Pathways to (specialized) care: patient costs and contacts en route to a first-episode psychosis clinic

Abstract

To estimate the public health costs of specific help-seeking pathways into an early intervention psychosis clinic. The sequence of police, emergency and mental health contacts utilized by 50 patients up to 1 year prior to admission was characterized using chart reviews and structured interviews. Cost estimates for contacts were obtained from provincial health/public service cost reports. A high-cost inpatient pathway and a low-cost outpatient pathway were identified, with the former exceeding the latter by a factor of 18.5 in cost. This discrepancy was attributable to both the high cost of inpatient services and the long duration of inpatient admissions, as well as more frequent inpatient use of high-cost urgent services (e.g. police, emergency services). Given the substantial cost differential between inpatient and outpatient routes, additional clarification of modifiable factors that determine pathways to care could have significant implications to health service delivery costs for this population.