Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 5, Issue 2, 2002. Pages: 79-87 Published Online: 11 Nov 2002 Copyright © 2002 ICMPE.

*Correspondence to: Dr. Justine Schneider, CASS, University of Durham, Elvet Riverside 2, New Elvet, Durham, DH6 1EN, England
Tel.:  + 44-191-374 2318      
Fax:  + 44-191-374 1591
E-mail: Justine.Schneider@dur.ac.uk

Source of Funding: This work described in this paper was undertaken by the Centre for Applied Social Studies at the University of Durham, who received funding from the Department of Health, England. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health.

Abstract

The impact on costs of high integration between health and social care providers, and of targeting at people with more severe mental health problems was investigated. 260 people in 4 areas were interviewed about their service use.  The sample could discern a difference of £50 (E 80) per week with 80% power and 5% significance.   People in targeted services had higher costs (p=0.001).   Integrated services had lower inpatient (p=0.003), lower primary care (p=0.003) and lower total health and social care costs (p=0.024). The a priori differences between districts were reflected in service use and costs.  This study shows that targeting services at people with more severe mental health problems may increase mean costs per service user.   It suggests that integration may generate lower costs.  Since both targeting and integration are increasingly common mental health policies, it is important to recognise their opposing effects on costs.

Background: Different forms of service organisation may be expected to affect costs. I is important to understand the distribution of costs amongst providers of mental health care, so that the effect of service developments on budgets can be better anticipated and planned. Aims: This study explored the association between different forms of mental health service organisation and costs. It tested the impact on costs of services with high degrees of integration between health and social care providers, and of services targeting at people with more severe mental health problems. Methods: 260 service users in 4 districts in the north of England were interviewed and costs identified for each person. The districts comprised examples of four types of service configuration. Use and non-use was compared by type of service, and after suitable  transformations, costs were also compared between districts and  between types of service. The sample was large enough to discern a difference of £50 (€ 80) per week with 80% power and 5% significance.   Results: Costs were closely related to severity. People in targeted services had higher mean costs (£136, SD £191 versus £92, SD £106; p=0.001). The costs of targeted services in this study were very similar to those of psychosis-only services in a London study. Integrated services were predicted to have lower inpatient costs (p=0.003), lower PCG costs (p=0.003) and lower total health and social care costs (p=0.024). Differences between use and costs of specific services were largely attributable to imprecise definitions and supply-side factors.  Discussion: While the sample is not representative, the a priori distinctions made in selecting the districts were reflected in service use and costs. This study suggests strongly that targeting services at people with more severe mental health problems seems likely to increase mean health and social care costs per service user. It also suggests that integration maybe associated with lower costs. Since both targeting and integration are increasingly common mental health policies, it is important to recognise that they may have opposing effects on costs.

Received 28 May 2002; accepted 2 October 2002

Copyright © 2002 ICMPE