Community care for long-stay psychiatric patients: need- or policy-driven?

This paper describes an economic analysis undertaken as part of an evaluation of mental health services in Clwyd. This project was conducted in response to the decision to close the North Wales Hospital, Denbigh; a long-stay psychiatric hospital. Cost data were collected in both the hospital setting and subsequent community care settings. These data are compared with effectiveness data developed in other parts of the overall project in order to place the discussion in a cost effectiveness framework. Little significant difference in care effectiveness between hospital and community settings is identified, although minor improvements in some aspects for some patients are noted. However, there are considerable changes in the care costs. The cost estimates show that old long-stay patients cost more to care for in the community than the new long-stay patients, whilst in hospital they had cost less. In addition, the results highlight the significant influence of pay scales and capital funding on cost of care. The paper concludes that the cost of care is substantially affected by non-needs-driven policy decisions as well as by direct patient needs.