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The cost of treatment of psychiatric emergencies: a comparison of hospital and community services

Published online by Cambridge University Press:  09 July 2009

S. Merson ,
P. Tyrer ,
D. Carlen  and
T. Johnson
S. Merson*
Affiliation:
Academic Department of Community Psychiatry, St Mary's Hospital Medical School and St Charles' Hospital, London
P. Tyrer
Affiliation:
Academic Department of Community Psychiatry, St Mary's Hospital Medical School and St Charles' Hospital, London
D. Carlen
Affiliation:
Academic Department of Community Psychiatry, St Mary's Hospital Medical School and St Charles' Hospital, London
T. Johnson
Affiliation:
Academic Department of Community Psychiatry, St Mary's Hospital Medical School and St Charles' Hospital, London
*
1Address for correspondence: Dr Stephen Merson, Hadrian Clinic, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, NE4 6BE.
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Synopsis

This study aimed to compare the costs of treatment by community-based and hospitalbased psychiatric services. The design entailed random allocation of patients presenting with psychiatric emergencies over a subsequent 3-month period to one of two services, followed by retrospective quantification of service use and its cost for each group. One hundred patients with emergency presentations to the psychiatric service via the Accident and Emergency Department, liaison psychiatrist and approved social worker were included in the study. Their use of a range of items of service was recorded and disaggregated costings of these items of service was calculated. The use of non-psychiatric services was similar for both groups, but the use of psychiatric services differed, with the hospital group making greater use of in-patient beds and the community group employing more frequent home-based interventions. The total cost of treatment for the community group (£56000) was much lower than for the hospital group (£130000), although the median patient cost was 50% higher in the community group (£938 v. £610), and a greater proportion of the community service expenditure (10% v. 2%) was due to failed contacts. Taken together with clinical outcome, which showed no advantages for the hospital-based service over the community-based service, our findings suggest that this form of community psychiatric service is a cost-efficient alternative to hospital-based care for this group of patients.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 4 , July 1996 , pp. 727 - 734
Copyright
Copyright © Cambridge University Press 1996

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