David Challis Completed 2014
Government policy for the care of working age adults with mental health problems has long been committed to the principle of community care. This is not to suggest that inpatient beds are not necessary. On the contrary, it is generally agreed that there will always be a significant minority of people who need hospital admission, with the intensive levels of assessment, monitoring and treatment this offers. Nevertheless, much still needs to change. Six-fold variations have been found in inpatient admission rates, while the development of specialist community care teams has delivered very good care in some areas, but fragmented, inefficient services in others. Indeed, it is commonly believed that if the ‘right’ services were available, significant gains could be made in quality of life and service efficiency.
Service planning is difficult in mental health care, however, as multiple organisations provide treatment and support for a heterogeneous population; outcomes are complex and difficult to measure; and little is known about the relative cost-effectiveness of institutional and non-institutional services. The allocation of resources has thus often been based on historical funding patterns and the piecemeal application of changing local and national priorities.
The study addressed the broad question: can the needs of certain service users receiving inpatient and community mental health team services be met in alternative ways which maximise independence and safeguard service quality? In so doing it sought to identify the characteristics of these service users at care margins (for example age, diagnosis and living arrangements); the alternative services they would require; and their cost.
The study was conducted in partnership with a mental health Trust between June 2013 and December 2014 and employed a Balance of Care (BoC) approach. There were eight interlinked