Abstract
Community-based family support is a new option to patients with severe mental illness in which the patient and a volunteer family meet on a regular basic. This study examined whether this support could reduce patients’ use of psychiatric services. This matched case-control study included 86 patients with severe mental illness. 40 patients were offered the intervention: community-based family support intervention. Patients’ use of psychiatric hospital services was followed from 2 years before to 2 years after the intervention using a difference-in-difference analytical approach. Although community-based family support seemed to reduce hospital admission, the reduction in cost did not compensate the cost of the programme. However, this does not rule out the potential cost effectiveness, and future studies should assess the clinical benefits and cost effectiveness of community-based family support. The present study does not provide sufficient basis for recommending the general implementation of community-based family support.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aagaard, J., Freiesleben, M., & Foldager, L. (2008). Crisis homes for adult psychiatric patients. Social Psychiatry and Psychiatric Epidemiology, 43(5), 403–409. https://doi.org/10.1007/s00127-008-0311-7.
Aagaard, J., & Hastrup, L. H. (2014). Costs and outcome of Assertive Community Treatment (ACT) in a rural area in Denmark: 4 years register-based follow-up. Nordic Journal of Psychiatry, 69(2), 110–117.
Borg, V., Nexø, M. A., Kolte, I. V., & Friis, M. (2010). Hvidbog om mentalt helbred, sygefravær og tilbagevenden til arbejde (Book regarding mental health, sickness absence and return to employment). Copenhagen. Retrieved from http://www.arbejdsmiljoforskning.dk/~/media/Boeger-og-rapporter/hvidbog-mentalt-helbred.pdf.
Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.
Brook, B. D., Cortes, M., March, R., & Sundberg-Stirling, M. (1976). Community families: An alternative to psychiatric hospital intensive care. Hospital & Community Psychiatry, 27(3), 195–197.
Carpenter, J., & Bithell, J. (2000). Bootstrap confidence intervals: When, which, what ? A practical guide for medical statisticians. Statistics in Medicine, 19, 1141–1164.
Cullberg, J., Mattsson, M., Levander, S., Holmqvist, R., Tomsmark, L., Elingfors, C., & Wieselgren, I.-M. (2006). Treatment costs and clinical outcome for first episode schizophrenia patients: A 3-year follow-up of the Swedish “Parachute Project” and two comparison groups. Acta Psychiatrica Scandinavica, 114(4), 274–281. https://doi.org/10.1111/j.1600-0447.2006.00788.x.
Danish Ministry of Health. (2000). Chapter 12, Den nationale Kræftplan (the national cancer plan). In Den nationale Kræftplan. Danish Ministry of Health. Retrieved from http://www.sum.dk/Aktuelt/Publikationer/Den-nationale-kraeftplan-marts-2000/Kapitel 12.aspx.
De Heer-Wunderink, C., Visser, E., Sytema, S., & Wiersma, D. (2012). Social inclusion of people with severe mental illness living in community housing programs. Psychiatric Services, 63(11), 1102–1107. https://doi.org/10.1176/appi.ps.201100538.
Denmark’s Nationalbank. (1999). Report and Accounts. Retrieved February 28, 2015, from http://www.nationalbanken.dk/en/publications/Documents/2000/03/re_ac99uk.pdf#search=bound to euro.
Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickinson, D., Goldberg, R. W., …, Kreyenbuhl, J. (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 36(1), 48–70. https://doi.org/10.1093/schbul/sbp115.
DRG Tariffs. (2014). Retrieved August 6, 2014, from http://drgservice.ssi.dk/grouper/Modules/Home/.
Ekman, M., Granström, O., Omérov, S., Jacob, J., & Landén, M. (2013). The societal cost of schizophrenia in Sweden. The Journal of Mental Health Policy and Economics, 16(1), 13–25.
Fenton, W. S., Hoch, J. S., Herrell, J. M., Mosher, L., & Dixon, L. (2002). Cost and cost-effectiveness of hospital vs residential crisis care for patients who have serious mental illness. Archives of General Psychiatry, 59(4), 357–364. https://doi.org/10.1001/archpsyc.59.4.357.
Gidugu, V., Rogers, E. S., Harrington, S., Maru, M., Johnson, G., Cohee, J., & Hinkel, J. (2014). Individual peer support: A qualitative study of mechanisms of its effectiveness. Community Mental Health Journal. https://doi.org/10.1007/s10597-014-9801-0.
Gyrd-Hansen, D. (2002). Økonomisk evaluering: Hvad handler det om? (Economic evaluation: What is it all about?) Månedsskrift for Praktisk Lægegerning, 80(4), 529–543.
Killaspy, H., Bebbington, P., Blizard, R., Johnson, S., Nolan, F., Pilling, S., & King, M. (2006). The REACT study: Randomised evaluation of assertive community treatment in north London. British Medical Journal, 332, 815–820. https://doi.org/10.1136/bmj.38773.518322.7C. doi.
Linn, M., Klett, C., & Caffey, E. (1980). Foster home characteristics and psychiatric patient outcome: The wisdom of gheel confirmed. Archives of General Psychiatry, 37(2), 129–132.
McCrone, P., Killaspy, H., Bebbington, P., Johnson, S., Nolan, F., Pilling, S., & King, M. (2009). The REACT study: Cost-effectiveness analysis of assertive community treatment in north London. Psychiatric Services, 60(7), 908–913. https://doi.org/10.1176/appi.ps.60.7.908.
Mors, O., Perto, G. P., & Mortensen, P. B. (2011). The Danish psychiatric central research register. Scandinavian Journal of Public Health, 39(7 Suppl), 54–57. https://doi.org/10.1177/1403494810395825.
Polak, P. R., & Kirby, M. W. (1976). A model to replace psychiatric hospitals. The Journal of Nervous and Mental Disease, 162(1), 13–22.
Preston, N., & Fazio, S. (2000). Establishing the efficacy and cost effectiveness of community intensive case management of long-term mentally ill: A matched control group study. Australian & New Zealand Journal of Psychiatry, 34(1), 114–121.
Reinharz, D., & Lesage, A. D., & Contandriopoulos, A. (2000). Cost-effectiveness analysis of psychiatric deinstitutionalization. Canadian Journal of Psychiatry, 45(6), 533–538.
Sono, T., Oshima, I., Ito, J., Nishio, M., Suzuki, Y., Horiuchi, K., …, Tsukada, K. (2012). Family support in assertive community treatment: An analysis of client outcomes. Community Mental Health Journal, 48(4), 463–470. https://doi.org/10.1007/s10597-011-9444-3.
Stant, A. D., Castelein, S., Bruggeman, R., Van Busschbach, J. T., Van Der Gaag, M., Knegtering, H., & Wiersma, D. (2011). Economic aspects of peer support groups for psychosis. Community Mental Health Journal, 47(1), 99–105. https://doi.org/10.1007/s10597-009-9193-8.
Thornicroft, G., Szmukler, G., Mueser, K. T., & Drake, R. E. (2011). Crisis and emergency services (Chap. 13). Oxford Textbook of Community Mental Health, Oxford: Oxford University Press, pp. 118–126.
Vendsborg, P. B., Nordentoft, M., Hvenegaard, A., & Søgaard, J. (1999). Opsøgende psykoseteam: En medicinsk teknologivurdering (assertive community treatment: A medical technology assessment). Institut for Sundhedsvæsen.
World Health Organization. (2015). ICD-10. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Retrieved February 28, 2015, from http://apps.who.int/classifications/icd10/browse/2015/en.
Salary Cleaning Assistant. (2014). Retrieved July 4, 2014, from http://www.oao.dk/index.php?id=515&tx_salarystatistics_pi1[regionCountyId]=751&tx_salarystatistics_pi1[agreementGroupId]=84&tx_salarystatistics_pi1[positionGroupId]=8401&tx_salarystatistics_pi1[tab]=1&tx_salarystatistics_pi1[option]=1&tx_salarystatistics_pi1[action]=tab1Option1&tx_salarystatistics_pi1[controller]=ReportSingleView&cHash=a4377e10732e5a663f89c4422f4c8e89.
Salary Front-line Coordinator(social worker). (2014). Retrieved July 4, 2014, from http://www.oao.dk/index.php?id=515&tx_salarystatistics_pi1[regionCountyId]=82&tx_salarystatistics_pi1[agreementGroupId]=270&tx_salarystatistics_pi1[positionGroupId]=27001&tx_salarystatistics_pi1[action]=tab1Option1&tx_salarystatistics_pi1[controller]=ReportSingleView&cHash=b2965fe3d22c61841069dcb6b87fb67a.
Acknowledgements
The authors gratefully acknowledge the cooperation of patients and staff members from the participating municipalities involved in the data collection, and the data manager at the Danish Psychiatric Central Research Register Søren Skadhede.
Funding
This research project was supported by the following foundations: TrygFonden (J. No. 7251-06), The Health Insurance Foundation (J. No. 2006D610) and by the Danish Ministry of Social Affairs and Integration (J. No. 87132-0374).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Villemoes, M.K., Aagaard, J., Væggemose, U. et al. Cost Analysis of Community Based Family Support of Patients with Severe Mental Illness. Community Ment Health J 54, 625–633 (2018). https://doi.org/10.1007/s10597-017-0184-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-017-0184-x