of accommodation and care: community provision for former long-stay psychiatric patients. Eur Arch Psychiatry Clin Neurosci 243: 304–309Google Scholar
  22. 22.
    Coid J (1984) How many psychiatric patients in prison? Br J Psychiatry 145: 78–86Google Scholar
  23. 23.
    Gunn J, Maden A, Swinton M (1991) Mentally disordered prisoners. Report to the Home Office. Department of Forensic Psychiatry, Institute of Psychiatry, LondonGoogle Scholar
  24. 24.
    Dell S, Robertson G, James K, Grounds A (1993) Remands and psychiatric assessments in Holloway Prison I: The psychotic population. Br J Psychiatry 163: 634–640Google Scholar
  25. 25.
    Harrison G, Mason P, Glazebrook C, Medly L, Croudace C, Doherty S (1994) Residence of incident cohort of psychotic patients after 13 years of follow up. BMJ 308: 813–816Google Scholar
  26. 26.
    Leary J, Johnstone EC, Owens DGC (1991) Disabilities and circumstances of schizophrenic patients—a follow-up study: II. Social outcome. Br J Psychiatry 159 [Suppl 13]: 13–20Google Scholar
  27. 27.
    McCrone P, Beecham JK, Knapp MRJ (1994) Community psychiatric nurse teams: cost-effectiveness of intensive support versus generic care. Br J Psychiatry 165: 218–221Google Scholar
  28. 28.
    Knapp MRJ, Beecham JK, Koutsogeorgopoulou V, Hallam A, Fenyo A, Marks M, Connolly J, Audini B, Muijen M (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry 165: 195–203Google Scholar
  29. 29.
    Beecham JK, Knapp MRJ, Allen C (1995) Comparative efficiency and equity in community based care. In: Knapp MRJ (ed) The economic evaluation of mental health care. Ashgate, Aldershot 175–194Google Scholar
  30. 30.
    Office of Population Censuses and Surveys (1989) Survey of disabled adults in private households 1985 (computer file). ESRC Data Archive, ColchesterGoogle Scholar
  31. 31.
    Burns T, Raftery J, Beardsomore 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
  32. 32.
    Jackson G, Gater R, Goldberg D, Jennett N, Lowson K, Saraf T, Warner R (1995) The care of patients with chronic schizophrenia: a comparison between two services. Department of Psychiatry, University of ManchesterGoogle Scholar
  33. 33.
    Netten A (1994) Unit costs of community care 1994. Personal Social Services Research Unit, University of Kent at Canterbury, CanterburyGoogle Scholar
  34. 34.
    Royal College of General Practitioners, Office of Population Censuses and Surveys, Department of Health and Social Security (1986) Morbidity statistics from general practice: third national survey. HMSO, LondonGoogle Scholar
  35. 35.
    Home office (1986) Annual report of the prison service. HMSO, LondonGoogle Scholar
  36. 36.
    Shanks NJ (1989) Previously diagnosed psychiatric illness among inhabitants of common lodging houses. J Epidermiol Community Health 43: 375–379Google Scholar
  37. 37.
    Weller BGA, Weller MPI, Coker E, Mahomed S (1987) Crisis at Christmas 1986. Lancet I: 533–534Google Scholar
  38. 38.
    Mclean V, Navmann L (1979) Primary medical cure for the single homeless: the Edinburgh experiment. Health Bull 37: 6Google Scholar
  39. 39.
    George SL, Shaks NJ, Westlake L (1991) Census of single homeless people in Sheffield. BMJ 302: 1387–1389Google Scholar
  40. 40.
    Scott J (1991) A survey of female users of resettlement units. Report to the Department of Social Security, University of Newcastle-upon-TyneGoogle Scholar
  41. 41.
    Department of Social Security (1992) Sickness and/or invalidily benefit: spells of certified incapacity in the period 02.04.90 to 30.03.91 Department of Social Security, Newcastle-upon-TyneGoogle Scholar
  42. 42.
    Department of Social security (1992 Severe disablement allowance: spells of certified incapacity due to prescribed diseases in the period 04.04.88 to 01.04.89. Department of Social Security, Newcastle-upon-TyneGoogle Scholar
  43. 43.
    Davidge M, Elias S, Jayes B, Wood K, Yates J (1993) Survey of English mental illness hospitals March 1993: prepared for the Mental Illness Task Force. Health Services Management Centre, University of Birmingham, BirminghamGoogle Scholar
  44. 44.
    Knapp MRJ (1995) From psychiatric hospital to community care: reflections on the English experience. In: Moscarelli M (ed) The economics of schizophrenia. Wiley, New York (in press)Google Scholar
  45. 45.
    Knapp MRJ (1994) The health economics of schizophrenia treatment. Clinician 12: 39–52Google Scholar
  46. 46.
    Anderson J, Dayson D, Wills W, Gooch C, Margolis O, O'Driscoll C, Leff J (1993) The TAPS Project 13: clinical and social outcomes of long-stay psychiatric patients after one year in the community. Br J Psychiatry 162 [Suppl 19]: 45–56Google Scholar
  47. 47.
    Knapp MRJ, Beecham JK, Fenyo AJ, Hallam A Predicting costs from needs and diagnoses: community care for former hospital inpatients. Br J Pshychiatry (1995) (in press)Google Scholar
  48. 48.
    Hyde C, Bridges D, Goldberg D et al (1987) The evaluation of a hostel ward. Br J Psychiatry 151: 805–812Google Scholar
  49. 49.
    Shaw J, Holloway J (1991) Who is your general practioner? BMJ 303: 628Google Scholar
  50. 50.
    Hollander D, Tobiansky R, Powell R (1990) Crisis in admission beds. BMJ 301: 664Google Scholar
  51. 51.
    Schneider J (1995) Costing the care programme approach. In: Knapp MRJ (ed) The economic evaluation of mental health care. Ashgate, Aldershot 157–174Google Scholar
  52. 52.
    Tudor-Hart J (1971) The inverse care law. Lancet I: 405–412Google Scholar
  53. 53.
    Craig T, Hepworth C, Klein O, Manning P, Ratcliffe M (1993) Homeless and mental health initiative. Second report to the Mental Health Foundation. Research and Development for Psychiatry, LondonGoogle Scholar
  54. 54.
    Maden A, Curle C, Meux C, Burrow S, Gunn J (1994) The treatment and security needs of patients in special hospitals. Crim Behav Ment Health 3: 290–306Google Scholar
  55. 55.
    Special Hospitals Service Authority (1994) Patient infomation. Special Hospitals Service Authority. LondonGoogle Scholar
  56. 56.
    Coid J (1994) Failure in community care: psychiatry's dilemma (editoria) BMJ 308: 805–806Google Scholar
  57. 57.
    NHS Management Executive (1994) Introduction of supervision registers for mentally ill people from 1 April 1994. HSG (94) 5. NHS Management Executive, LondonGoogle Scholar
  58. 58.
    Knapp MRJ (1995) Community mental health services: towards an understanding of cost-effectiveness. In: Tyrer P, Creed F (eds) Evaluation of community psychiatric services Cambridge University Press, CambridgeGoogle Scholar
  59. 59.
    Dean C, Gadd EM (1990) Home treatment for acute psychiatric illness. BMJ 301: 1021–23Google Scholar
  60. 60.
    Dean C, Phillips J, Gadd EM, Joseph M, England S (1993) Comparison of community based service with hospital based service for people with acute, severe psychiatric illness. BMJ 307: 473–476Google Scholar
  61. 61.
    Merson S, Tyrer P, Onyett S, Lack S, Birkett P, Lynch S, Johnson T. (1992) Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet 339: 1311–1314Google Scholar
  62. 62.
    Burns T, beardsmore A, Bhat AV, Oliver A Mathers C (1993) A controlled trial of home-based acute psychiatric services I: Clinical and social outcome. Br J Psychiatry. 163: 49–54Google Scholar
  63. 63.
    Marks IM, Connolly J, Muijen M McNamee G, Audini B, Lawrence RE (1994) Home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry 165: 179–194Google Scholar
  64. 64.
    Muijen M, Conney M, Strathdee G (1994) Community psychiatric nurse teams: intensive support versus generic care. Br J Psychiatry 165: 211–217Google Scholar
  65. 65.
    Davies LM, Drummond MF (1993) Assessments of costs and benefits of drug therapy for treatment resistant schizophrenia in the United Kingdom. Br J Psychiatry 162: 38–42Google Scholar
  66. 66.
    Addington DE, Jones B, Bloom D, Choinard G, Remington G, Allbright P (1993) Reduction of hospital days in chronic schizophrenia patients treated with risperidone: a retrospective study. clin Ther 15: 917–926Google Scholar
  67. 67.
    Hale A (1993) Will the new anti-psychotics improve the treatment of schizophrenia? (editorial). BMJ 307: 749–750Google Scholar
  68. 68.
    Fadden GB, Bebbingon PE, Kuipers L (1987) The burden of care: the impact of functional psychiatric illness on the patient's family. Br J Psychiatry 150: 285–292Google Scholar
  69. 69.
    Kuipers L (1993) Family burden in schizophrenia: implications for services. Soc Psychiatry Psychiatr Epidemio 28: 207–210Google Scholar
  70. 70.
    Kuipers L, Bebbington PE (1994) The social management of long-standing schizophrenia II: Social-psychological techniques for helping patients and carers. Clinician 12: 30–38Google Scholar
  71. 71.
    Kendrick T, Sibbald B, Burns T, Freeling P (1991) Role of general practioners in care of long-term mentally ill patients. BMJ 302: 508–510Google Scholar
  72. 72.
    Nazareth ID, King MB (1992) Controlled evaluation of management of schizophrenia in one general practice: a pilot study. Fam Pract 9: 171–172Google Scholar
  73. 73.
    Beecham JK, Knapp MRJ, Fenyo AJ (1991) Costs, needs and outcomes. Schizophr Bull 17: 427–439Google Scholar
  74. 74.
    Kendrick T (1994) Fund-holding and commissioning general practioners. Psychiatr Bull 18: 196–199Google Scholar
  75. 75.
    Wistow G, Knapp MRJ Hardy B, Allen C (1994) Social Care in a Mixed Economy. Open University Press BuckinghamGoogle Scholar
  76. 76.
    Kavanagh S, Knapp M (1995) Market rationales, rationing and rationality: mental health care reform in England. Health Affairs (in press)Google Scholar
  77. 77.
    Audit Commission (1994) Finding a place: a review of mental health services for adults. HMSO, LondonGoogle Scholar
  78. 78.
    Conway AS, Melzer D, Hale AS (1994) The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort. BMJ 308: 627–630Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • S. Kavanagh
    • 1
  • L. Opit
    • 2
  • M. Knapp
    • 3
    • 4
  • J. Beecham
    • 3
    • 4
  1. 1.Personal Social Services Research Unit (PSSRU)University of Kent at CanterburyCanterburyUK
  2. 2.Centre for Health Services StudiesUniversity of Kent at CanterburyUK
  3. 3.PSSRU, University of Kent at CanterburyCanterburyUK
  4. 4.Institute of PsychiatryCentre for the Economics of Mental Health (CEMH)LondonUK

Personalised recommendations