Background. Altering the balance of provision between
hospital
and community care is a key and
often contentious component of mental health care policy in many countries.
Implementation of
this policy in the UK has been slowed by the apparent shortage of suitable
community accommodation for people with long-term needs for care and support.
Among the consequences could
be the silting up of hospital beds by people who could be supported more
appropriately elsewhere, in turn denying in-patient treatment to people
with
acute psychiatric problems and unnecessarily pushing up health
service expenditure.
Methods. Using data collected in a survey of hospital and residential
accommodation services
and their residents in eight areas of England and Wales, the cost components
of
today's balance
of care were explored. Comprehensive costs were calculated and their associations
with resident characteristics examined using multiple regression analyses.
Results. On a like-with-like basis, the costs of hospital in-patient
treatment for inappropriately
placed patients greatly exceeded the costs of community-based care.
Conclusion. Further reduction of hospital beds, however, is
not the
panacea for an appropriate
balance of mental health care, given the unknown but potentially considerable
extent of unmet
demand, as well as the impact of previous in-patient bed reductions apparent
in the services
surveyed. Rather, service providers and purchasers should focus on developing
community-based
care (including increased provision of 24-hour nursed beds) by ensuring
that
resources released
through earlier closure programmes have been redeployed for their intended
use
and by accessing additional pump-priming or bridging resources.