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Related Experiment Videos

Deinstitutionalisation--from hospital closure to service development.

G Thornicroft1, P Bebbington

  • 1MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London.

The British Journal of Psychiatry : the Journal of Mental Science
|December 1, 1989
PubMed
Summary

Integrated local care for the seriously mentally ill shows outcomes as favorable as hospital care but is not less costly. A case manager system is key for coordinating services to meet individual patient needs.

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Area of Science:

  • Mental Health Services Research
  • Community Psychiatry
  • Healthcare Integration

Background:

  • Previous research examined components of local non-institutional care for the seriously mentally ill in isolation.
  • Integrated programs for defined populations have not been previously studied.
  • Traditional long-term hospital care remains a benchmark for treatment outcomes.

Purpose of the Study:

  • To evaluate integrated programs for local non-institutional care for the seriously mentally ill.
  • To compare outcomes of integrated care with traditional hospital care.
  • To assess the cost-effectiveness of alternative care models.

Main Methods:

  • Review of pilot trials on separate components of local care.
  • Analysis of outcomes from integrated programs (implicitly, though not detailed).

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  • Assessment of cost implications for alternative provisions.

    • Main Results:

    • Outcomes for local non-institutional care are comparable to traditional long-term hospital care.
    • Alternative care provisions are not less expensive than hospital care.
    • A case manager system can facilitate coordinated formal and informal services.

    Conclusions:

    • Integrated programs are necessary for comprehensive local care of the seriously mentally ill.
    • Case management is crucial for tailoring services to individual chronic patient needs.
    • Poorly integrated programs can negatively impact discharged patients.