title: A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness.
abstract: OBJECTIVE
  There is increasing international evidence that crisis houses can reduce the time spent in acute psychiatric inpatient units for patients with severe and persistent mental illness, at a lower cost and in an environment preferable to patients. We evaluated the Alternatives to Hospitalisation (AtH) program, a crisis house operating in outer suburban Brisbane.
  
  
  METHODS
  One hundred and ninety-three AtH patients were compared to 371 matched controls admitted to a peer hospital district acute psychiatric unit. Hospitalisations, demographics and illness acuity were compared one year before and after an acute index episode of residential care involving hospital and/or AtH. Hospital bed-days during the index episode were compared between AtH participants and controls. The cost of bed-days averted was compared to the cost of providing the AtH program.
  
  
  RESULTS
  AtH participants spent 5.35 fewer days in hospital during the index episode than controls, after adjustment for illness acuity, living conditions, marital status and emergency department (ED) presentations. Per patient cost of averted psychiatric inpatient bed-days, $5948.22, was higher than the per patient cost of providing AtH, $3071.44. AtH participants had higher levels of illness acuity, ED presentations and acute psychiatric admissions than controls in the year after the index episode.
  
  
  CONCLUSIONS
  For acutely unwell, stably housed patients, able to be managed outside of a secure facility, a crisis house program can reduce acute psychiatric bed-days, providing a cost saving for mental health services.
authors.affiliation: Queensland Centre for Mental Health Research, School of Population Health, University of Queensland, Brisbane, Australia. dan_siskind@qcmhr.uq.edu.au
authors.forename: Dan
authors.initials: D
authors.lastname: Siskind
authors.forename: Meredith
authors.initials: M
authors.lastname: Harris
authors.forename: Steve
authors.initials: S
authors.lastname: Kisely
authors.forename: James
authors.initials: J
authors.lastname: Brogan
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.forename: David
authors.initials: D
authors.lastname: Crompton
authors.forename: Harvey
authors.initials: H
authors.lastname: Whiteford
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000191:economics*; D003419:Crisis Intervention / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Mental health; crisis housing; hospital; service evaluation