Book contents
- Frontmatter
- Contents
- List of contributors
- 1 Essential issues in community psychiatry
- 2 Evaluation of community treatments for acute psychiatric illness
- 3 Synopsis of the Daily Living Programme for the seriously mentally ill: a controlled comparison of home and hospital based care
- 4 Evaluation of a complete community service
- 5 Early intervention study of psychiatric emergencies
- 6 Evaluation of psychiatric services: the merits of regular review
- 7 A home based assessment study
- 8 Home treatment as an alternative to acute psychiatric inpatient admission: a discussion
- 9 The toxicity of community care
- 10 Community mental health services: towards an understanding of cost-effectiveness
- 11 Future research strategies
- Index
10 - Community mental health services: towards an understanding of cost-effectiveness
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- 1 Essential issues in community psychiatry
- 2 Evaluation of community treatments for acute psychiatric illness
- 3 Synopsis of the Daily Living Programme for the seriously mentally ill: a controlled comparison of home and hospital based care
- 4 Evaluation of a complete community service
- 5 Early intervention study of psychiatric emergencies
- 6 Evaluation of psychiatric services: the merits of regular review
- 7 A home based assessment study
- 8 Home treatment as an alternative to acute psychiatric inpatient admission: a discussion
- 9 The toxicity of community care
- 10 Community mental health services: towards an understanding of cost-effectiveness
- 11 Future research strategies
- Index
Summary
Policy context
The community care reforms introduced by the 1990 UK National Health Service and Community Care Act provide an important context for understanding the relevance and application of mental health service evaluations. They also generate or consolidate a number of demands for cost information and a better understanding of cost-effectiveness.
The 1990 reforms comprise a number of strategic changes (Social Services Inspectorate, 1992; Wistow et ai, 1994). They seek to alter the balance between institutional and community care, moving the emphasis away from long-term hospital provision in favour of care in the community and away from residential and nursing homes towards support in domiciliary settings. They stress the importance of decisions which are purchaser dominated rather than provider dominated and needs led rather than supply led. Care management and care programmes should be important elements in the new system, comprehensive assessment procedures should be adopted and users and carers given greater influence and choice. There will also be some shifting of responsibilities for decision-making and funding from the National Health Service (NHS) to local government. This will make it harder, for example, for health authorities to discharge hospital inpatients to residential or nursing homes without the agreement and funding of local authorities. Greater pluralism within the ‘mixed economy of care’ is encouraged.
These reforms are being introduced in pursuit of familiar, broad policy aims. For example, the community care White Paper, Caring for People (Cm 849, 1989), argued that these changes would improve user choice, service innovation and quality. It was also unequivocal in its emphasis on system cost-effectiveness.
- Type
- Chapter
- Information
- Community Psychiatry in ActionAnalysis and Prospects, pp. 111 - 146Publisher: Cambridge University PressPrint publication year: 1995
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