Containing mental health treatment costs through program design: a Massachusetts study.

Abstract

A single site pre-post study of seriously mentally ill patients treated in a public mental health system shows that annual treatment costs can be substantially reduced with the use of day hospital treatment. Two cohorts of psychiatric patients-282 consecutive admissions to a traditional public inpatient unit in 1980, and 340 consecutive admissions to a combination of inpatient and day hospital care in 1984-were followed 12 months after admission. With the introduction of day programs into the array of treatment modalities offered, mental health policymakers have assumed that resources would flow naturally from expensive inpatient care to less expensive, community-based care. In fact, the anticipated shift in services does not necessarily occur. Many state systems operate within a fixed budget allocation, yet for the most part they have been slow to shift resources from inpatient care to alternative services. Patterns of service delivery seem to be so entrenched that they drive the public system as much as financial payment mechanisms do. Thus, structural issues must be addressed as part of the effort to shift resources from inpatient hospitalization to alternative care.A chance to reconsider these issues occurred when a state mental health facility was restructured to substitute day

Replacing the Last Week of a Motivational Inpatient Alcohol Withdrawal Programme by a Day-Clinic Setting

“…The reduction of changes to long-term treatment may raise the amount of severe relapses and the costs for subsequent detoxications. As inpatient treatment is replaced by day-clinic to a larger extent, short-term savings in the institutions for detoxication and for rehabilitation may be larger [13]. However, this may lead to prolonged consumption and induce additional harm and the need for subsequent treatment.…”

Randomized Controlled Trials in Evidence-Based Mental Health Care: Getting the Right Answer to the Right Question

“…We can illustrate this point with a well-known example from the mental health field. A number of randomized effectiveness trials of partial hospitalization were undertaken in the 1970s and 1980s (Horvitz-Lennon et al 2001) showing that partial hospitalization was effective and cost-effective relative to traditional inpatient treatment (Dickey et al 1989; Creed et al 1990). Those studies were based on the random assignment of people at risk for hospitalization to either a partial hospital program or a psychiatric inpatient setting.…”