title: An assessment of need for mental health rehabilitation amongst in-patients in a Welsh region.
abstract: Rehabilitation services have received little attention in the literature compared with other types of mental health service provision over the past 15 years. However, they are an important component of whole-system functioning in mental health services. Lack of provision has a particular impact on acute in-patient services. Poor pathway management can result in delayed discharges, placement of service users far from home, and resultant loss of resource for the local mental health economy.
  
  
  
  A cross-sectional study gathered demographic, clinical, service utilisation, and financial data on 100 participants from out of area, rehabilitation and acute mental health units. Financial data was provided by the Health Board. Other data were gathered by two clinicians from case records and staff interviews.
  
  
  
  26.0 % of people were inappropriately placed, with frequent overprovision of support. It was calculated that within an annual budget of £12.7 M, £2.5 M (19.7 % of the total expenditure on this patient group) could be saved if all placements were appropriate.
  
  
  
  There were differences between the three cohorts. Those placed out of area had the most complex needs, although those in rehabilitation placements were similar. Most participants had been in contact with services for more than 5 years. A system better matched to their needs would benefit these patients and would also generate financial savings for reinvestment in the mental health economy.
authors.affiliation: Tony Ryan Associates, Manchester, UK. info@tonyryan.org.|Centre for Mental Health and Society, Bangor University, Bangor, UK. info@tonyryan.org.
authors.forename: Tony
authors.initials: T
authors.lastname: Ryan
authors.affiliation: Betsi Cadwaladr University Health Board, Wrexham, UK.|Centre for Mental Health and Society, Bangor University, Bangor, UK.
authors.forename: John
authors.initials: J
authors.lastname: Carden
authors.affiliation: Betsi Cadwaladr University Health Board, Wrexham, UK.|Centre for Mental Health and Society, Bangor University, Bangor, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Higgo
authors.affiliation: Betsi Cadwaladr University Health Board, Wrexham, UK.|Centre for Mental Health and Society, Bangor University, Bangor, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Poole
authors.affiliation: Centre for Mental Health and Society, Bangor University, Bangor, UK.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D020380:Needs Assessment; D000067250:Psychiatric Rehabilitation / Q000191:economics / Q000379:methods*; D013222:State Medicine; D014852:Wales; D055815:Young Adult
keywords: Commissioning; Needs assessment; Out of area treatments; Rehabilitation; Service redesign