title: Costs, needs, and outcomes.
abstract: There is a tendency in discussions of mental health policy and psychiatric practice to talk of the cost of a treatment, facility, or policy and to ignore variations. These variations can be considerable, which alone suggests they should not be overlooked, and they can be explored and perhaps exploited to improve the delivery of services. This article describes a theoretical framework for the examination of cost differences, applies it to a particularly rich data base on people with long-term mental health problems moving from hospital to the community, and uses the empirical evidence to address four key policy questions. The study finds encouragingly strong positive associations between costs, needs, and outcomes. It also uncovers significant cost-effectiveness differences between the public and private sectors and between community accommodation types.
authors.affiliation: Personal Social Services Research Unit, University of Kent, Canterbury, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Beecham
authors.forename: M
authors.initials: M
authors.lastname: Knapp
authors.forename: A
authors.initials: A
authors.lastname: Fenyo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000191:economics; D003191:Comprehensive Health Care / Q000191:economics; D003363:Cost Control / Q000639:trends; D004180:Direct Service Costs / Q000639:trends*; D004739:England; D005260:Female; D006291:Health Policy / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D012559:Schizophrenia / Q000191:economics* / Q000534:rehabilitation*; D012565:Schizophrenic Psychology