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Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis

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Listed:
  • Knapp, Martin
  • Andrew, Alison
  • McDaid, David
  • Iemmi, Valentina
  • McCrone, Paul
  • Park, A-La
  • Parsonage, Michael
  • Boardman, Jed
  • Shepherd, Geoff

Abstract

The health service spent £2.0 billion on services for people with psychosis in 2012/13. Over half (54%) of this total was devoted to inpatient care. This means that spending is currently skewed towards the more expensive parts of the system, at £350 average cost per day for inpatient care compared with £13 average cost per day in community settings. There is a strong business case for investing in the early intervention and community-based interventions proven to generate savings or value-for-money gains through reduced inpatient admission, or through other routes. This report provides the most up-to-date economic evidence to support the business case for investment in effective, recovery-focused services. Drawing on a wide range of data, evidence for the cost-effectiveness of recovery-focused interventions is set out: • Early Detection (ED) services • Early Intervention (EI) teams • Individual Placement and Support (IPS) • Family therapy • Criminal justice liaison and diversion • Physical health promotion, including health behaviours • Supported housing • Crisis Resolution and Home Treatment (CRHT) teams • Crisis houses • Peer support • Self-management • Cognitive Behavioural Therapy (CBT) • Anti-stigma and discrimination campaigns • Personal Budgets (PBs) • Welfare advice Many of these interventions are shown to be cost-effective, in some cases due to the role they play inpreventing or delaying relapse, or reducing the need for the most expensive care. Some have much wider benefits related to wider recovery outcomes, such as employment, settled housing and better physical health. There is particularly clear evidence for interventions such as EI teams, IPS for employment, CBT and CRHT teams. However, there is evidence to suggest that all of the above interventions contribute to recovery outcomes, reduced costs and/or better value for money. Illustrative examples of the savings incurred through particular interventions include: • Early Intervention: net savings of £7,972 per person after four years. Over a ten-year period, £15 in costs can be avoided for every £1 invested. • Smoking cessation: £1,255 to gain an extra Quality-Adjusted Life Year (QALY), which lies well below the upper threshold of £30,000 recommended by National Institute for Health and Care Excellence (NICE). • Peer support: £4.76 can be gained for every £1 invested. • CBT: Cost per QALY gained of £27,373 for CBT compared to usual care, which is below the upper threshold used by NICE. Local and regional commissioning and pathway development should draw on this evidence, since these interventions are both clinically effective and many will contribute to savings to be reinvested in care. While the scope of this report is primarily at intervention level, the intention is to inform local implementation.

Suggested Citation

  • Knapp, Martin & Andrew, Alison & McDaid, David & Iemmi, Valentina & McCrone, Paul & Park, A-La & Parsonage, Michael & Boardman, Jed & Shepherd, Geoff, 2014. "Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis," LSE Research Online Documents on Economics 56773, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:56773
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    File URL: http://eprints.lse.ac.uk/56773/
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    References listed on IDEAS

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    1. Knapp, Martin & McDaid, David & Parsonage, Michael, 2011. "Mental health promotion and mental illness prevention: the economic case," LSE Research Online Documents on Economics 32311, London School of Economics and Political Science, LSE Library.
    2. Karen Jones & Ann Netten & José-Luis Fernández & Martin Knapp & David Challis & Caroline Glendinning & Sally Jacobs & Jill Manthorpe & Nicola Moran & Martin Stevens & Mark Wilberforce, 2012. "The impact of individual budgets on the targeting of support: findings from a national evaluation of pilot projects in England," Public Money & Management, Taylor & Francis Journals, vol. 32(6), pages 417-424, November.
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    4. Trachtenberg, Marija & Parsonage, Michael & Shepherd, Geoff & Boardman, Jed, 2013. "Peer support in mental health care: is it good value for money?," LSE Research Online Documents on Economics 60793, London School of Economics and Political Science, LSE Library.
    5. Greve, Jane & Nielsen, Louise Herrup, 2013. "Useful beautiful minds—An analysis of the relationship between schizophrenia and employment," Journal of Health Economics, Elsevier, vol. 32(6), pages 1066-1076.
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    Cited by:

    1. Tighe Margaret & Murphy Caroline, 2020. "Facilitating the employment of people with mental health difficulties in Ireland," The Irish Journal of Management, Sciendo, vol. 40(1), pages 13-26, July.
    2. Rubina Jhadray & Gráinne Fadden & Martin Atchison & Paula Conneely & Julia Danks & Alison Lee & Chris Mansell, 2015. "Applying the Behavioural Family Therapy Model in Complex Family Situations," Social Sciences, MDPI, vol. 4(2), pages 1-10, June.
    3. Eilish M Burke & Melissa Pyle & Karen Machin & Anthony P Morrison, 2018. "Providing mental health peer support 1: A Delphi study to develop consensus on the essential components, costs, benefits, barriers and facilitators," International Journal of Social Psychiatry, , vol. 64(8), pages 799-812, December.

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    JEL classification:

    • E6 - Macroeconomics and Monetary Economics - - Macroeconomic Policy, Macroeconomic Aspects of Public Finance, and General Outlook

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