Evaluating sustainability: a retrospective cohort analysis of the Oxfordshire therapeutic community.

Daniel Maughan,Toby Pillinger,Rob Lillywhite,Scott Weich,Steve Pearce

doi:10.1186/s12888-016-0994-3

Abstract

BackgroundTherapeutic communities (TCs) could reduce the health care use of people with personality disorder (Davies S, Campling P and Ryan K, Psychiatrist 23:79–83, 1999; Barr W, Kirkcaldy A, Horne A, Hodge S, Hellin K and Göpfert M, J Ment Health 19:412–421, 2010) and in turn reduce the financial and environmental costs of services. Our hypothesis is that 3 years following entry to a TC service, patients have reduced subsequent health care use and associated reductions in financial costs and carbon footprint.MethodsA retrospective 4-year cohort study examined changes in health care use following entry to the Oxfordshire TC service. Comparative analysis was undertaken on a treated (n = 40) and a control group (referred but who declined treatment; n = 45). Financial costs and carbon footprint of health care use were calculated using national tariffs and standard carbon conversion factors. Mean changes in these outcomes were compared over 1, 2 and 3 years and adjusted for costs and carbon footprints in the year prior to joining the TC service.ResultsCompared to baseline, the group receiving TC care had greater reductions in financial costs and carbon footprint associated with A&E attendances (p = 0.04) and crisis mental health appointments (p = 0.04) than the control group. There were significantly greater reductions in carbon footprint for all secondary health care use, both physical and mental health care, after 3 years (p = 0.04) in the TC group.ConclusionsTC services may have the potential to reduce the financial cost and carbon footprint of health care.

Highlights

Therapeutic communities (TCs) could reduce the health care use of people with personality disorder (Davies S, Campling P and Ryan K, Psychiatrist 23:79–83, 1999; Barr W, Kirkcaldy A, Horne A, Hodge S, Hellin K and Göpfert M, J Ment Health 19:412–421, 2010) and in turn reduce the financial and environmental costs of services
This paper explores the novel concept of evaluating the carbon footprint of care pathways in mental health through an analysis of the financial costs and greenhouse gases (GHGs) emissions associated with a therapeutic community (TC) service for those with personality disorder (PD)
Our hypothesis is that 3 years following entry to a TC service, patients have reduced subsequent health care use and associated reductions in financial costs and carbon footprint

Summary

Introduction

Therapeutic communities (TCs) could reduce the health care use of people with personality disorder (Davies S, Campling P and Ryan K, Psychiatrist 23:79–83, 1999; Barr W, Kirkcaldy A, Horne A, Hodge S, Hellin K and Göpfert M, J Ment Health 19:412–421, 2010) and in turn reduce the financial and environmental costs of services. Our hypothesis is that 3 years following entry to a TC service, patients have reduced subsequent health care use and associated reductions in financial costs and carbon footprint. The NHS has signed up to meet the Climate Change Act targets [1], which demand carbon emission reductions of 80 % by 2050. 11 pilot projects were set up across England between 2004 and 2007 to provide care for people with PD [6]. These provided varying models of therapy programmes. This study examines the TC intervention delivered by one of these pilot projects, based in Oxfordshire

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