Clinical outcomes and costs for people with complex psychosis: a naturalistic prospective cohort study of mental health rehabilitation service users in England

Helen Killaspy; Louise Marston; Nicholas Green; Isobel Harrison; Melanie Lean; F Holloway; Thomas Kern Jamieson-Craig; G. Leavey; Maurice Arbuthnott; Leonardo Alberto Koeser; Paul Richard McCrone; Rumana Omar; Michael King

doi:10.1186/s12888-016-0797-6

Clinical outcomes and costs for people with complex psychosis: a naturalistic prospective cohort study of mental health rehabilitation service users in England

Helen Killaspy, Louise Marston, Nicholas Green, Isobel Harrison, Melanie Lean, F Holloway, Thomas Kern Jamieson-Craig, G. Leavey, Maurice Arbuthnott, Leonardo Alberto Koeser, Paul Richard McCrone, Rumana Omar, Michael King

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome.MethodInpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care.ResultsAcross England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients’ social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00–1.08), and patients’ activity (OR 1.03, 95 % CI 1.01–1.05) and social skills (OR 1.13, 95 % CI 1.04–1.24) at recruitment.ConclusionInpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients’ social skills and activities may further enhance the effectiveness of these services.

Original language	English
Article number	95
Journal	BMC Psychiatry
Volume	16
DOIs	https://doi.org/10.1186/s12888-016-0797-6
Publication status	Published - 7 Apr 2016

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10.1186/s12888-016-0797-6

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Killaspy, H., Marston, L., Green, N., Harrison, I., Lean, M., Holloway, F., Jamieson-Craig, T. K., Leavey, G., Arbuthnott, M., Koeser, L. A., McCrone, P. R., Omar, R., & King, M. (2016). Clinical outcomes and costs for people with complex psychosis: a naturalistic prospective cohort study of mental health rehabilitation service users in England. BMC Psychiatry, 16, Article 95. https://doi.org/10.1186/s12888-016-0797-6

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title = "Clinical outcomes and costs for people with complex psychosis: a naturalistic prospective cohort study of mental health rehabilitation service users in England",

abstract = "BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome.MethodInpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care.ResultsAcross England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients{\textquoteright} social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00–1.08), and patients{\textquoteright} activity (OR 1.03, 95 % CI 1.01–1.05) and social skills (OR 1.13, 95 % CI 1.04–1.24) at recruitment.ConclusionInpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients{\textquoteright} social skills and activities may further enhance the effectiveness of these services.",

author = "Helen Killaspy and Louise Marston and Nicholas Green and Isobel Harrison and Melanie Lean and F Holloway and Jamieson-Craig, {Thomas Kern} and G. Leavey and Maurice Arbuthnott and Koeser, {Leonardo Alberto} and McCrone, {Paul Richard} and Rumana Omar and Michael King",

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doi = "10.1186/s12888-016-0797-6",

language = "English",

volume = "16",

journal = "BMC Psychiatry",

issn = "1471-244X",

publisher = "BioMed Central",

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Killaspy, H, Marston, L, Green, N, Harrison, I, Lean, M, Holloway, F, Jamieson-Craig, TK, Leavey, G, Arbuthnott, M, Koeser, LA, McCrone, PR, Omar, R & King, M 2016, 'Clinical outcomes and costs for people with complex psychosis: a naturalistic prospective cohort study of mental health rehabilitation service users in England', BMC Psychiatry, vol. 16, 95. https://doi.org/10.1186/s12888-016-0797-6

TY - JOUR

T1 - Clinical outcomes and costs for people with complex psychosis

T2 - a naturalistic prospective cohort study of mental health rehabilitation service users in England

AU - Killaspy, Helen

AU - Marston, Louise

AU - Green, Nicholas

AU - Harrison, Isobel

AU - Lean, Melanie

AU - Holloway, F

AU - Jamieson-Craig, Thomas Kern

AU - Leavey, G.

AU - Arbuthnott, Maurice

AU - Koeser, Leonardo Alberto

AU - McCrone, Paul Richard

AU - Omar, Rumana

AU - King, Michael

PY - 2016/4/7

Y1 - 2016/4/7

N2 - BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome.MethodInpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care.ResultsAcross England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients’ social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00–1.08), and patients’ activity (OR 1.03, 95 % CI 1.01–1.05) and social skills (OR 1.13, 95 % CI 1.04–1.24) at recruitment.ConclusionInpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients’ social skills and activities may further enhance the effectiveness of these services.

AB - BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome.MethodInpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care.ResultsAcross England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients’ social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00–1.08), and patients’ activity (OR 1.03, 95 % CI 1.01–1.05) and social skills (OR 1.13, 95 % CI 1.04–1.24) at recruitment.ConclusionInpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients’ social skills and activities may further enhance the effectiveness of these services.

U2 - 10.1186/s12888-016-0797-6

DO - 10.1186/s12888-016-0797-6

M3 - Article

SN - 1471-244X

VL - 16

JO - BMC Psychiatry

JF - BMC Psychiatry

M1 - 95

ER -