title: Evaluating sustainability: a retrospective cohort analysis of the Oxfordshire therapeutic community.
abstract: Therapeutic communities (TCs) could reduce the health care use of people with personality disorder (Davies S, Campling P and Ryan K, Psychiatrist 23:79-83, 1999; Barr W, Kirkcaldy A, Horne A, Hodge S, Hellin K and Göpfert M, J Ment Health 19:412-421, 2010) and in turn reduce the financial and environmental costs of services. Our hypothesis is that 3 years following entry to a TC service, patients have reduced subsequent health care use and associated reductions in financial costs and carbon footprint.
  
  
  
  A retrospective 4-year cohort study examined changes in health care use following entry to the Oxfordshire TC service. Comparative analysis was undertaken on a treated (n = 40) and a control group (referred but who declined treatment; n = 45). Financial costs and carbon footprint of health care use were calculated using national tariffs and standard carbon conversion factors. Mean changes in these outcomes were compared over 1, 2 and 3 years and adjusted for costs and carbon footprints in the year prior to joining the TC service.
  
  
  
  Compared to baseline, the group receiving TC care had greater reductions in financial costs and carbon footprint associated with A&E attendances (p = 0.04) and crisis mental health appointments (p = 0.04) than the control group. There were significantly greater reductions in carbon footprint for all secondary health care use, both physical and mental health care, after 3 years (p = 0.04) in the TC group.
  
  
  
  TC services may have the potential to reduce the financial cost and carbon footprint of health care.
authors: Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. drdanielmaughan@gmail.com.|Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK. drdanielmaughan@gmail.com.
authors: Daniel
authors: D
authors: Maughan
authors: Life Sciences, Warwick University, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
authors: Rob
authors: R
authors: Lillywhite
authors: Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
authors: Steve
authors: S
authors: Pearce
authors: South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.
authors: Toby
authors: T
authors: Pillinger
authors: Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
authors: Scott
authors: S
authors: Weich
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013808:Therapeutic Community
keywords: Carbon footprint; Economic evaluation; Personality disorders; Sustainability