Twelve years on: service use and costs for people with mental health problems who left psychiatric hospitals

Background: Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. Aims: To assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and people's characteristics, needs and outcomes. Method: Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative. For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Results: Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (555 per week) are lower than long-stay hospital residence or community costs 1 year later. Conclusions: High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents' increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs. Declaration of interest: The Department of Health funded the research.