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Population-based indices for the funding of mental health care: a review and implications
- Authors:
- TULLOCH Simon, PRIEBE Stefan
- Journal article citation:
- Journal of Public Mental Health, 9(2), June 2010, pp.15-22.
- Publisher:
- Emerald
Population-based indices of needs have an influence on mental health care funding. Over the last 30 years, a number of needs indices have been developed that utilise sociodemographic and service utilisation data to calculate a proxy indicator of population-based need. This approach is used because indicators of socio-economic disadvantage expressed as weighted deprivation show a strong relationship with mental health morbidity. This paper reviews the existing population-based indices of mental health needs in the UK: the Underprivileged Areas score; the York Index; the Mental Illness Needs Index; the Psychiatric Needs Index; the Indices of Multiple Deprivation; and the Local Index of Needs. It illustrates the application of these indices using east London as an example, and considers the methodological and conceptual limitations of these indices. Although none of the current indices provide a definitive picture, commissioners and providers may find them to be a useful source of contextual information, which may be useful in combination. In England, this is particularly relevant in the light of the increased liberalisation of commissioning services and changes in the funding process.
Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care
- Authors:
- PRIEBE Stefan, et al
- Journal article citation:
- British Journal of Psychiatry, 188, March 2006, pp.243-249.
- Publisher:
- Cambridge University Press
In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria. Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group. Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.
Assertive outreach teams in London: patient characteristics and outcomes: Pan-London Assertive Outreach Study, Part 3
- Authors:
- PRIEBE Stefan, et al
- Journal article citation:
- British Journal of Psychiatry, 183(8), August 2003, pp.148-154.
- Publisher:
- Cambridge University Press
Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions. Patients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes – days spent in hospital and compulsory hospitalisation – were assessed over a 9-month follow-up. The 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for. Routine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.