Private, voluntary or public? Comparative cost-effectiveness in community mental health care

Two prominent features of mental health policy in the UK in recent years have been the rundown of hospital provision and the changing of the balance between public and other provider sectors. This article examines the cost, quality of care and outcome implications. Public,voluntary and private providers of mental health care are compared, based on a long-term study of people moving out of psychiatric hospitals in London. Costs are found to be lowest in the private (for-profit) sector, and highest in the NHS and consortium (NHS and voluntary sector partnership) sectors. However, quality of care indicators suggest that the lowest cost sector is performing least well, and the highest cost sectors offer the best quality. These are associated with some differences in user outcome.