title: Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England.
abstract: BACKGROUND
  Mental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10-20 % of all those with psychosis, they absorb 25-50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome.
  
  
  METHODS
  Inpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care.
  
  
  RESULTS
  Across England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients' social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00-1.08), and patients' activity (OR 1.03, 95 % CI 1.01-1.05) and social skills (OR 1.13, 95 % CI 1.04-1.24) at recruitment.
  
  
  CONCLUSIONS
  Inpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients' social skills and activities may further enhance the effectiveness of these services.
authors.affiliation: Division of Psychiatry, University College London (UCL), Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. h.killaspy@ucl.ac.uk.|Camden and Islington NHS Foundation Trust, London, NW1 OPE, UK. h.killaspy@ucl.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
authors.affiliation: Department of Primary Care and Population Health, UCL, Rowland Hill Street, London, NW3 2PF, UK.|UCL PRIMENT Clinical Trials Unit, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.affiliation: Division of Psychiatry, University College London (UCL), Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Green
authors.affiliation: Division of Psychiatry, University College London (UCL), Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: Harrison
authors.affiliation: Division of Psychiatry, University College London (UCL), Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Lean
authors.affiliation: South London and Maudsley Hospital NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Holloway
authors.affiliation: South London and Maudsley Hospital NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.|Health Services Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Craig
authors.affiliation: Bamford Centre for Mental Health and Wellbeing, University of Ulster, Northland Road, Derry, BT48 7JL, UK.
authors.forename: Gerard
authors.initials: G
authors.lastname: Leavey
authors.affiliation: North London Service User Research Forum, Division of Psychiatry, UCL, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Maurice
authors.initials: M
authors.lastname: Arbuthnott
authors.affiliation: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Derry, SE5 8AF, UK.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Koeser
authors.affiliation: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Derry, SE5 8AF, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: UCL PRIMENT Clinical Trials Unit, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.|UCL Department of Statistical Science, Gower Street, London, WC1E 6BT, UK.
authors.forename: Rumana Z
authors.initials: RZ
authors.lastname: Omar
authors.affiliation: Division of Psychiatry, University College London (UCL), Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.|Camden and Islington NHS Foundation Trust, London, NW1 OPE, UK.|UCL PRIMENT Clinical Trials Unit, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004739:England; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D000067250:Psychiatric Rehabilitation; D011618:Psychotic Disorders / Q000191:economics* / Q000534:rehabilitation*