Cost-effectiveness studies in the evaluation of mental health services in the community: current knowledge and unsolved problems.

Care in the community has consistently been found to be cheaper, and has often been found to be better, for selected patients on demonstration sites. Most cost advantages are obtained by shortening or even eliminating the initial period of in-patient care. Health economists can compute cost equations which relate clinical characteristics of patients to treatment costs incurred later. As old long stay patients are discharged, a degree of cost inflation is inevitable for both the hospital and the community service. Strong links have been shown both between costs and client needs, and costs, and client outcomes. Integrating mental health services with primary care has been shown to increase total costs of the service, but to decrease costs per treated case. One weakness of CMH schemes is that they are vulnerable to sudden cutbacks, so that the shift of resource to the community may not actually occur. The evidence about the efficacy of case management is conflicting, but day-care can be used as a method of shortening initial admission for some patients.