Case-mix funding and legislated psychiatric care

Abstract

The importance of adequately providing acute care hospital services for psychiatric patients can be argued on both humanitarian and cost-effective grounds. In the recent past, however, the humanitarian argument has proved insufficient to insure that the mentally ill receive adequate care. For example, although the humanitarian intentions of those who originally heralded deinstitutionalization are not contested, more recent evidence describing the grim plight of the mentally ill in communities seems to have had little impact on service improvements and, in most communities, services for the mentally ill remain underfunded. According to Gralnick, “deinstitutionalization results in relative neglect of the acutely ill and the consequent amassing of the chronically ill” (Gralnick, 1985). Considering a cost-effective argument, the burden of mental illness on the population is known to be large, making mental illness a major public health problem. In established market economies, for example, 19% of all disabilityadjusted life years are lost to neuropsychiatric disease and intentional injuries. Mental disorders are tied with cancers as the leading causes of disabilityadjusted years of life lost. Worldwide, 10.5% of all disability-adjusted years of life lost are attributable to serious mental disorders and intentional injuries, more than any other health problem (The World Bank, 1993). Community epidemiological surveys conducted in the United States and Canada reveal that approximately 22% of the adult population are affected by a mental disorder during any given year (National Advisory Mental Health Council, 1993; Bland, Newman, and Orn, 1988), and that between 2% and 3% of the adult popula-