Home-based and hospital-based care for people with serious mental health problems: examining the costs of the Daily Living Programme

<p>The Daily Living Programme (DLP) offers home-based care for people facing emergency admission referred to the Bethlem-Maudsley Hospital with severe mental illness. The DLP model was built on a number of earlier experiments with intensive community care support teams, particularly the Stein and Test service developed in Madison. The multi-disciplinary DLP team acts both as direct provider as well as liaison with other services, with each patient allocated a key worker. A research team at the PSSRU examined the costs and cost-effectiveness of the DLP when compared to standard hospital-based care. The randomised controlled comparison reveals that the DLP service is significantly less costly than standard treatment based initially on in-patient care, both over the full evaluation period (extending approximately 21 months from admission) and during the final phase of that period (months 11 to 21). The relative long term cost saving accrues almost exclusively to the NHS in terms of reduced inpatient expenditure, with a small but significant relative saving in local authority social services expenditure.