Skip to main content
×
×
Home

Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

  • Sue Tucker (a1), Jane Hughes (a2), David Jolley (a3), Deborah Buck (a4), Claire Hargreaves (a4) and David Challis (a5)...
Abstract
Background

Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.

Aims

To identify which individuals require what services, at what cost.

Method

A ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.

Results

Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.

Conclusions

The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Reconfiguring in-patient services for adults with mental health problems: changing the balance of care
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Reconfiguring in-patient services for adults with mental health problems: changing the balance of care
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Reconfiguring in-patient services for adults with mental health problems: changing the balance of care
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Sue Tucker, Personal Social Services Research Unit, University of Manchester, Room 2.16, Second Floor, Crawford House, Booth Street East, Manchester M13 9QS, UK. Email: sue.tucker@manchester.ac.uk
References
Hide All
1Gilburt, H. Under Pressure. King's Fund, 2015.
2Crisp, N, Smith, G, Nicholson, K. Old Problems, New Solutions – Improving Acute Psychiatric Care for Adults in England. The Commission on Acute Adult Psychiatric Care, 2016.
3Naylor, C, Bell, A. Mental Health and the Productivity Challenge. Improving Quality and Value for Money. King's Fund, 2010.
4Department of Health. No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. Supporting Document – The Economic Case for Improving Efficiency and Quality in Mental Health. Department of Health, 2011.
5Audit Commission. Maximising Resources in Adult Mental Health. Audit Commission, 2010.
6McDonagh, MS, Smith, DH, Goddard, M. Measuring appropriate use of acute beds. A systematic review of methods and results. Health Policy 2000; 53: 157–84.
7National Audit Office. Helping People Through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Services. The Stationery Office, 2007.
8Mooney, GH. Planning for balance of care of the elderly. Scott J Polit Econ 1978; 25: 149–64.
9Challis, D, Hughes, J. Frail old people at the margins of care: some recent research findings. Br J Psychiatry 2002; 180: 126–30.
10Tucker, S, Brand, C, Wilberforce, M, Challis, D. The balance of care approach to health and social care planning: lessons from a systematic literature review. Health Serv Manag Res 2013; 26: 1828.
11Huxley, P, Reilly, S, Gater, R, Robinshaw, E, Harrison, J, Mohammed, H, et al. Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1). Soc Psychiatry Psychiatr Epidemiol 2000; 35: 312–7.
12Huxley, P, Evans, S, Munroe, M, Cestari, L. Mental health policy reforms and case complexity in CMHTs in England: replication study. Psychiatr Bull 2008; 32: 4952.
13Wing, JK, Curtis, RH, Beevor, AS. HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993-December 1995. Royal College of Psychiatrists, 1996.
14Department of Health Payment by Results team. Mental Health Clustering Booklet (V2.03) (2012/13). Department of Health, 2012.
15Bowling, A. Consensus methods. In Research Methods in Health. Investigating Health and Health Services (ed Bowling, A): 362–5. Open University Press, 1997.
16Tucker, S, Brand, C, Wilberforce, M, Challis, D. Optimising Health and Social Services for Older People. The Balance of Care Approach to Strategic Planning: A Handbook for Service Planners, Providers and Commissioners. PSSRU University of Manchester, 2014.
17Brand, C, Tucker, S, Wilberforce, M, Challis, D. Balance of Care Workbook for Short-Stay Settings v1.1. PSSRU University of Manchester, 2015 (http://research.bmh.manchester.ac.uk/pssru/nihrsscr/productsandtoolkits/).
18Curtis, L. Unit Costs of Health and Social Care 2013. PSSRU University of Kent, 2013.
19Department of Health. NHS Reference Costs 2012 to 2013. Department of Health, 2013 (https://www.gov.uk/government/publications/nhs-reference-costs-2012-to-2013).
20NHS Confederation Mental Health Network. Defining Mental Health Services. Promoting Effective Commissioning and Supporting QIPP. NHS Confederation, 2012.
21Thornicroft, G, Tansella, M. The balanced care model: the case for both hospital- and community-based mental healthcare. Br J Psychiatry 2013; 202: 246–8.
22Gorrindo, T, Goldfarb, E, Chevalier, L, Hoeppner, BB, Birnbaum, RJ, Meller, B, et al. Inter professional differences in disposition decisions: results from a standardized web-based patient assessment. Psychiatr Serv 2013; 64: 808–11.
23 Challis, D, Tucker, S, Wilberforce, M, Brand, C, Abendstern, M, Stewart, K, et al. National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. Programme Grants Appl Res 2014; 2: 1480.
24Phillips, G, Gerdtz, MF, Elsom, SJ, Weiland, TJ, Castle, D. Mental health nurses’ dispositional decision-making for people presenting to the emergency department with deliberate self-harm: an exploratory study. Perspect Psychiatr Care 2014; 51: 148–53.
25Care Quality Commission. Right Here, Right Now – Help, Care and Support During a Mental Health Crisis. Care Quality Commission, 2015.
26NHS England. Implementing the Five Year Forward View for Mental Health. NHS England, 2016.
27Mooney, G. Priority setting in mental health services. Appl Health Econ Health Policy 2002; 1: 6574.
28Tucker, S, Hughes, J, Brand, C, Buck, D, Challis, D. The quality and implications of Balance of Care studies: lessons from a systematic literature review. Health Serv Manag Res 2015; 28: 3445.
29McDonald, AG, Cuddeford, GC, Beale, EML. Balance of care: some mathematical models of the National Health Service. Br Med Bull 1974; 30: 262–71.
30Knapp, M, Chisholm, D, Astin, J, Lelliott, P, Audini, B. The cost consequences of changing the hospital-community balance: the mental health residential care study. Psychol Med 1997; 27: 681–92.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Tucker et al. supplementary material
Tucker et al. supplementary material 1

 Unknown (107 KB)
107 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

  • Sue Tucker (a1), Jane Hughes (a2), David Jolley (a3), Deborah Buck (a4), Claire Hargreaves (a4) and David Challis (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *