– This study estimated service and non-service costs in a random sample of patients attending a community psychiatric mental health centre in Italy.

– A randomly selected sample of patients identified during 1 week of routine clinical activity was enrolled. Information was collected using the Italian-language checklist Questionario Economico per l’attività clinica dei Servizi Psichiatrici (QESP). Costs were classified in two categories: service costs (from the provision of services) and non-service costs (loss of productivity and informal care).

– One hundred and twenty patients were included. Patients suffering from schizophrenia and related disorders (n = 50) had a mean age of 44.5 years (S.D. 12.9), and patients with other diagnoses (n = 70) had a mean age of 44.9 years (S.D. 14.8). More patients in the schizophrenia group were single, living alone, had a low educational level and a higher unemployment rate. In patients suffering from schizophrenia, the monthly service cost per patient was nearly double that for patients with other diagnoses. Non-service costs associated with patients’ lack of job opportunities were more than three times higher for patients with schizophrenia. Non-service costs associated with patients’ and care-givers’ time off work were similar in the two groups. In the multivariate analysis, being unemployed was associated with higher service costs. Younger age, length of illness and diagnosis of schizophrenia were determinants of higher non-service costs. The latter three independent variables were also associated with overall (service and non-service) costs.

– The present study estimated service and non-service costs under routine circumstances to provide information on costs that community psychiatric services, patients and care-givers sustain when dealing with psychiatric problems.

Families express a need for information to support people with severe anorexia nervosa.

To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care.

Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge.

Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months.

Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.

Although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK.

To describe the use of services and calculate recent (past 6 months) and early adulthood (since the age of 18 years) public expenditure costs incurred by young adults who had hyperactivity and/or conduct problems during childhood.

A 20-year follow-up of a community sample of 6- to 7-year old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated.

High levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts. Although the mixed problems group had the highest recent costs in terms of receipt of benefits and health and social care, they had the lowest criminal justice costs.

High levels of early childhood conduct problems are particularly associated with increased health, social care and criminal justice costs in adulthood.

Despite its high prevalence, help-seeking for depression is low.

To assess the effectiveness and cost-effectiveness of 1-day cognitive–behavioural therapy (CBT) self-confidence workshops in reducing depression. Anxiety, self-esteem, prognostic indicators as well as access were also assessed.

An open randomised controlled trial (RCT) waiting list control design with 12-week follow-up was used (trial registration: ISRCTN26634837). A total of 459 adult participants with depression (Beck Depression Inventory (BDI) scores of 14) self-referred and 382 participants (83%) were followed up.

At follow-up, experimental and control participants differed significantly on the BDI, with an effect size of 0.55. Anxiety and self-esteem also differed. Of those who participated, 25% were GP non-consulters and 32% were from Black and minority ethnic groups. Women benefited more than men on depression scores. The intervention has a 90% chance of being considered cost-effective if a depression-free day is valued at £14.

Self-confidence workshops appear promising in terms of clinical effectiveness, cost-effectiveness and access by difficult-to-engage groups.

Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.

To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively.

In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.

Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group.

Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

Este estudió estimo los costes de servicio y no de servicio en una muestra aleatoria de pacientes que asistían a un centro psiquiátrico comunitario de salud mental en Italia.

Se incluyó una muestra seleccionada aleatoriamente de pacientes identificados durante una semana de actividad clínica ordinaria. La información se recogió utilizando la lista en lengua italiana Questionario Economico per l ‘attivitá clinica dei Servizi Psichiatrici (QESP). Los costes se clasificaron en dos categorías: costes de servicio (de la próvision de servicios) y costes no de servicio (pérdida de productividad y atención informal).

Se incluyó a 120 pacientes. Los pacientes que sufrían de esquizofrenia y trastornos relacionados (n = 50) tenían una edad media de 44,5 años (DT = 12,9) y los pacientes con otros diagnósticos (n = 70), de 44,9 años (DT = 14,8). En el grupo de esquizofrenia, había más pacientes que estaban solteros, vivían solos, tenían un nivel educativo bajo y una tasa de desempleo más alta. En los pacientes que sufrían de esquizofrenia, el coste mensual de servicio por paciente era casi el doble que para los que tenían otros diagnósticos. Los costes no de servicio asociados con la falta de oportunidades de empleo de los pacientes eran superiores en mas de tres veces para los que tenian esquizofrenia. Los costes no de servicio asociados con el tiempo sin trabajar de los pacientes y los cuidadores eran similares en los dos grupos. En el análisis multivariante, estar desempleado se asociaba con costes de servicio más altos. La edad menor, la duración de la enfermedad y el diagnóstico de esquizofrenia eran determinantes de costes no de servicio más altos. Estas tres últimas variables independientes se asociaban también con los costes globales (de servicio y no de servicio).

El presente estudio estimó los costes de servicio y no de servicio en circunstancias ordinarias para proporcionar información sobre los costes que los servicios psiquiátricos comunitarios, los pacientes y los cuidadores soportan al ocuparse de los problemas psiquiatricos.

Child and adolescent inpatient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services.

To estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units.

Data collection alongside a national survey with cost estimations guided by principles drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences.

Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean=$197 (s.d.=71.6; 1999–2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation.

Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.

There is underdiagnosis of and low use of specialist services for attention-deficit hyperactivity disorder (ADHD).

To quantify the filters in the help-seeking pathway through primary care and to investigate factors influencing progress for children at risk of ADHD.

A total of 127 children (5–11 years old) with pervasive hyperactivity who passed each filter (primary care attendance and general practitioner (GP) recognition of disorder) were compared with those who had not.

Primary care attendance was only associated with parental perception of the behaviour as problematic (OR 2.11; 95% CI 1.11-4.03). However, GP recognition was related to both parent and child factors – parental request for referral (OR 20.83; 95% CI 3.05-142.08) and conduct problems (OR 1.48; 95% CI 1.04-2.12). GP non-recognition was the main barrier in the pathway to care; following recognition, most children were referred.

Parents can be regarded as the main gatekeepers for access to specialist services.

Depression in childhood or adolescence often has morbidity implications continuing into adulthood, generating needs for specialist services and support.

To estimate the patterns of service use and costs in adulthood of former patients.

Service use and other cost-related data were collected from former patients. Comparisons were made between those people with and without comorbid conduct disorder in childhood and with data for the general population.

Data on 91 people with depression (only) and 49 with comorbid conduct disorder revealed high adulthood service utilisation rates and costs. Inpatient care and criminal justice services were used more frequently by the comorbid group and total costs were significantly higher. There were also indications of higher service use by the comorbid group than the general adult population.

The high and enduring long-term costs associated with childhood depression and conduct disorder give further reason for early and effective intervention.

The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.

A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).

The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.

The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.

Non-compliance rates with antipsychotic medication can be high, and the personal and societal costs are considerable. A new psychological intervention, compliance therapy seeks to improve compliance and patient outcomes and reduce treatment costs.

A randomised controlled study examined the cost-effectiveness of compliance therapy compared to nonspecific counselling over 18 months for 74 people with psychosis admitted as inpatients at the Maudsley Hospital. Bivariate and multivariate analyses were conducted to test for differences and to explore inter-patient cost variations.

Compliance therapy is more effective and is no more expensive. Consequently, compliance therapy is more cost-effective than non-specific counselling at six, 12 and 18 months.

There are compliance, outcome and cost-effectiveness arguments in favour of compliance therapy in preference to non-specific counselling.

Long-stay patients with learning disabilities (n=214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation.

Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation.

There was little or no change in peoples low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P ⩽ 0.01) 12 months after discharge (n=119) and were more satisfied (P ⩽ 0.05) with their new ‘homes’ (n=108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge.

The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of ‘ordinary’ accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.

Part of the community psychiatric nurse (CPN) service was reorganised into a community support team (CST), with staff acting as case managers. An economic evaluation ran parallel to the comparison with generic CPN care.

Eighty-two clients were randomly allocated to experimental and control groups. Costs were comprehensively measured over a pre-referral period (three months), and then at 6, 12, and 18 months.

The economic evaluation found a cost difference between the groups. Generic group costs averaged £89 per patient per week more than CST group costs. The difference was only significant for the first six months. Changes in the burden of cost across agencies were observed.

Although CPN inputs and costs were higher for the CST group, there was a significant short-term reduction in total cost. Beyond the short term, the CST did not confer cost or cost-effectiveness advantages.