Patient characteristics, length of treatment and costs in a model institution of community mental health care

Abstract

Since the 1970s, a model institution for community mental health care with three partial hospitalisation programmes and various out-patient services was run in the Berlin district Charlottenburg. The study evaluates, to what extent the institution fulfilled its aim to provide long-term care for severely and chronically ill patients at relatively low costs. It also identified predictors of outcome. Case register data of 1194 patients who were treated within a period of 23 years were analysed. Patient characteristics, length of care and treatment costs are presented. Costs were calculated on the basis of daily rates as paid to care providers in 1996. Regression analyses were computed for predicting length of care and costs after the first year. On average, length of care was 2.4 years and costs per year were 57 000,- German Marks ( 29 000,-). Patients with shorter and longer duration of care differed in only a few of the recorded sociodemographic and clinical characteristics. Significant predictors for long-term costs were the legal status of being under a care order and costs in the first year. However, only 18 % of the variance of costs after the first year were explained. The findings suggest that a) community mental health care in the studied form may not reach all patients with severe mental illness, b) in most cases, the notion of a lifelong treatment in such care systems does not reflect reality, c) the paid costs are lower than for long-term in-patient care, but still rather high, and d) the usually recorded patient characteristics are of little value for predicting long-term outcome.