Predicting the community costs of closing psychiatric hospitals: national extrapolations

There were 56,900 in-patients `under one of the mental illness specialties' in England's National Health Service hospitals in March 1990. Approximately 31,000 of these people had been in continuous residence for at least a year, and most of these long-stay patients were living in the 91 psychiatric hospitals that remain open in England. It is widely expected that these numbers will be reduced dramatically over the next few years by the resettlement of long-stay residents in alternative accommodation, and by efforts to prevent the accumulation of the `new long-stay'. In this paper we report a prediction of service consequences and costs for the 24,000 long-stay psychiatric hospital in-patients who do not have a dementia diagnosis. We build on our previous prediction of community care service utilisation and extending the estimates to the whole of England. This prediction suggests that £391 million will be needed annually to support these 24,000 people in the community. The largest financial burdens will fall to district health authorities (57 per cent), service users (26 per cent, mainly from social security benefit) and local authorities (14 per cent).

<p><p><p>There were 56,900 in-patients `under one of the mental illness specialties' in England's National Health Service hospitals in March 1990 (Department of Health, 1991a). Approximately 31,000 of these people had been in continuous residence for at least a year, and most of these long-stay patients were living in the 91 psychiatric hospitals that remain open in England. It is widely expected by most people working in the mental health field, and an explicit Government policy (Department of Health, 1991b), that these numbers will be reduced dramatically over the next few years by the resettlement of long-stay residents in alternative accommodation, and by efforts to prevent the accumulation of the `new long-stay'. Health authorities are being encouraged to work with other statutory and non-statutory bodies, and of course with relatives and service users, to develop community alternatives to hospital. The demands which this policy might place on those who move from hospital, their relatives and `the community' can be immense, but with properly planned services and programmes, there is evidence that former long-stay residents can enjoy a quality of life in the community which is at least as good as hospital, and in some respects better (Knapp et al., 1992; TAPS, 1990).