THE COST CONSEQUENCES OF CHANGING THE HOSPITAL-COMMUNITY BALANCE - THE MENTAL-HEALTH RESIDENTIAL CARE STUDY

Background. Altering the balance of provision between hospital and com munity care is a key and often contentious component of mental health care policy in many countries. Implementation of this policy in the UK has been slowed by the apparent shortage of suitable community accomm odation for people with long-term needs for care and support. Among th e consequences could be the silting up of hospital beds by people who could be supported more appropriately elsewhere, in turn denying in-pa tient treatment to people with acute psychiatric problems and unnecess arily pushing up health service expenditure. Methods. Using data colle cted in a survey of hospital and residential accommodation services an d their residents in eight areas of England and Wales, the cost compon ents of today's balance of care were explored. Comprehensive costs wer e calculated and their associations with resident characteristics exam ined using multiple regression analyses. Results. On a like-with-like basis, the costs of hospital in-patient treatment for inappropriately placed patients greatly exceeded the costs of community-based care. Co nclusion. Further reduction of hospital beds, however, is not the pana cea for an appropriate balance of mental health care, given the unknow n but potentially considerable extent of unmet demand, as well as the impact of previous in-patient bed reductions apparent in the services surveyed. Rather, service providers and purchasers should focus on dev eloping community-based care (including increased provision of 24-hour nursed beds) by ensuring that resources released through earlier clos ure programmes have been redeployed for their intended use and by acce ssing additional pump-priming or bridging resources.