The TAPS Project. 3: Predicting the Community Costs of Closing Psychiatric Hospitals

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has h...

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Bibliographic Details
Published in:British journal of psychiatry 1990-11, Vol.157 (5), p.661-670
Main Authors: Knapp, Martin, Beecham, Jeni, Anderson, Jeremy, Dayson, David, Leff, Julian, Margolius, Olga, O'driscoll, Cathie, Wills, Walter
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Behavior problems
Community health care
Community Mental Health Services - economics
Cost Control - trends
Costs and Cost Analysis
Deinstitutionalization - economics
England
Female
Health Facility Closure - economics
Health Policy - economics
Hospital costs
Hospitals
Hospitals, Psychiatric - economics
Humans
Inpatient care
Long term health care
Long-Term Care - economics
Male
Mental disorders
Mental Disorders - economics
Mental Disorders - rehabilitation
Middle Aged
Patients
Psychiatric hospitals
Psychiatric symptoms
Resident physicians
Symptoms
Vacuum
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Summary:The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these ‘baseline’ characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.157.5.661