II. Cost-effectiveness analysis of psychiatric deinstitutionalization

Background: The cost-effectiveness of the eventual deinstitutionalization o f patients with severe and persistent mental disorders who are currently ho spitalized in long-term care remains a controversial matter. Methods: A retrospective cohort of 96 pairs of psychiatric hospital patient s with 1 member deinstitutionalized between 1989 and 1998 was followed up f or nearly 10 years. All use of medical and social services was documented. Patients were evaluated at the start and end of the study on various clinic al and social dimensions, as well as on quality of life. Results: On several dimensions, deinstitutionalized patients scored more po sitively than did those patients still hospitalized. The lower daily cost o f living accommodations for deinstitutionalized patients easily offsets the cost of services required for treatment in the community. Conclusion: Deinstitutionalization, as implemented in the hospital studied, remains for many patients a less costly option than continued hospitalizat ion and is likely to improve their mental state and well-being.