Accommodation and Health Costs of Deinstitutionalized People with Mental Illness Living in Residential Services in Brazil.

Abstract

BackgroundHealth costs are the main hindrances for expanding community mental health services. Exploring patient profiles and cost predictors may be useful for optimising financial resources. However, the deinstitutionalisation process may burden health budgets in terms of supporting multiple community services based on varying levels of need.ObjectiveThis study assessed accommodation and health service costs, quality of life and clinical and psychosocial profiles among individuals receiving mental healthcare through residential services. Specific accommodation cost predictors were also verified.MethodsHealth costs were assessed from the perspective of a public health provider using a microcosting bottom-up approach at 20 residential services in São Paulo, Brazil. Instruments used to assess health costs and patient profiles included the Brazilian version of the Client Socio-demographic and Service Receipt Inventory (CSSRI), the Mini International Neuropsychiatric Interview (MINI), the Clinical Global Impression–Severity Scale (CGI-S), the Independent Living Skills Survey (ILLS), the Social Behaviour Scale (SBS) and the Quality of Life Scale (QLS).ResultsOne hundred and forty-seven residents, predominantly experiencing psychotic disorders, were interviewed. The geographical region and length of time spent living in residential services or in a psychiatric hospital predicted 66% of the variance in accommodation costs. The CGI-S and ILLS scores and years of education explained 52.7% of the variance in quality of life.ConclusionAccommodation costs were not driven by patient profile variables, while region and time spent in a hospital or in residential services were the main cost predictors. Semi-staffed homes may be an alternative for resource optimisation among individuals with mild impairment, particularly if strategies for psychosocial rehabilitation and improving quality of life are implemented.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0078-z) contains supplementary material, which is available to authorized users.