The Evaluation of Mental Health Care Systems

While the demand for deinstitutionalisation, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiv...

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Bibliographic Details
Published in:British journal of psychiatry 1989-07, Vol.155 (1), p.12-17
Main Authors: Häfner, Heinz, an der Heiden, Wolfram
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cohort Studies
Community Mental Health Services - economics
Cost-Benefit Analysis - trends
Deinstitutionalization - economics
Follow-Up Studies
Germany, West
Hospitals, Psychiatric - economics
Humans
Length of Stay - economics
Medical sciences
Mental health
Patient Readmission - economics
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Quality Assurance, Health Care - economics
Schizophrenia - rehabilitation
Schizophrenic Psychology
Social Environment
Social psychiatry. Ethnopsychiatry
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Summary:While the demand for deinstitutionalisation, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of outpatient psychiatric treatment on length of stay in hospital and length of stay in the community. Outpatient care had a significant influence on read mission, but no effect on the length of inpatient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued inpatient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.155.1.12