Cost-effectiveness over 10 years. A study of community-based social psychiatric care in the 1980s.

More and more, the chronically mentally ill are treated in community-based facilities. A review of international findings indicates that these treatments are on average considerably cheaper than traditional inpatient treatments. The present study adds some further evidence on the cost-effectiveness of a comprehensive programme of community-based treatments provided to a large number of mainly chronically mentally ill patients within a clearly defined catchment area over a 10-year period (1981-1990). The study revealed important needs, as mainly chronically ill, socially handicapped and frequently unoccupied patients, suffering from severe disorders were admitted to the different treatments. These needs were well compensated for by the offer of a differentiated network of crisis-intervention, half-way and community-based treatment facilities. Despite the low staff-patient ratios (0.04-0.5), a coherent pattern of transitions from admission to discharge indicated a good rehabilitative power of this network by diminishing referrals to hospitals and increasing referrals to outpatient and independent services. Performances and costs varied according to the structure of the different services. On average, direct daily costs for community-based social psychiatric care were about half the costs of inpatient treatment over the whole period. Whereas the mean costs for community treatment followed inflation rates, costs for inpatient treatment grew faster. Among the short-term effects, goals set at admission were reached to a great extent, while success rates for autonomy varied according to the different treatment philosophies. In the long-term, success rates for the different treatment facilities studied tended to be confirmed for independent living and work, but professional care was still needed by most of the patients. Despite certain methodological weaknesses of the present study, we suggest that funds for community-based social psychiatric treatment be maintained and we strongly recommend the further allocation of funds for this form of treatment.